What is LADA?

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The beta cells within islets (islets pictured above) get attacked by the immune system in LADA

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.

Learn more about Joslin Diabetes Center by visiting www.joslin.org, or find out how to make an appointment at the Joslin Clinic.

11 Responses to What is LADA?

  1. Pingback: Joslin Diabetes – What is latent autoimmune diabetes of adults or LADA?

  2. Alan bateman says:

    Is this the same as MODY?

    • Nora Saul, Manager Nutrition Services says:

      Dear Mr. Bateman:
      LADA and MODY are two different types of diabetes. Think of LADA as a slow moving type 1 diabetes. MODY- which stands for Maturity Onset Diabetes in Youth- is a constellation of genetic disorders that strike young people which share components of type 2 diabetes. We will be posting a blog on MODY soon.

  3. Chun chan says:

    Does the LADA also has other immun diseases such as SLE thyroid it’s etc

  4. Kathleen says:

    That is me!

    I was overweight, and diagnosed as non-insulin dependent diabetic 7 years ago, but after an initial blood glucose improvement using oral medication and losing weight, my numbers staryed to rise and then skyrocket.

    After 6 years of running and hiding from my Drs abd ever increasing bgl’s, I finally found a Medical team who wouldn’t let me dismiss them with a promise of taking a blood test “later” and I got my diagnosis of insulin dependent diabetes.

    My health has not been this on track in years!

  5. Eve says:

    Unfortunately, autoimmune diseases are stil not revealed by the medicine…I have one since 9 years old.

  6. Melitta says:

    LADA, or slowly progressive Type 1 diabetes, is actually WAY more common than classic, sudden onset Type 1 diabetes. If 10% of people who have been diagnosed with Type 2 diabetes are autoantibody positive and have Type 1 autoimmune diabetes, then LADA greatly exceeds classic T1D. Also, onset of Type 1 diabetes in babies is much more rapid than Type 1 diabetes in teenagers, but no one in the medical community is saying that those teenagers should be kicked out of the Type 1 Club. It is the disease process, not rate of onset or age of onset, that defines Type 1 diabetes. And saying that LADA is defined by not needing exogenous insulin for six months is a specious argument–prior to 1922, Dr. Frederick Allen kept children with rapid-onset Type 1 diabetes alive for 5 years or more with a very low carbohydrate/very low calorie diet. But now that we have excellent insulins, there is no reason to deny ANY person with Type 1 diabetes/LADA the insulin treatment that they need.

  7. Pingback: Thin and Type 2: Non-Obese Risk Factors for Developing Diabetes | Speaking of Diabetes | The Joslin Blog

  8. melanie says:

    Latent autoimmune diabetes of adults is serious. It was first discovered back in the early 1970s. Contrary to popular belief, some people who have LADA are overweight and do carry a family history of type 2 diabetes.

  9. klensumrieves says:

    Diabetes is a curable disease but it can cause serious health complications if you leave this untreated. Try to eat healthy foods because diabetes occurs when your blood sugar becomes higher than normal. To manage this condition, try to avoid eating or drinking sugary items. There are two types of diabetes type 1 and type 2. In type 1 your body does not make insulin and type 2 diabetes is very common type in which your body does not make or use insulin well.

  10. Shannon dodson says:

    My 11 year old son was diagnosed with LADA .he is on an insulin pump and takes metformin. He also has the markers for hypothyroidism. It didnt sound like LADA fit his condition? What are your thouhhts.

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