LADA (LATENT AUTOIMMUNE DIABETES IN ADULTS)

Latent autoimmune diabetes in adults (LADA) is a disorder in which, despite the presence of islet antibodies at diagnosis of diabetes, the progression of autoimmune β-cell failure is slow. LADA patients are therefore not insulin requiring, at least during the first 6 months after diagnosis of diabetes. Among patients with phenotypic type 2 diabetes, LADA occurs in 10% of individuals older than 35 years and in 25% below that age. Prospective studies of β-cell function show that LADA patients with multiple islet antibodies develop β-cell failure within 5 years, whereas those with only GAD antibodies (GADAs) or only islet cell antibodies (ICAs) mostly develop β-cell failure after 5 years. Even though it may take up to 12 years until β-cell failure occurs in some patients, impairments in the β-cell response to intravenous glucose and glucagon can be detected at diagnosis of diabetes. Consequently, LADA is not a latent disease; therefore, autoimmune diabetes in adults with slowly progressive β-cell failure might be a more adequate concept. In agreement with proved impaired β-cell function at diagnosis of diabetes, insulin is the treatment of choice.

Diabetes Types Key characteristics of type 1, LADA (latent autoimmune diabetes in adults), and type 2.
	Type 1	LADA	Type 2
Typical age of onset	Youth or adult	Adult	Adult
Progression to insulin dependence	Rapid (days/weeks)	Latent (months/years)	Slow (years)
Presence of autoantibodies*	Yes	Yes	No
Insulin dependence	At diagnosis	Within 6 years	Over time, if at all
Insulin resistance	No	Some	Yes

 SURPRISE FINDING

 Doctors stumbled upon the LADA phenomenon quite by accident back in the 1970s. They were testing a way of identifying proteins called auto ­antibodies in the blood of people with type 1. The presence of these proteins is evidence of an attack by one’s own immune system. The new test was successful and confirmed for the first time that type 1 is an autoimmune disease in which the body’s immune system kills off the beta cells in the pancreas, the makers of insulin.
As part of their study, the researchers also looked for the same auto antibodies in the general population and in people with type 2 diabetes (which is not an autoimmune disease). The proteins were virtually absent in the general population, but they showed up, to the scientists’ surprise, in about 10 percent of people diagnosed with type 2. This suggested that there was a subcategory of people who could now be diagnosed as having LADA instead, even though there was no obvious difference in their symptoms from those of people with type 2.
While not everyone has settled on calling the condition LADA (some prefer “type 1.5”), or even whether it’s distinct from type 1, researchers are working on a set of criteria for its diagnosis: 1) the presence of auto­antibodies in the blood, 2) adult age at onset, and 3) no need for insulin treatment in the first six months after diagnosis. This definition would distinguish LADA from type 1—because people diagnosed with type 1 typically need to start insulin immediately—and from type 2, because of the presence of auto antibodies in the blood.

The Warning Signs YOU May Have LADA

1. You are diagnosed with Type 2 diabetes while at a normal weight.

2. Whatever your weight, either you or a member of your family has some other autoimmune disease such as thyroid disease, rheumatoid arthritis, lupus, or multiple sclerosis.

3. You lower your carbohydrate intake shortly after diagnosis to no more than 15 grams a meal and still have a fasting blood sugar over 110 mg/dl and blood sugars that rise 40 mg/dl or more after each meal.

4. No matter what your weight, you do not see a dramatic drop in your blood sugar when you take metformin, Avandia, Actos, Januvia or Byetta in combination with a lowered carbohydrate intake.

5. Your blood sugar deteriorates significantly over the period of a year despite treatment with oral drugs and carbohydrate restriction.

What To Do To Get A LADA Diagnosis

If you think you have LADA ask your doctor for:

1. A fasting C-peptide test. If the value is low, it is suggestive of LADA.

2. GAD and Islets antibody tests. High levels of these antibodies are diagnostic of LADA especially in combination with lowered C-peptide.

WHAT IS DIABETES

1) Type 1 diabetes is an autoimmune disease that occurs when the insulin-producing beta cells within the pancreas are destroyed and fail to produce insulin. Insulin is a hormone that helps the body's cells use glucose for energy. Blood glucose (or blood sugar) is manufactured from the food we eat (primarily carbohydrates) and by the liver. If glucose can't be absorbed by the cells, it builds up in the bloodstream instead. Untreated, the high blood sugars that result can be toxic to every system of the body, causing serious complications.

2) Type 2 diabetes is the most common form of the disease, accounting for 90 to 95% of all diabetes cases in America. Most people with type 2 diabetes are still able to produce insulin at diagnosis. However, the insulin they make does not work properly and is unable to perform its primary job, which is helping the body's cells use glucose for energy.  This characteristic of type 2 diabetes is called insulin resistance.

If left untreated, the high blood sugar levels from uncontrolled diabetes can cause serious long-term diabetic complications. Eventually, they damage the insulin-producing beta cells of the pancreas, reducing insulin output. 

Although the majority of people with type 2 diabetes are adults, children and adolescents are increasingly at risk for the disease due to growing childhood weight problems and sedentary lifestyles.

3) GESTATIONAL DIABETES-The hormonal changes that happen in pregnancy can cause gestational diabetes in pregnant women at risk for the condition.  Hormones produced by the placenta -- including estrogen, cortisol, and human placental lactogen (HPL) --  increase insulin resistance in some women, which results in high blood sugars.  This usually occurs between 20 and 24 weeks of pregnancy. Gestational diabetes goes away when the baby is born, but women who have had the condition are at a higher risk of developing type 2 diabetes later in life.

4) LADA- Short for Latent Autoimmune Diabetes in Adults, LADA is also known as Slow-Onset Type 1 Diabetes, Type 1.5 Diabetes, Late-Onset Autoimmune Diabetes of Adulthood, and even "double diabetes," since it has elements of both type 1 and type 2 diabetes. LADA patients, however, are closer to type 1 patients because, just as I did, they will test positive for antibodies against insulin-producing beta cells of the pancreas.

LEARN BELOW IN THIS VIDEO -WHAT IS DIABETES