If you have diabetes or know someone who has diabetes, you are likely familiar with type 1, type 2, and maybe even gestational diabetes. But in reality, there are other forms of diabetes, as well. There’s type 1.5 diabetes, also called LADA (latent autoimmune diabetes in adults). What is this type of diabetes and how might you know if you have it?
Type 1.5 or LADA?
The terms type 1.5 diabetes and LADA refer to diabetes that has some features of both type 1 and type 2 (so that’s where the “type 1” or “type 1 1/2” comes in).
For our purposes, we’ll use the term LADA (latent autoimmune diabetes in adults) when discussing this “in between” form of diabetes.
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So, what is LADA?
The authors of an article published in 2022 in StatPearls state that “Latent autoimmune diabetes of adults (LADA) is autoimmune diabetes that begins in adulthood and does not need insulin for glycemic control at least in the first six months after diagnosis.” As with type 1 diabetes, LADA occurs because the pancreas stops making enough insulin. But because LADA usually develops after the age of 30, it may easily be misdiagnosed as type 2 diabetes.
An international expert panel published a consensus statement in 2020 about LADA in the journal Diabetes. According to this consensus statement, people with LADA have a “slowly progressive form of autoimmune diabetes with serum markers of T1D but not requiring insulin at diagnosis.” The authors state that LADA accounts for 2% to 12% of all patients with diabetes. And, there are no established guidelines for management of LADA.
What are symptoms of LADA?
Symptoms of LADA are similar to symptoms of both type 1 and type 2 diabetes, but they tend to come on gradually:
- Frequent urination
- Increased thirst
- Dry mouth
- Dry skin
- Increased hunger
- Blurry vision
- Tingling in the hands or feet
- Weight loss
- Recurring infections, such as yeast infections
People with LADA are less likely to be overweight compared with people who have type 2 diabetes.
How is LADA diagnosed?
Diagnosing LADA can be difficult and take time since many people with LADA are often first diagnosed as having type 2 diabetes. The Immunology of Diabetes Society has established three main criteria for diagnosing LADA, as outlined in an article published in 2018 in the journal Endocrinology and Metabolism:
- Adult age (over the age of 30)
- Presence of any islet cell antibody (people with type 2 diabetes do not have these antibodies)
- Absence of insulin requirement for at least 6 months after diagnosis
People with LADA may have a personal or family history of autoimmune disease, such as celiac disease, Grave’s disease, or Hashimoto’s. And other factors that a health care provider might take into consideration is body weight (meaning, the person is not overweight or obese), the absence of high blood pressure or high cholesterol, and no family history of type 2 diabetes.
Bloodwork that might be done to diagnose LADA typically includes:
- A fasting blood sugar, random blood sugar, and/or an oral glucose tolerance test
- Hemoglobin A1C
- C-peptide, which shows how much insulin the body is making (usually low to normal in LADA)
- Antibody testing (the presence of at least one antibody can be indicative of LADA)
How is LADA treated?
The consensus statement published in the journal Diabetes says that patients with LADA still have functioning beta cells, which means that they still produce insulin. The goals for therapy, then, are to improve metabolic control, prevent or delay complications, and preserve the function of the beta cells.
Some people with LADA are able to manage their blood sugars, at least early on, with lifestyle measures, including controlling carbohydrate intake and increasing physical activity. Diabetes pills and non-insulin injectable medicines can be effective early on, as well. These may include:
- DPP-4 inhibitors, such as Januvia (sitagliptin) and Onglyza (saxagliptin)
- GLP-1 agonists, such as Ozempic (semaglutide), Trulicity (dulaglutide), and Byetta (exenatide)
- Thiazolidinediones, such as pioglitazone
Sulfonylureas, such as glipizide, glimepiride, or glyburide, are not recommended because they can deplete the beta cells of insulin. And SGLT2 inhibitors, such as Farxiga (dapagliflozin), and Jardiance (empagliflozin) have not been well studied for the treatment of LADA, but they likely are not recommended due to their link with causing diabetic ketoacidosis (DKA).
Over time, lifestyle measures and the use of the above medicines are generally not enough to manage blood sugars. At this point, the use of insulin is necessary. If you are prescribed insulin, your health care provider may also have you continue with other diabetes medicines that you’ve been taking, as well.
Blood sugar monitoring is an important part of managing any type of diabetes, including LADA. Your health care provider or a diabetes educator can help you with get started with blood sugar monitoring, and advise you on when and how often to check your blood sugars.
If you think you might have LADA, based on the above criteria, talk with your health care provider. Advocate for yourself and be persistent so that you can get the proper tests in order to get a diagnosis and start on a treatment plan that will help you manage your diabetes and lower the risk of developing complications.
Want to learn more about LADA? Read “LADA Diabetes Symptoms and Treatment” and “What’s Your Diabetes ‘Type’?”