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Is it Type 2 or is it LADA?

David Spero

July 18, 2007

At the end of my blog post a couple of weeks ago ("Type 2 Diabetes—An Environmental Illness), Mary A wrote: “I am female, white, 47 years old, 5′9", 142 pounds, a runner, and in January 2007, I was diagnosed with Type 2. No one else in my family has diabetes. I have always been active. I have never been obese. Go figure.”

Here’s what I figure, Mary: You may not have Type 2 at all.

You may have late-onset of Type 1. This is sometimes called LADA (latent autoimmune diabetes of adults). It’s also called Type 1.5 diabetes or “slow-onset Type 1.”

In researching my book Diabetes: Sugar-coated Crisis—who gets it, who profits, and how to stop it, I came across no fewer than three cases of people misdiagnosed with Type 2 diabetes. These were people who, like Mary, were thin, athletic, middle-class, and not especially stressed or depressed. It didn’t make sense to me that they would have a lot of insulin resistance, which is what Type 2 is all about.

It seemed more likely that they were just not producing enough insulin. They were taking pills for insulin resistance, knocking themselves out with lots of exercise and a very strict meal plan, and their HbA1c levels still wouldn’t come down below 9% or 10%. When they went back to their doctors and asked to have their insulin production tested, it turned out that those levels were quite low. They needed insulin. When they got it, their blood sugar levels returned to near normal, and they resumed their healthy lives.

In LADA, your own immune system, or possibly a virus or chemical exposure, damages your beta cells. It doesn’t destroy them completely, so you still produce some insulin—just not enough. LADA or Type 1.5 diabetes usually comes on in adulthood, often slowly, so many doctors assume that you have Type 2 diabetes (which used to be known as “adult onset” diabetes) when you really don’t. People have died or developed unnecessary complications because they were treated for insulin resistance when they really needed insulin injections or inhalers.

Whether you have Type 1.5 or Type 2 diabetes, I encourage you to ask your health-care provider about insulin. The West Suffolk Diabetes Service in England encourages all of its Type 2 diabetes patients to consider insulin. “Up to 70% [of people with diabetes] report an increase in well-being following the change to insulin,” they say. They see an average HbA1c reduction of 1% to 2% with insulin. “Insulin used to be considered a last resort in Type 2,” these doctors say. “But the new trend is to start insulin at a much earlier stage.”

Even though Type 2 diabetes is a condition strongly related to insulin resistance, as long as your pancreas can pump enough insulin to overcome the resistance, blood glucose levels tend to stay normal. It’s only when the pancreas can’t keep up that a person starts to experience symptoms. So starting insulin therapy sooner may be the best treatment for many people.

That’s in Type 2 diabetes. If you have LADA or Type 1.5 diabetes, you can expect even better results. Getting the correct diagnosis and treatment might save your life.

If you have lots of abdominal fat, high cholesterol, and high blood pressure (elements of the metabolic syndrome), you probably have Type 2 diabetes. But if you’re like Mary, fit and active, there’s a chance you may have Type 1.5, so please aks your health-care professional to test you.

And let me know how it goes—post comments and questions here.

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