The term “latent autoimmune diabetes in adults” (LADA) is used more commonly than “slow diabetes” or “diabetes 1.5” and is probably a more accurate description.
LADA is a controversial diagnosis in the diabetes community.
Roughly 10 percent of adults with diabetes actually have LADA, making it even more widespread than Type 1.
However, many of these diabetics were initially diagnosed with Type 2 diabetes.
Latent autoimmune diabetes in adults (LADA) is a term used to describe a form of autoimmune diabetes that resembles Type 1 diabetes, but has a later onset and slower progression toward an absolute insulin requirement.
Adults with LADA may initially be diagnosed as having Type 2 diabetes based on their age, particularly if they have risk factors for Type 2 diabetes such as a strong family history or obesity.
LADA is sometimes referred to as type 1.5 diabetes. This is not an official term but it does illustrate the fact that LADA is a form of Type 1 diabetes that shares some characteristics with Type 2 diabetes.
As a form of Type 1 diabetes, LADA is an autoimmune disease in which the body’s immune system attacks and kills off insulin producing cells.
The reasons why LADA can often be mistaken for Type 2 diabetes is it develops over a longer period of time than Type 1 diabetes in children or younger adults.
Whereas Type 1 diabetes in children tends to develop quickly, sometimes within the space of days,
LADA develops more slowly, sometimes over a period of years.
Autoantibodies and their effect on beta cell health may be the key to defining the relationships among Type 1, Type 2, and LADA.
Scientists have discovered several different types of autoantibodies related to diabetes.
People with Type 1 have higher levels and more types of these proteins than do those with LADA, which may be the reason beta cells are destroyed faster in Type 1 than in LADA.
In Type 2 diabetes, autoantibodies are generally absent and, as a consequence, beta cell decline is the slowest.
Genetically, LADA has features of both Type 1 and Type 2 diabetes.
So, in autoantibodies and genetics, LADA appears to fall somewhere between Types 1 and 2 on the diabetes spectrum, though perhaps closer to Type 1.
People with LADA are often thin, so if you are thin and are told you have Type 2 diabetes, you should demand the antibody tests that are used to diagnose LADA.
But not all people with LADA are slim.
People with defective autoimmune genes are also prone to get thyroid disease and rheumatoid arthritis both of which can promote obesity, the first because incorrectly treated thyroid disease will make you fat and the latter because it limits mobility and hence the ability to exercise and because it is often treated with steroids that promote weight gain.
At first, LADA can be managed by controlling your blood glucose with diet, weight reduction if appropriate, exercise and, possibly, oral medications.
But as your body gradually loses its ability to produce insulin, insulin shots will eventually be needed.
People with LADA benefit from being put onto full basal/bolus insulin regimens as soon as possible.
The sooner you start insulin the easier it will be to control your blood sugar with insulin for many years to come.
A Japanese study in 2008 concluded that early insulin treatment may keep beta cells in the business of producing insulin for diabetics with LADA.
Also medicines being developed to prevent or cure Type 1 diabetes may also turn out to be effective against LADA.
Insulin shots are painless and if you have been running high blood sugars for a while, you will feel much, much better once you start using insulin to get normal blood sugars.
The Warning Signs You May Have LADA
1. You are diagnosed with Type 2 diabetes while at a normal weight.
2.A family history of Type 1 diabetes.
There is a genetic tendency towards developing autoimmune diabetes, so if you have a close family member who has autoimmune diabetes, it is more likely that you have that same genetic make up and the same tendency towards developing autoimmune diabetes.
3. Whatever your weight, either you or a member of your family has some other autoimmune disease such as thyroid disease, rheumatoid arthritis, lupus, or multiple sclerosis.
4. You lower your carbohydrate intake shortly after diagnosis to no more than 15 grams a meal and still have a fasting blood sugar over 110 mg/dl and blood sugars that rise 40 mg/dl or more after each meal.
5. No matter what your weight, you do not see a dramatic drop in your blood sugar when you take metformin, Avandia, Actos, Januvia or Byetta in combination with a lowered carbohydrate intake.
6. Your blood sugar deteriorates significantly over the period of a year despite treatment with oral drugs and carbohydrate restriction.
Symptoms Of LADA
Symptoms of LADA may occur suddenly and could include:
3.Drowsiness or lethargy
4.Sugar in urine
5.Sudden vision changes
7.Sudden weight loss
8.Fruity or sweet odor on the breath
9.Heavy, labored breathing
10,Stupor or unconsciousness
If you experience any of these symptoms, contact your health-care provider immediately.
The exact causes of LADA are not known, although researchers have identified certain genes that are associated with a higher diabetes risk.
Comparison between LADA, Type 1 Diabetes and Type 2 Diabetes
LADA is neither classified as type 2 diabetes or type 1 diabetes but considered somewhere in between. It is a form of type 1 diabetes that has similarities and differences to both type 1 and type 2 diabetes.
How to Test for LADA
The most common test for LADA is one that looks for GAD (glutamic acid decarboxylase) antibodies.
Glutamic acid decarboxylase (GAD) is an enzyme which is found in all human cells.
It catalyzes the degradation of glutamic acid, part of the cycle for the disposal of a waste (ammonia) in the body.
The presence in the blood of self-antibodies to GAD is an early marker of the process that leads to the destruction of insulin producing islet cells, and thus of Type 1 diabetes.
However, a small number of people with autoimmune diabetes will not have GAD antibodies, but they will have islet cell antibodies and/or tyrosine phosphatase antibodies.
So a lack of GAD antibodies does not entirely rule out LADA. Another issue is that very early on in the disease process there may be no detectable antibodies, but over time they may emerge.
The other important test for LADA is the fasting C-peptide test.
A very low C-peptide result suggests that the beta cells have stopped making insulin, possibly because they are dead.
People with Type 2 diabetes often test with normal or high levels of C-peptide.
So a low C-peptide level is suggestive of LADA, though it should be confirmed with antibody tests.
LADA does not present like type 1 diabetes with significant weight loss and ketoacidosis from rapidly progressive β-cell failure.
Because of the slow progressive β-cell failure, LADA presents similarly to type 2 diabetes, with elevated blood glucose values and typical symptoms of hyperglycemia, such as polyuria, polydipsia, polyphagia, and visual blurring.
What To Do If You Think You Have LADA
If you have LADA, you’d do best to get treated by an endocrinologist who specializes in treating Type 1 diabetes as you will need an up-to-date insulin regimen and the kind of diabetes education Type 1 diabetics get which will help you learn how to use insulin to get more normal blood sugar numbers.
It is important to note that people with LADA have the same risk of damaging their organs by running higher than normal blood sugar as do people with other forms of diabetes.
This means that it is essential that you learn What Is a Normal Blood Sugar and strive to achieve Healthy Blood Sugar Targets.
The best blood sugar level for a person with insulin-dependent diabetes is the lowest level they can achieve without experiencing hypos–with hypos being defined as blood sugars under 70 mg/dl.
Unlike the case with Type 2 diabetes, it is usually not possible to reverse or control LADA with carbohydrate restriction alone.
That said, it is much easier to make insulin work when you are eating a lower carbohydrate diet than it is with a high carbohydrate diet.
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LADA Treatment And Prevention
1.Distinguishing LADA diabetics from diabetics with type 2 diabetes is important .
Since insulin resistance is minimal or non-existent in LADA diabetes, medications designed to reduce insulin resistance such as Avandia and Actos are not effective.
Also, several of the oral drugs used to treat Type 2 diabetes stimulate the beta cells to produce insulin, and because LADA involves an autoimmune attack which is stimulated by the production of insulin at the beta cells, stimulating insulin production by the beta cells with drugs may increase the ferocity of the attack, killing more beta cells.
So it is very important to get a correct diagnosis so you can avoid the drugs that stimulate insulin production by the beta cells.
These drugs include the sulfonylureas like Amaryl and Glipizide and may also include the incretin drugs, Byetta and Januvia because they also stimulate insulin production by the beta cells.
Other medications that stimulate the pancreas to produce insulin, slow digestion of carbohydrates, or reduce excess glucose production by the liver are often effective in controlling the blood sugar for a few years.
Because LADA develops slowly, someone with LADA may be able to produce enough of their own insulin to keep sugar levels under control without needing insulin for a number of months or sometimes even years after the initial diagnosis of diabetes.
Insulin will almost certainly be required at some point in the future.
In some cases, insulin therapy may be postponed.
However, there is evidence to suggest that starting insulin treatment soon after a diagnosis of LADA will help to better preserve the pancreas’ ability to produce insulin.
Regular blood glucose testing is advised for people with LADA at a similar number of tests per day that are advised for people with type 1 diabetes.
This means that it is advisable to test your blood sugar levels before each meal and before bed.
One major benefit for patients with Type 1.5 LADA diabetes is that when their blood sugars are controlled they usually do not have the high risk for heart problems more often found with the high cholesterol and blood pressure seen in true Type 2 diabetes.
People with LADA diabetes comprise an important section of the diabetic population.
Although LADA can occur in any age group, including children and adolescents,it is characterized predominantly by adult age at onset (30–40 years),mainly nonobese body type, gradually leading to insulin dependency, characteristically low C-peptide levels, and marked presence of GAD autoantibodies.
Thus determination of C-peptide levels and GAD autoantibodies is strongly recommended for confirmatory diagnosis of LADA.
Appropriate diagnosis of LADA would prevent misdiagnosis as type 2 diabetes and would help in optimum treatment of LADA diabetes so that residual β-cell function is preserved and the further autoimmune destruction of β-cells is delayed.
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