Islets of Hope for persons with  latent autoimmune diabetes in adults (LADA)

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Article by Lahle Wolfe, Founder, Islets of Hope.

References
(this page & LADA article)

(1) Latent Autoimmune Diabetes in Adults; David Leslie, Cristina Valerie DiabetesVoice.org; 2003

(2) Diabetes Mellitus, Type 1: A Review; eMedicine.com; updated 07/02/2006

(3) Autoimmune diabetes not requiring insulin at diagnosis (latent autoimmune diabetes of the adult): definition, characterization, and potential prevention''. Pozzilli P, Di Mario U. Universita Campus Biomedico and the. Universita La Sapienza, Rome, Italy.

(4) Latent Autoimmune Diabetes in Adults; Mona Landin-Olsson; Department of Diabetology and Endocrinology, University Hospital, S-221 85 Lund, Sweden;  Annals of the New York Academy of Sciences 958:112-116 (2002)

(5) The prevalence of selective IgA deficiency in type 1 diabetes mellitus. APMIS. 1992 Aug; 100(8):709-12.; Liblau RS, Caillat-Zucman, S. Fischer AM, Bach JF Boitard C Department of Clinical Immunology, INSERM U 25, Necker Hospital, Paris, France.; PMID: 1520483 [PubMed - indexed for MEDLINE]

(6) Elevation of IgA levels in the non-insulin-dependent (type II) diabetic patient; CW Gill, WS Bush, WM Burleigh and D Cooke-Gomes ; Diabetes Care, Vol 4, Issue 6 636-639, Copyright © 1981 by American Diabetes Association

(7) Prevalence of GAD65 Antibodies in Lean Subjects with Type 2 Diabetes; A G Unnikrishnan, S K Singh and C B Sanjeevi; Ann. N.Y. Acad. Sci. 1037: 118–121 (2004). doi: 10.1196/annals.1337.018
Copyright © 2004 by the
New York Academy of Sciences

(8) Cellular and Molecular Physiology: Molecular Precursors to Diabetes; Joselin Diabetes Center

(9) Autoanitbodies against islet cell antigens; Euroimmun

(10) Antibodies in type 1 diabetes mellitus; SpecialtyLabs.com

(11)  Diabetes Statistics; Diabetes.com

(12) Statistics by country: type 1 diabetes; WrongDiagnosis.com

(13) Statistics by country: type 2 diabetes; WrongDiagnosis.com

(14) C-peptide test; Labtestsoline.org

(15) Understanding Diabetes; uchsc.edu


Islets of Hope has also authored an article about LADA on Wikipedia.com

 

 

islets of hope diabetes medical library                                      main Medical Information page
Diabetes Information

Latent Autoimmune Diabetes in Adults (LADA)
Symptoms, Diagnosis, Treatment, and Prognosis

Join LADA Support Group


Chart - Comparison of LADA & types 1 & 2 diabetes
LADA compared with (juvenile) type 1 diabetes and type 2

Mini Site Index
What is latent autoimmune diabetes in adults (LADA)?
Other names for LADA
Diagnostic criteria for LADA
Prevalence of LADA
Treatment for LADA
Patient education
Daily medical concerns
Long-term complications of LADA
Prognosis for persons with LADA
Diagnostic tests for differential diagnosis of LADA
 

What is latent autoimmune diabetes in adults (LADA)?
(Sometimes Referred to as Type 1.5 or Slow Onset Type 1)

'''Latent Autoimmune Diabetes in Adults''' (LADA) is a genetically-linked, hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responds by attacking and destroying the insulin-producing beta islet cells of the pancreas.  Simply stated, autoimmune disorders, including LADA, are an "allergy to self."

In its early stages LADA typically presents as type 2 diabetes and is often misdiagnosed as such. However, LADA more closely resembles the juvenile form of type 1 diabetes, although it is not classified as the same disease .

LADA carries a high-risk factor of becoming insulin dependent and shares common physiological characteristics of type 1 diabetes for metabolic dysfunction, genetics, and autoimmune features but does not affect children.[1]


Other names For LADA

LADA may diagnosed using any of the following terms:

  • latent autoimmnue diabetes of adulthood
  • late-onset autoimmune diabetes of adulthood
  • slow onset type 1 diabetes, or
  • type 1.5 (type one-and-a-half) diabetes  


Diagnostic criteria for LADA

LADA is often mistaken for type 2 diabetes because onset is typically over the ages of 25-30 years old and the initial presentation mimics type 2 symptoms.  Type 1 diabetes (formerly called Juvenile diabetes, childhood diabetes, or, insulin-dependent diabetes mellitus) is more commonly diagnosed in childhood or under the age of 25, however, LADA bears striking similiarity with the juvenile form of type 1.

Since LADA can be mistaken for non-obesity related type 2 diabetes, adults, especially those who are thin or normal weight, should be tested for LADA antibodies (see chart) to rule out type 2 diabetes. Other characteristics of LADA that may aid in differential diagnosis include:

  • onset usually at 25 years of age or older
  • initially mimics non-obese type 2 diabetes
  • HLA genes
  • lack of family history of type 2 diabetes
  • tests positive for LADA antibodies (see chart)
  • low C-peptide levels
  • is not insulin resistant

Note: Persons with prediabetes and type 2 diabetes are usually insulin resistant.


Prevalence of LADA

It is estimated that approximately 20% of all persons diagnosed with type 2 diabetes may actually have LADA. This number could account for an estimated 5-10% of the total diabetes population in the U.S.[2]  


Treatment for LADA

LADA often does not require insulin at the time of diagnosis, and may even be managed with changes in lifestyle in its early stages.  However, some clinicians believe that insulin should be started at onset, or, as soon as possible rather than using sulfonylureas or other diabetes pills for initial treatment. It is not clear whether early insulin therapy is of benefit to the remaining beta islet cells.[1]  

Initially, a person with LADA may respond to oral diabetes medications and lifestyle changes, however, beta cells continue to be destroyed and LADA patients should be closely monitored.  Some studies have demonstrated that the use of sulfonylureas and the insulin-sensitizing drug metformin, may increase the risk of severe metabolic disorder in persons with LADA.  Once blood glucose can no longer be managed through lifestyle and medications, daily insulin injections will be required.

80% of persons initially diagnosed with type 2 but test positive for GAD (an indication of LADA). progress to insulin dependency within 6 years. But those who test positive for both GAD and IA2 will progress more rapidly to insulin dependence.[1]

Living with any chronic illness is stressful and patients with LADA may be more prone to depression and eating disorders as a result. Counseling, therapy and participation in support groups can play an important and positive role in the lives of persons with LADA.

       


Patient education

Part of diabetes therapy should include patient education about diet, exercise, stress management, and how to handle their diabetes on "sick" days.

Patients need to understand how to manage their diabetes, as well as how to recognize, treat, and prevent hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar).

       


Daily medical concerns'

Blood glucose levels should be checked not less than 4-5 times per day, and at least once during the night.  Your doctor will provide you with target ranges for your own blood glucose levels and how often to test your blood glucose.

Hypoglycemia

Hypoglycemia' (low blood sugar) presents an immediate and life-threatening danger.  Any reading 70 mg/dL or below, for a person with diabetes, classifies as "low."

When blood glucose falls too low a person can become disoriented and unable to swallow.  Without being able to ingest a fast-acting sugar they may lose consciousness.  Untreated, hypoglycemia can lead to death.  

Onset of hypoglycemia is often rapid and may be attributed to many things including too much insulin (insulin shock), not eating enough, heavy exercise, excitement, certain medications, or a combination of factors.

Because of the potential danger associated with hypoglycemia, persons using insulin should carry a glucagon kit, fast-acting food sugars, and medical identification with them at all times.  Report all serious or repeated lows to your doctor who can help you learn how to prevent low blood glucose.

Hyperglycemia

Hyperglycemia (high blood glucose levels) occurs when too much food is eaten for insulin that was taken, not enough insulin, stress, dehydration, or illness are present.  See "Causes of Hyperglycemia."

Hyperglycemia, untreated, can lead to a deadly state called diabetic ketoacidosis (DKA. When insufficient insulin is present the body cannot use blood glucose as energy.  A combination of things happen, one of which is the body turning to fat stores for energy.  Burning of fat during a ketonic state results in an excess of ketones.  Persons with high blood glucose levels should use a test strip to check their urine for ketones anytime their glucose levels are 240 mg/dL or higher.  You should always call your doctor anytime that ketones in the moderate- to high-range are present.

A person in DKA requires immediate medical attention and should not attempt to simply administer more insulin independent of a physician's recommendation.  Doing so (self-treating) could lead to serious health risks, even death.

DKA can lead to heart failure, cerebral edema, coma, and death.

       


Long-term complications of LADA

The long-term complications of LADA are the same as for those with insulin-dependent type 1 diabetes (juvenile diabetes).  The risk of long-term consequences are directly related to how well the disease is managed both from on-set and over time.

Uncontrolled diabetes results in high blood glucose levels (hyperglycemia) which, over time may cause, diabetic neuropathy, diabetic retinopathy, kidney failure, heart disease, high blood pressure, stroke, peripheral arterial disease (PAD), chronic infections and wounds that may not heal, erectile and other urologic dysfunction, gastroparesis (delayed emptying of stomach contents), blindness, amputation, lactic acidosis, diabetic ketoacidosis (DKA).  See "Complications of Diabetes."   

       


Prognosis for persons with LADA

According to one study "Similar as in prediabetic relatives of type 1 diabetic patients, the risk for beta cell failure in adult "type 2 diabetic" patients increases with the number of antibodies positive."[1]

Eventually, LADA patients will become dependent upon insulin in order to maintain glucose control.  But it is possible for any person with a type 1 form of diabetes to lead a normal life.  Patient education, motivation, and state of mental health all play an important role in how well a person with LADA will be able to manage their disease.

Diagnostic tests for differential diagnosis of LADA

The following tests may be useful to your doctor in determining if you have LADA or type 2 diabetes:

  • Diabetes Mellitus Autoantibody Panel (Glutamic Acid Decarboxylase (GAD) Autoantibodies, Radioimmunoassay (RIA) and Insulin Antibodies, Radioimmunoassay, RIA
     
  • Islet Cell IgG Cytoplasmic Autoantibodies, IFA; Islet Cell Complement Fixing Autoantibodies, Indirect Fluorescent Antibody (IFA); Islet Cell Autoantibodies Evaluation; Islet Cell Complement Fixing Autoantibodies - These tests aid in making a differential diagnosis between LADA and type 2 diabetes.
     
  • Microplate ELISA: Anti-GAD, Anti-IA2, Anti-GAD/IA2 Pool; Glutamic Acid Decarboxylase (GAD) Antibodies - In addition to be useful in making an early diagnosis for type 1 diabetes mellitus, this test is also used for differential diagnosis between LADA and type 2 diabetes. May also be used for differential diagnosis of gestational diabetes, risk prediction in immediate family members for type 1, as well as a tool to monitor prognosis of the clinical progression of type 1 diabetes.
     
  • RIA: Anti-GAD, Anti-IA2, Anti-Insulin;  Insulin Antibodies - These test are also used in early diagnosis for type 1 diabetes mellitus, and for differential diagnosis between LADA and type 2 diabetes, as well as for differential diagnosis of gestational diabetes, risk prediction in immediate family members for type 1, and to monitor prognosis of the clinical progression of type 1 diabetes.
     
  • C-peptide (also known as Insulin C-peptide, Connecting peptide) - This test measures residual beta cell function.  The level of insulin secretion is detected in the C-petide test. Persons with LADA typically have low levels of insulin as the disease progresses.  Patients with insulin resistant type 2 diabetes are more likely to have high levels of C-peptide due to an over production of insulin.[14]

         

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Page Updated 05/27/2006