To understand LADA, you must first know the two basic types of diabetes and how autoimmune diseases work.
In an autoimmune disease, the body’s immune (defence) system is overactive. The body attacks its own cells, destroying them. In type 1 diabetes, the immune system has destroyed the beta cells of the pancreas. These beta cells make insulin. Insulin permits the cells of the body to use glucose, the sugar from food, for energy. Without beta cells, the body has no insulin. The amount of glucose in the blood and urine increases, and this can occur very quickly. Type 1 diabetes is usually diagnosed in children and young adults. It was previously known as juvenile diabetes.
Those who have type 2 still do produce some insulin. However, the insulin does not work as well as it should. The cells of the body resist the insulin. The glucose stays in the blood, and the result is high blood glucose. This type occurs most often in adults. Type 2 diabetes is linked with obesity, metabolic syndrome, and high blood pressure and cholesterol, rather than having an autoimmune cause.
LADA is both an autoimmune disorder and a subtype of type 1 diabetes. With LADA, the body attacks and destroys beta cells, much like type 1 diabetes although at a much slower pace. At first, some cells still make insulin, but eventually they are destroyed as the disease progresses. LADA appears in people older than the age when type 1 diabetes typically starts. As it affects adults over age 30, it is often confused with type 2 diabetes. LADA does not fit either category, and so is sometimes called type 1.5 diabetes. It can be inherited.
Certain following tests can help decide whether you have LADA.
Although both type 2 diabetes and LADA start later in life, the two are quite different. People who have LADA often share certain characteristics. They:
LADA is thought to affect 10 to 15 per cent of all people diagnosed with type 2 diabetes. This suggests that about five to 10 per cent of those with diabetes have LADA, although this number may be significantly higher.
As it usually appears later in life, LADA is often initially diagnosed as type 2 diabetes. Although people may respond well to oral medications at first, the effect may be short-lived (months to a few years). Sometimes they are not effective at all. People over age 30 who are newly diagnosed with diabetes, have a slender build, and no family history of type 2 diabetes, might want further tests to check for LADA.
Even after LADA appears, the body still makes some insulin at first. Lifestyle factors, such as eating a healthy and balanced diet, may be enough to manage the disease for a while. Medications that treat insulin resistance are not effective, since insulin resistance is minimal or not occurring. The specific role of metformin and other insulin sensitizing drugs is not known, as no studies have evaluated their effect on LADA. Oral anti-diabetes medications can be effective early on. Sulfonylureas have proved effective in controlling blood glucose levels, as long as some beta cells in the pancreas still make insulin.
Debate exists about whether to prescribe insulin immediately or delay it until needed. Since the beta cells that make insulin are continually and gradually destroyed, insulin will eventually be required. Some believe that using insulin earlier allows the remaining beta cells to survive longer. However, this is yet to be determined. On average, half of those who have LADA require insulin within four years of being diagnosed. Those who have true type 2 diabetes usually have over 10 years.
Long-term complications of LADA are the same as for people with type 1 and type 2 diabetes. The need for blood glucose control and targets are also the same, though targets are often set individually for each person. Special care must be taken to avoid hypoglycemia and hyperglycemia. These can result in very serious complications. Check-ups with the doctor and an eye care specialist must be done regularly.
One major benefit is that once people with LADA have their blood glucose under control, they usually do not have the high risk of heart problems found with type 2 diabetes.
Although LADA is becoming better known, your doctor may not be aware of it. Adults who have LADA are often incorrectly diagnosed at first as having type 2 diabetes. They are often put on oral type 2 diabetes medication with minimal or short lasting effectiveness.
If you are not benefiting from traditional diabetes medications and suspect you have LADA, ask your doctor to test you for it. If this is the type of diabetes affecting you, correct diagnosis can get you on the right track with your diabetes management.