Latent Autoimmune Diabetes in Adults (LADA)

What is LADA? (Latent Autoimmune Diabetes in Adults)

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Latent Autoimmune Diabetes in Adults, or LADA, is a slow-progressing form of diabetes diagnosed in adulthood.

Many researchers consider LADA to be a less-aggressive form of type 1 diabetes.

Most people with LADA won’t need insulin injections for several months or even years after their diagnosis. Because the condition’s onset appears to be more similar to type 2 diabetes than type 1, LADA is often referred to as, “type 1.5 diabetes.” In fact, LADA is frequently misdiagnosed as type 2 diabetes.

How LADA is Unique

LADA, like all forms of diabetes, is defined primarily by high blood sugar. But it has three unique features that distinguish it from any other type of diabetes. By definition, patients with LADA:

  1. Are at least 35 years old
  2. Have autoantibodies that attack the pancreatic Beta cells (similar to type 1 diabetes)
  3. Do not need insulin for at least 6 months after diagnosis

How LADA is Identified

LADA is a sneaky condition — it often takes months, or even years, to identify.

First, clinicians will probably diagnose general diabetes. Diabetes is defined by high blood sugar levels; in the United States, the standards for the definition of diabetes are set by the American Diabetes Association. Before their diagnosis, some patients will experience the classic symptoms of diabetes, including:

  • Blurred vision
  • Weight loss
  • Need to frequently urinate
  • Extreme thirst

Other patients will have very mild symptoms or no symptoms at all, and are more likely to be diagnosed after a routine blood test.

Unlike type 1 diabetes, which is frequently characterized by a very rapid and dangerous onset (frequently requiring hospitalization), LADA is defined by a slower onset that is superficially similar to type 2 diabetes. Patients may be able to treat their condition with diet, exercise, and non-insulin medications for months or years before they require insulin injections to control their blood sugar. As a result, many people will LADA will initially be told that they have type 2 diabetes.

People with LADA may be somewhat younger and leaner than the stereotypical person with type 2 diabetes. This difference is not universal and is not used to make an official diagnosis, but it may help raise the suspicions of the treating physician that the patient in question does not have type 2.

To positively identify LADA, clinicians will need to run an autoantibody test, which will indicate whether or not the patient is experiencing the autoimmune attack that causes type 1 diabetes and LADA. A C-peptide test, which can indicate how much insulin the body is making, may also be instructive.

The Treatment and Progression of LADA

Initially, patients are mostly able to manage their blood sugars through diet, exercise, and non-insulin medications. But soon, this isn’t enough. People with early LADA are in fact experiencing a slow-motion but increasingly catastrophic loss of beta cell function, leading to a dangerous lack of insulin. Non-insulin therapies will not be enough to keep their blood sugar under control.

This surprisingly rapid glycemic decline may be one way for clinicians to realize that people with LADA do not actually have type 2 diabetes.

Eventually, LADA patients will require insulin injections, including “intensive” basal and bolus therapy. At this point, the condition may be nearly indistinguishable from type 1 diabetes.

With that said, all LADA cases are not alike, and the condition may progress differently in different people. Some people with diagnosed LADA may be able to thrive for years without beginning insulin injections.

How Common is LADA?

LADA may seem like an obscure diagnosis, but some researchers believe that it is shockingly common. A 2015 review stated that LADA is “probably the most prevalent form of autoimmune diabetes in general.” If this is the case, it probably means that many people taking treatment for type 2 diabetes today are unaware that they have LADA.

The earlier LADA is diagnosed, the better it is for your short- and long-term health. 

Complications of LADA

Like other forms of diabetes, LADA is associated with a great number of poor long-term health outcomes. It appears that LADA leads to complications at about the same rate as type 2 diabetes. Major complications may include:

  • Cardiovascular disease
  • Kidney disease
  • Neuropathy
  • Retinopathy

Could You Have LADA?

Some readers that have been diagnosed with type 2 diabetes may feel that their diagnosis feels “off” in some way. Perhaps you are not overweight, or have no family history of type 2 diabetes. Perhaps your blood sugar seems more difficult to manage than it should be. You should feel free to talk to your doctor about the possibility that you have LADA instead, and whether you are a good candidate for an autoantibody blood test.

A LADA diagnosis does not have to stop you from living a long, healthy life. Getting the correct diagnosis as soon as possible is key to achieving and maintaining optimal health outcomes with this autoimmune disease. 

Diabetes Management: A Work in Progress

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 snow footprint

 

 

There’s a blizzard outside and today we’re snowed in. In Rochester, NY where I grew up, we rarely had snow days. Being close to Canada and having snow for almost 8 months of the year meant the city was well equipped to meet extreme weather.

But here in New York state, it’s been snowing in snowballs. It’s been too cold to go outside, too cold to go anywhere and did I mention… it’s frigging cold out there! I am not sure what I was thinking leaving behind endless summers ,but it’s been quite a shock to my blood sugar levels. I really thought I had things down but I’ve realized that my diabetes management is still a work in progress.

In spite of the cold, I went into the city this week to meet with Craig Kasper the creator of the Bravest Podcast. Craig also lives with type 1 and created the podcast so he could learn and explore what it is that enables people to live extraordinary lives in spite of their diabetes.

In the interview, we talked about levels of bravery. As our discussion progressed I shared that acceptance continues to be a process. There was that moment of diagnosis, where I felt like I had to swallow a bitter pill, the long years of denial where I kept thinking that controlling my diet and walking up hills would cure me, the moment where I gave myself my first injection through a rain of tears, the day where I knew I needed to change my management strategy by splitting my basal dose and finally yesterday pulling up a ½ unit of bolus insulin into a syringe and taking the plunge.

insulin pen

Living with Latent Autoimmune Diabetes in Adults (LADA) is no picnic. A friend recently commented that it’s easier to calculate your insulin to carb ratio when your beta cells don’t produce any insulin. Living with LADA is like playing roulette. Some days the ball lands on the money and other days I leave the table in despair.

The only way I get through each and every wonky moment is with the varied practices of yoga. I love working with the medium of sound in my practice because sound is so direct and immediately calms and centers me.

Working with sound in yoga is called mantra. The word mantra comes from two words, manas, meaning mind and trayati meaning freedom. A mantra is a sound, which frees the mind by giving the mind a focus so it’s naturally drawn out of its preoccupation with thoughts, ideas, and beliefs.

I know it’s natural to be obsessed with thoughts about the ins and outs of daily management. In working up to that first bolus injection I would sit down to meditate and replay worst case scenarios over and over.

That thought loop went on for days until I caught myself. It’s up to me to stop my need to identify with the thought by asking myself; what kind of investment do I have in that thought? Can a thought make me happy? How can a thought, which has no substance or dimension get the better of me?

It’s like trying to catch a snowflake. Impossible!

And it’s not about stopping the thought either. Try and banish any thought, another impossible task.

Mantra is such a profound way to bring the mind into a one-pointed focus, it can be chanted out loud or internally. Each nuance has a different effect on the mind and body. Chanting audibly affects the pituitary gland, the master gland in the body. It vibrates during chanting which tones and tunes all the other glands in the body. It also affects the vagus nerve which is responsible for increasing immunity

Chanting out loud increases the length of exhalation too. The longer the exhale the calmer the nervous system. Finally, mantra increases our ability to recognize that moment of getting lost in a thought. Thoughts come and go. It’s the thinker of the thoughts that matters.

For today’s practice join me in a simple chanting practice with the sound, om.

URL: https://soundcloud.com/the-flying-yogini/om-chanting-for-health-and-wellbeing

Many Cases of Type 1 Diabetes Happen in Adults and These Diagnoses Are Tough

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adults diagnosed with type 1

Years ago, type 1 diabetes was often called “juvenile diabetes” which is a term that wasn’t accurate because of how not all type 1 diabetes diagnosis happen in childhood. Over time we’ve learned just how inaccurate that term indeed was.

Among those with a high genetic risk for type 1 diabetes, at what age do they most often develop type 1 diabetes well into adulthood and what are the clinical characteristics of those patients?

Researchers conducted a cross-sectional analysis using a type 1 diabetes genetic risk score that was based on 29 common variants to pinpoint individuals of white European descent in the UK Biobank “in the half of the population with high or low genetic susceptibility to type 1 diabetes, ” wrote the researchers in their study abstract.

They looked at the number of cases of diabetes in both of those groups over their first 60 years of life and then “genetically defined type 1 diabetes as the additional cases of diabetes that occurred in the high genetic susceptibility group compared with the low genetic susceptibility group”.

Remaining cases were defined as type 2 diabetes and the clinical characteristics of the groups with genetically defined type 1 or 2 diabetes were investigated.

Study Results

Researchers found that 13,250 of the 379,511 individuals from the UK Biobank had developed diabetes in their first 60 years of life. They write that 537 or 42% of individuals were diagnosed between age 31-60 which comprised 4% of the total diabetes cases diagnosed after age 30.

The clinical characteristics in those diagnosed with type 1 diabetes after age 30 were similar to those diagnosed with type 1 under age 30 and different from those diagnosed with type 2 diabetes. All those diagnosed with type 1 diabetes generally had a lower BMI, were more likely to use insulin in their first year of diagnosis, and were more likely to develop diabetic ketoacidosis.

Diagnosing Type 1 in Adults is Daunting

These findings show that type 1 diabetes often develops in individuals after age 30, but since these cases of type 1 diabetes are such a small percentage of cases, with type 2 diabetes being the overwhelming majority and therefore likelihood, properly identifying type 1 diabetes in this age group is very challenging.

Yet, failing to do so can lead to “serious consequences because these patients rapidly develop insulin dependency”.

The researchers state that tests that check C-peptide and islet-specific autoantibodies can be used to figure out if a patient has type 1 or 2 diabetes but these tests aren’t routinely done and sometimes aren’t enough.

They write that “Progression to absolute insulin deficiency, defined by measurement of serum C-peptide concentration, can be used to identify type 1 diabetes, but is only useful 3–5 years after diagnosis.”

Sometimes, to diagnose type 1 diabetes, healthcare providers use a test that looks for autoantibodies to the GAD islet antigen but that isn’t a sure thing because only about 70% of type 1 patients have those autoantibodies.

All this despite the other complications for professionals trying to figure out which diabetes a patient has like the way that patients diagnosed later in life tend to have a slower progression of type 1 diabetes compared to children which can make them look like a type 2, at least initially.

In conclusion, the researchers explain that half of the population has a very low genetic risk for type 1 which means that if they develop diabetes, it is most likely to be type 2 diabetes. The other half of the population with a high risk for type 1 diabetes has a likelihood for either type 1 or 2 diabetes, leaving medical professionals struggling to properly identify patients.

Were you diagnosed with type 1 diabetes as an adult? Was there trouble getting a diagnosis? Please share in the comments.