Type 1.5 Diabetes Overview: What Should You Know About Latent Autoimmune Diabetes In Adults (LADA)

Diabetes is characterized by high levels of glucose — a type of sugar — in the blood. Type 1 diabetes is a form of diabetes that generally develops in childhood due to autoimmunity,  a process in which the immune system attacks the pancreas, organ responsible for producing insulin (the hormone that helps metabolize glucose).

Generally, people develop LADA when they are 30 to 50 years of age. They have antibodies for a protein known as glutamic acid decarboxylase (GAD). Unlike type 1 diabetes, LADA symptoms are similar to those of type 2 diabetes and appear slowly and over a longer period of time; sometimes year. Type 1 diabetes symptoms, on the other hand, develop over a period of days. Therefore, many people are mistakenly diagnosed with type 2 diabetes instead of LADA.

While the estimates for how common LADA is are not entirely accurate due to the fact that many people are misdiagnosed with type 2 diabetes, studies have found that between six and 10 percent of all diabetes patients have antibodies that are specific to LADA. Furthermore, 25 percent of people younger than 35 years who are diagnosed with diabetes may have LADA. 

What are the symptoms of LADA?

The symptoms associated with LADA include:

• Being tired or fatigued throughout the day
• Being tired right after meals
• Having headaches and cognitive problems
• Feeling hungry right after a meal
• Excessive thirst
• Frequent urination
• Impaired/blurred vision
• Numb or tingling nerves — this symptom is particularly important to take note of because it develops when your diabetes causes neuropathy (damage to nerves). If you notice tingling nerves consistently then make sure to check in with your doctor.

While some of these symptoms are going to be appear at the beginning, others will be develop as time goes on.

Diagnosis: How can you find out if you have LADA?

Generally, LADA is diagnosed just like other types of diabetes. The doctor will ask you questions about your symptoms, and then send you for some blood tests such as:

• The hemoglobin A1c test (which evaluates your blood sugar level over the last two to three months)
• The fasting blood glucose test (which evaluates your blood sugar level after you have been fasting for eight hours)
• The random blood glucose test.
• If your doctor suspects that you have LADA, then they can send you for a test that will look for antibodies against GAD. If you have LADA, then you will have GAD and this test will be able to show it. Another test that can be conducted for LADA is known as the C-peptide test, which is generally not a conclusive test, particularly at an early stage of development.

Misdiagnosis: Did you get the wrong label?

LADA is often misdiagnosed as type 2 diabetes due to the overlap of symptoms between the two diseases. However, it is important to correctly diagnose LADA as treatment methods can differ depending on the diagnosis. Without the right treatment, your blood glucose levels are not going to be well-controlled and that leads to complications and further reduces your ability to make insulin.

So how do you distinguish between the two diseases? There are some clues:

• If you don’t have features associated with metabolic syndrome including obesity, high cholesterol levels and high blood pressure, then you likely have LADA instead of type 2 diabetes. However, if you have features of metabolic syndrome, you can still have LADA.
• If you keep using oral agents, but still have high blood glucose levels, then you may have LADA.
• If you have other autoimmune diseases, such as Graves’ disease, then you may have LADA.

Treatment: How is LADA managed?

Initially, as LADA develops gradually, many people are able to control their sugar levels by producing more insulin. Hence, they likely won’t need insulin replacement for a few months or even years, depending on how quickly they progress. However, there will definitely be a point in their future where they will need to take insulin.

While some people may want to postpone starting their insulin treatment, some studies show that early insulin treatment as benefits — it better preserves the ability of the pancreas to make insulin. The important thing is to monitor your blood glucose levels as closely as possible so you can figure out when the best time is to start insulin. Work closely with a doctor and try to test your blood sugar levels around mealtime.

Complications of LADA

There are both short-term and long-term complications associated with LADA. A short-term complications is ketoacidosis, which occurs once the pancreas can no longer produce sufficient insulin and you start to make ketones (which can be toxic).

Long-term complications include:

• Cardiovascular disease
• Stroke
• Eye issues
• Kidney disease
• Nerve damage
• Foot problems