LADA isn’t the newest version of a hot coffee and milk beverage; rather it stands for latent autoimmune diabetes in adults. You may not have heard of it—it isn’t as common as type 2 diabetes or gestational diabetes, or even regular type 1 diabetes— but physicians have been familiar with it for a while. Like type 1 diabetes, LADA involves the almost complete destruction of the beta producing insulin cells by the body’s own immune system. Some researchers categorize LADA as a subset of type 1 diabetes, while others think of it as simply a way station in the continuum between type 1 diabetes and type 2 diabetes. Other scientists do not believe it is a separate disease at all. For them, type 1 diabetes has many different expressions and LADA is simply one of them.
Interestingly enough, LADA was discovered by scientists looking at ways to test for auto-antibodies in the blood of people with diabetes. When they tested the blood of people with type 2 diabetes, they found that about ten percent of them carried insulin antibodies. Insulin antibodies are usually found in people with type 1 diabetes. Since type 2 diabetes isn’t an autoimmune disease, these folks had “something” different. In fact, they would go on to need full insulin replacement even though in other ways they resembled the profile of someone with type 2 diabetes. These slow starters were named LADA.
What some people believe makes LADA different from type 1 diabetes is the delay in the need for insulin replacement and the age of the population who contracts it. For most people with type 1 diabetes the need for insulin replacement is abrupt. Once symptoms such as polyuria, polydipsia and polyphagia appear insulin is needed, even if the disease was years in the making. LADA is slow-moving. Sometimes people with LADA can take months and even years to require insulin replacement. Many can control their blood glucose with lifestyle and oral agents for a considerable amount of time. One of the defining characteristics of LADA is the ability to control blood glucose without the need for insulin for at least six months after diagnosis.
The second disparity is the age at which LADA strikes. Although type 1 diabetes can occur at any age, people with LADA tend to be beyond their young adult years, which sometimes accounts for it being incorrectly diagnosed as type 2 diabetes. While it is true that pills and lifestyle measures may be sufficient to control blood glucose levels for a short period of time in people with LADA, they all eventually need insulin and their disease is the result of an autoimmune insult.
LADA can often be misdiagnosed because it tends to occur in older adults who don’t initially need insulin. An older person whose glucose levels initially response to oral agents may be diagnosed mistakenly as having type 2 diabetes, especially if they are at all overweight. People who are misdiagnosed may spend a considerable amount of time in poor control because oral medications cannot stimulate non-functioning beta cells.
IF you have been diagnosed with type 2 diabetes, but do not have diabetes in the family, are not overweight and do not seem to be responding to oral agents and lifestyle measures, talk with your healthcare provider about your diagnosis.