If you have been diagnosed with Type 2 diabetes or prediabetes but standard diets and treatments aren’t helping much, you may have LADA (latent autoimmune diabetes in adults). What causes LADA? What are the symptoms and treatment?
What is LADA?
We usually hear that there are two types of diabetes. Type 2 is caused primarily by insulin resistance. The insulin isn’t effectively used by the body’s cells, so too much glucose stays in the blood and causes complications. Type 2 comes on slowly and used to be called “adult-onset diabetes.”
Type 1 is caused by the body’s immune system destroying the beta cells in the pancreas, which produce insulin. Without insulin, our bodies can’t use glucose, and eventually people with Type 1 will die without injected insulin. Type 1 usually comes on rapidly in childhood or adolescence.
LADA is a mixed type. It comes on slowly during adulthood like Type 2, but is caused mostly by an immune system reaction like Type 1.
The diabetes website diabetes.co.uk defines LADA as “initially non-insulin requiring diabetes diagnosed in people aged 30–50 years.”
It’s a common and serious problem. According to a study in the journal Diabetes, “Among patients [who appear to have] Type 2 diabetes, LADA occurs in 10% of individuals older than 35 years and in 25% below that age.” LADA is often misdiagnosed as Type 2. People with LADA may be denied needed insulin and given advice that doesn’t work.
Symptoms of LADA
According to diabetes.co.uk, early LADA symptoms may be vague. They include:
• Foggy headedness
• Feeling tired all the time or feeling tired after meals
• Feeling hungry again soon after meals
As LADA develops, a person’s ability to produce insulin will gradually decrease, and this may lead to more typical diabetes symptoms such as:
• Constant or extreme thirst
• Needing to frequently urinate
• Blurred vision
• Tingling nerves
Diabetes is diagnosed by higher-than-normal blood sugars, as shown on a fasting plasma glucose (FPG) test, oral glucose tolerance test (OGTT), random plasma glucose test or A1C test. But what type of diabetes do you have? There are some clues that should lead you and your doctor to suspect LADA rather than Type 2.
• An absence of metabolic syndrome features. People with metabolic syndrome often have Type 2 and tend to be heavy and have high blood pressure and bad cholesterol levels. A person with above-normal sugars but without these other factors may well have LADA. However, overweight or obese people with metabolic syndrome can have LADA, too.
• Glucose that stays high despite taking oral diabetes medicines. Most Type 2 diabetes drugs treat insulin resistance, which is not the cause of LADA, so the pills won’t work.
• Evidence of other autoimmune diseases including Grave’s disease, rheumatoid arthritis or hundreds of others you can see here.
• No family history of Type 2 diabetes.
If any of these clues are present, or if you are a thin, physically active person with high blood sugars, you might want to be tested for autoantibodies. Autoantibodies are the proteins that attack the pancreas or destroy insulin. Antibodies to glutamic acid decarboxylase (GAD) are the most common. Others are called islet cell antibodies (ICAs). A person with LADA will usually test positive for one or both groups of antibodies, but there are several other types as well.
Treatment for LADA
Treatment for LADA includes basic diabetes self-management. Exercise more; avoid refined carbs; eat a healthful diet; and check your blood sugar levels to find out what makes them go up and down, for example.
Oral diabetes medicines like metformin (brand names Glucophage, Glucophage XR, Glumetza, Riomet) probably won’t help unless you also have Type 2, which often happens. Another class of diabetes pills, the sulfonylureas (tolbutamide [Orinase], tolazamide [Tolinase], chlorpropamide [Diabinese], glimepiride [Amaryl], glipizide [Glucotrol and Glucotrol XL] and glyburide [Diabeta, Micronase, and Glynase]) may actually worsen LADA by increasing autoimmunity.
You may, however, benefit from insulin. Many experts say start insulin sooner rather than later, because some studies show injected insulin protects beta cells from damage.
This is why it’s important to know if you have LADA. Your doctor may prescribe sulfonylureas and not prescribe insulin if he thinks you’re Type 2.
Other studies have found the TZD, or thiazolidinedione, drugs (pioglitazone [Actos] and rosiglitazone [Avandia]) help preserve beta cells in people with LADA. The incretin drugs, such as exenatide (Byetta and Bydureon), liraglutide (Victoza), albiglutide (Tanzeum) and dulaglutide (Trulicity), have been shown to increase beta-cell growth and improve glucose control, but have not yet been tested in people with LADA.
If LADA continues, you may eventually need insulin even with good self-management. If you want to stop the LADA process, your pancreas may benefit from the support of outside insulin, and other measures like the ones listed above.