Latent Autoimmune Diabetes in Adults (LADA): What You Need to Know
As of 2021, roughly 37.3 million Americans have diabetes.¹ This means that about 1 in 10 people in America have diabetes. You most likely know someone with diabetes, or maybe you have it yourself. And with the cases of diabetes on the rise, being educated on this disease may save your life or the life of a loved one.
My husband was diagnosed with diabetes in February of 2021, and his diabetes was thankfully caught early on routine blood work. After this, we both started to reflect on the weeks leading up to his diagnosis, and it all made sense. The month before his diagnosis, he experienced increased thirst, hunger, urination, dizziness, and lightheadedness, which are all symptoms of diabetes.
He was initially started on oral medication and insulin to lower his blood sugars, and he made several changes to his diet that also helped his sugars. He initially had so much success with intermittent fasting that he was able to completely stop insulin.
Unfortunately, this didn’t last.
All of his symptoms and his response to treatment initially pointed to a diagnosis of type 2 diabetes, which is reversible. But when the medications and intermittent fasting couldn’t keep his blood sugar levels below 250, we both knew that something else was going on.
The worsening of his blood sugars led us to seek expert advice and treatment by a diabetes doctor, also called an endocrinologist. Soon after our first appointment with them, my husband was diagnosed with a disease called Latent Autoimmune Diabetes in Adults (LADA).
LADA was discovered in 1993 and has been nicknamed type 1.5 diabetes because it has characteristics of both type 1 and type 2. It’s relatively rare and only accounts for about 3-12% of those with diabetes.²
There are three types of diabetes, and each type is diagnosed and treated differently. The stigma surrounding diabetes is one that places blame on the individual with the disease. Many people believe that simple diet changes, weight loss, and medication will cure diabetes, regardless of the type. And yes, many cases of diabetes are reversible, but this isn’t the case with LADA.
LADA is a lifelong, autoimmune condition, and while it can be properly managed with insulin, the disease itself cannot be cured.
Understanding the different types of diabetes, how they’re diagnosed, and how they’re treated will allow you to better support and understand those affected by diabetes.
Type 1 Diabetes vs Type 2 Diabetes vs LADA: What’s the Difference?
In order to understand what LADA is, there needs to be an understanding of the differences between type 1 and type 2 diabetes.
In general, diabetes is a disease that affects the body’s ability to regulate blood sugar. When we eat something that contains sugar or carbohydrates, it is absorbed by the stomach and intestines and released into the bloodstream. Once the sugar is in the bloodstream, it’s called glucose.
However, in order for our muscles and organs to use glucose as energy to function, the glucose needs to get inside of the body’s cells.
In a person without diabetes, an organ in the body called the pancreas would then be signaled to release insulin into the bloodstream. Insulin attaches itself to cells in the body to basically “open the door” for glucose to enter the cells. See the image below on the left.
But, when insulin cannot “open the door” to let glucose into the cell, this is called insulin resistance. See the image above on the right.
Insulin resistance and reduced insulin production occurs in type 2 diabetes. These changes occur over time, and people are usually diagnosed with it later in life. It can be the result of things like:³
Obesity or being overweight
High carbohydrate diets
Lack of exercise
Genetics
Type 2 diabetes can be treated with oral medication and in some cases requires insulin. It’s reversible with weight loss, exercise, and dietary changes.
In contrast, type 1 diabetes is not reversible.
Type 1 diabetes is an autoimmune disease where the body’s immune system attacks and destroys cells in the pancreas that produce insulin. Those with type 1 diabetes are born with the condition, and it’s typically diagnosed in childhood or adolescence.
People with type 1 diabetes need insulin to survive. Dietary changes such as eating less carbohydrates may help them not need as much insulin, but they do not improve the disease itself.
Why is LADA Called Type 1.5 Diabetes?
LADA is essentially “type 1.5 diabetes” in that it’s a combination of both type 1 and type 2 diabetes. People with LADA initially present with characteristics of type 2 diabetes, meaning that their pancreas is still producing some insulin, and they may even have some insulin resistance.
However, people with LADA have antibodies (fighter cells) that destroy insulin-producing cells in the pancreas. So over time, the pancreas loses its ability to make insulin. This results in those affected to be completely insulin-dependent, which is what’s seen in type 1 diabetes.
Genetics may play a big role in the cause of LADA. Some studies have found that people with LADA contain genes seen in both type 1 and type 2 diabetes, but research is ongoing about this. It’s also been found that people that do have genetics that put them at risk may be at an even higher risk of developing LADA if they are overweight.³
Because of what causes LADA, it’s similar to type 1 diabetes in that it’s not reversible either. However, some researchers are looking for ways to possibly slow the progression of the disease and preserve function of the pancreas. This will be discussed further in the treatment section.
So are the symptoms of LADA different from those with type 1 or type 2 diabetes? Surprisingly, they’re not.
What Are the Symptoms of LADA?
The symptoms of diabetes develop due to the effects of elevated blood sugars. Typically, blood sugars have to be at least over 200 consistently to result in noticeable symptoms.
The symptoms of diabetes can include:²
Increased thirst
Increased appetite
Increased urination
Unintentional weight loss
Fatigue
Dizziness/lightheadedness
Blurred vision
These symptoms occur because the glucose the body needs to use for energy and maintain weight is stuck outside of the body’s cells. As mentioned above, this occurs because there is no insulin available to “open the door” for the glucose to enter the cells of the body.
Because the glucose is trapped in the bloodstream, the cells in the body’s organs and muscles are essentially “starving.” This is what causes the increased appetite. The body also attempts to flush this extra sugar in the bloodstream out through the urine by increasing thirst and urination.
These symptoms are one way that a doctor may begin to suspect a diagnosis of diabetes. However, there are other factors including testing and blood work that result in a diagnosis of LADA.
What's Involved in the Diagnosis Of LADA?
Regardless of which type, diabetes is diagnosed with specific blood tests including blood glucose and a test called Hemoglobin A1c.
A medical provider may begin to suspect a diagnosis of diabetes if fasting (no food or drink except water for 12 hours) blood work reveals a blood sugar greater than 126. Suspicion will also be high if any blood sugar regardless of fasting status is greater than 200.²
The next step is to check a blood test called Hemoglobin A1c. This is basically an average blood sugar over 2-3 months, and the values are broken into three categories:⁴
Less than 5.7 means no diabetes
5.7 to 6.4 is a diagnosis of prediabetes
Greater than 6.5 is a diagnosis of diabetes
If an adult is diagnosed with diabetes using the above criteria, many healthcare providers tend to lean towards a diagnosis of type 2 diabetes. However, if the treatments for type 2 diabetes like oral medications, dietary changes, and weight loss don’t seem to work, additional tests to evaluate for LADA are warranted.
The diagnosis of LADA is based on three criteria:³
Adult age at onset
Presence of antibodies (islet autoantibodies) that destroy cells in the pancreas
Positive C-peptides, which indicates ongoing insulin production
It’s important to note that those with LADA test positive for BOTH islet autoantibodies as well as C-peptides. This shows that the pancreas is still trying to produce insulin while the body is also producing immune cells to attack cells in the pancreas. LADA has features of both type 1 and type 2 diabetes, and that’s why it’s referred to as type 1.5 diabetes.
And because the body will continue to attack and destroy all of the insulin-producing cells in the pancreas, the eventual treatment option for those with LADA is insulin.
The Treatment of LADA vs Other Forms of Diabetes
Because of the irreversible damage inflicted on the pancreas in those with LADA, people with the disease eventually rely completely on insulin.
However, like mentioned earlier, researchers are starting to study certain injectable medications in the treatment in those with LADA. The medication Ozempic, which was originally made for those with type 2 diabetes, works to stimulate and increase insulin production in the pancreas.
Because there is still some pancreatic function in the beginning stages of LADA, there is an idea that using a medication like Ozempic may possibly prolong the functioning of whatever is left of the pancreas. Given the mechanism of Ozempic, the theory of its potential role in LADA, albeit new, makes sense. Read more about this clinical trial on University at Buffalo’s website.
But because of the antibodies against the insulin-producing cells in the pancreas, those with LADA are eventually unable to make their own insulin. Therefore, they rely on injectable forms of insulin.
When someone with LADA is started on insulin, they are started on two types of insulin: long-acting and short-acting. Long-acting insulin is taken either once or twice daily, and short-acting insulin is taken with meals.
Insulin can only be absorbed by the body subcutaneously, which essentially means beneath the skin within the fat of the body. The administration of insulin requires a small needle, and it can be delivered through insulin pens or an insulin pump.
Advancements in the treatment of all types of insulin-dependent diabetes have come a long way, and researchers continue to make great strides in this field.
Do You Have Symptoms of Latent Autoimmune Diabetes in Adults? When To See A Doctor
Even if you haven’t been diagnosed with diabetes, there are some key reasons that you should see a medical provider. You should see a medical provider if you:
Have a family history of any type of diabetes
Have symptoms of diabetes
Haven’t had routine blood work done in the last year
Are overdue for your annual physical
It’s good to get routine blood work done: this is how my husband’s doctor caught his diabetes. Even though he had symptoms, everyday life got in the way, and we didn’t notice the changes. If he hadn’t gone in for routine labs, his diabetes likely would’ve gone undiagnosed until his dangerously high blood sugars landed him in the hospital.
If you haven’t had routine blood work done or haven’t seen your primary care physician in the last year, make an appointment to see them. It just may save your life.
Diabetes is best treated with proper education and compliance to treatment. Many of the serious long-term complications of diabetes can be prevented with routine preventative care, which will be reviewed in my next blog.
To get more up-to-date, evidence-based information about health and wellness, make sure to check out some of my other articles.
Stay informed, stay healthy.
Works Cited
1. National Diabetes Statistics Report – (cdc.gov)
2. Diagnosis and Classification of Diabetes Mellitus – (nih.gov)
3. Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes – (nih.gov)
4. Diagnosis | American Diabetes Association – (diabetes.org)
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