LADA (latent autoimmune diabetes in adults) is different than a “traditional” type 1 diabetes diagnosis because the loss of pancreatic beta cells is slower, so many doctors incorrectly diagnose it initially as type 2. Dr. Edelman and Dr. Pettus explain the stages of LADA, what to look out for, what tests can confirm the diagnosis of type 1, and how to adjust to the natural progression of the disease.
Steve: Hello Nation, I’m here with my good friend and colleague, Jeremy Pettus. Today we’re going to talk about LADA. Not like a melody – la da la da la da – we’re talking latent autoimmune diabetes in adults. It’s basically when you get type 1 diabetes later in life. It presents much differently and I will say this, if there are any caregivers watching, it’s the most missed diagnosis in diabetes. I know many of you who have LADA, when you were diagnosed you were frustrated because when you were diagnosed they just said, “Oh you’re type 2” and it took years before you got the correct diagnosis.
Jeremy: You know, we do these TCOYD conferences around the world and this is one of the most common things that comes up. People say, “I got type 1 diabetes when I was 40, some people say I have LADA, what do I have?” It’s really just type 1 diabetes as an adult. We give it this fancy name of LADA because it is a little bit different. But some of the important differences are these. I got diabetes when I was 15, Steve got it when he was 15, it comes on like a ton of bricks, you get really sick, you go into DKA, and it’s pretty hard to miss that diagnosis. You’re a young kid and you get diabetes, and you see a pediatrician who’s very used to seeing this presentation, and he or she diagnoses you with type 1 diabetes and you’re on your way.
When you get it when you’re 30, 40, 50…it can kind of smolder along so your blood sugars get elevated but you’re not super sick, and then you go to see an adult physician (not a pediatrician who is used to seeing type 1) and they diagnose you as having type 2 diabetes and maybe start you on metformin or some medications that aren’t going to work because you don’t have type 2 diabetes, and it can take years for people to get the right diagnosis.
Steve: You know, it’s very frustrating for diabetes specialists like ourselves to see this all the time. Adult = type 2 and kid = type 1. These folks don’t look like an individual with type 2. Type 2s do have that propensity to have a lot of abdominal obesity. They have high triglycerides, low HDL, they have a family history of type 2 diabetes. You see people who get diagnosed with LADA and they’re skinny minnie, they don’t have any family history, their cholesterol levels are normal, no high blood pressure and the doctor says, “You better go on a diet” because that’s all they’re used to teaching and it’s very frustrating. As Jeremy said, the loss of the pancreatic beta cells is slower, so you don’t crash and burn like we did when we were 15.
Jeremy: So to make the diagnosis, you have to go in to see your doctor and they might check the GAD antibodies, and that’s a marker that you have some kind of autoimmunity. It can really help to tip the diagnosis that this is type 1 and not type 2. They can also check something called C-peptide which is a measure of how much insulin your body makes. If you have type 1 diabetes, that’s going to be really low.
Another important point I want to make is that sometimes with type 2 diabetes, it’s very common that over time people will go on insulin and they’ll say they “converted” to type 1 diabetes, but that’s not true. It’s just that you’ve had type 2 diabetes for awhile, and you now require insulin. But it’s not that you “got” type 1 diabetes.
Steve: What should people with LADA expect? What’s the progression and how will their therapy typically change over time? In the beginning, sometimes they may just need one shot of basal insulin, and sometimes they stay on oral agents for awhile.
Jeremy: I think the good news is that it does smolder, and you have more time to work your way into it. The bad news is that that can also kind of mess with you. Over time your blood sugars start creeping up and you start thinking, what am I doing wrong, now I have to add mealtime insulin, but that’s just the progression of the disease. It’s very different than when you and I got it and we just had to be on insulin and we knew the gig from the get-go. You LADAs have this advantage that you’re still making insulin, so you might just get away with a basal shot, but eventually those beta cells get killed and eventually you will have to go on a full type 1 therapy. And it does get more difficult over time to control your blood sugars.
Steve: I think that’s important for expectations. You know, it’s really nice to have LADA because you’ve got a couple of years to get used to living with type 1 before you have to go on a pump or a multiple daily injection regimen. What kind of prognosis do these folks have?
Jeremy: Well, it all depends. If you’re a LADA and you don’t take care of yourself and your A1c goes to 15, of course you’re going to have complications. But I tend to think that LADAs tend to do better in general because you got it when you were 35 instead of 5, so that’s 30 extra years where you had normal blood sugar control, so you kind of have that runway. And when you’re diagnosed, you still make insulin and you still have better blood sugars, so people in my experience seem to be less prone to complications.
Steve: In closing, is there any research going on to take people who have pretty good beta cell function and their blood sugars are not too bad at all (though they’re creeping up slowly) to prevent them from progressing?
Jeremy: So for people who are at risk for developing type 1 diabetes, there’s this program called TrialNet that people can enroll in to screen relatives. If you have type 1 diabetes and you want to know if your brother or sister or kids are at risk for developing it, you can reach out to them. But for people who are newly diagnosed, let’s say you’re 30 years old and you just got type 1 diabetes, what can you do to preserve the bets cells you have left? There are a lot of different clinical trials going on, mostly immunotherapies, medications to try to stop it. We don’t have anything to date that’s been proven to be effective, but there are some things in the pipeline that look promising.
Steve: Keep an eye on TrialNet, and JDRF has a good research site as well. Thanks so much for coming on the show Jeremy.
Jeremy: No problem, I enjoyed it.