- LADA is a slower-progressing form of type 1 diabetes that appears in adulthood, and can initially look like type 2 diabetes.
- Because LADA develops gradually and doesn’t always require insulin right away, it often falls outside the “classic” picture many doctors are trained to recognize.
- A significant number of people with type 1 diabetes are initially misdiagnosed with type 2 diabetes, resulting in months (or years) of ineffective treatments.
- Simple blood tests that check for GAD and C-peptide levels can help distinguish LADA from type 2 diabetes.
- Broader education is needed to dispel the myth that type 1 diabetes is only a childhood condition, because it can be diagnosed at any age.
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A super-fit 38-year-old Marine goes in for a physical and tells his doctor that he’s been hungrier and thirstier than normal, urinating often, and losing weight. His doctor takes a look at his prematurely graying hair and the high A1c on his chart and says, “Looks like you have type 2 diabetes. Try eating better, exercising, and maybe drop a few pounds.” He puts him on metformin and sends him on his way.
But what if there’s more to the story? What if it wasn’t type 2 diabetes, but a slower-moving form of type 1 that can be mistaken for type 2 primarily due to the age of the patient?
Interestingly, this is not how people with type 2 diabetes typically present when they are first diagnosed. They are usually asymptomatic, and diabetes is discovered from an abnormal glucose level on a routine lab test.
Unfortunately, we hear stories like this all the time. These misdiagnoses mean months (often years) of the wrong treatment, in addition to a whole lada frustration and confusion for the patient along the way. It’s time to get some things straight about LADA!
What Is Latent Autoimmune Diabetes in Adults (LADA)?
LADA stands for “Latent Autoimmune Diabetes in Adults”. In non-medical speak, all it means is type 1 diabetes that’s diagnosed in adulthood.
The term LADA was created because the condition presents a little differently than “classic” type 1 diabetes. Some people call it LADA diabetes or LADA type 1.5, but it’s not a different type – it’s part of the type 1 diabetes spectrum.
How Is LADA Different from Classic Type 1 Diabetes?
The primary differences between LADA and classic type 1 diabetes are related to the speed and timing of onset. Classic type 1 typically happens in childhood or adolescence and comes on fast, with symptoms that escalate quickly and require insulin right away. Many people get super sick and are diagnosed after being hospitalized for diabetic ketoacidosis (DKA), which is a serious and dangerous condition if left untreated.
LADA, on the other hand, shows up in adulthood and develops slowly. People with LADA can still produce some insulin for a while, and their symptoms may not be as extreme.
Key Characteristics of Classic Type 1:
- Most commonly occurs in children and adolescents, but can develop at any age
- Sudden onset with extreme thirst, frequent urination, and weight loss (people typically get really sick and go into DKA right before diagnosis)
- Insulin is needed immediately to manage glucose
- One or more T1D autoantibodies are present in the blood at diagnosis
Key Characteristics of LADA:
- Occurs in adults, often over the age of 30
- Onset is slow due to a gradual decline in beta cell function, so it takes longer for blood sugars to become elevated
- DKA is uncommon at first
- Insulin is not always needed at the time of diagnosis
- One or more T1D autoantibodies are present in the blood at diagnosis
Anyone at any age can be diagnosed with new onset “crash and burn” classic type 1 diabetes – not all new adult cases are LADA.
Why LADA Gets Misdiagnosed…a LOT!
There are three main reasons why LADA is the most frequently missed diagnosis in diabetes:
First, there’s a long-held belief that type 1 diabetes is a childhood disease. For decades, T1D was labeled “juvenile diabetes”, but the reality is that more adults are diagnosed with type 1 diabetes than children every year.
Second, LADA doesn’t follow the typical patterns doctors are trained to expect for type 1 diabetes. It shows up in adulthood, it progresses slowly, and it doesn’t always require insulin right away.
Third, most adults typically see primary care providers who may be less familiar with LADA, so they assume someone has type 2 diabetes simply due to age and the slow onset of the condition. And you know what they say about making assumptions! 😉
Type 2 diabetes is associated with a distinct set of features that are not commonly seen in LADA, including:
- A genetic predisposition and/or family history of type 2 diabetes
- Excess weight, especially around the midsection
- Signs of metabolic syndrome, such as high triglycerides, low HDL, high LDL, and high blood pressure
- The ability to IMPROVE blood sugar management through lifestyle modifications like diet and exercise
So, How Is LADA Diagnosed?
If type 1 diabetes is suspected (and it might have to be you pushing for this!), your HCP can order blood tests that look for the following type 1 diabetes autoantibodies:
- Insulin autoantibody (IAA)
- Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD)
- Insulinoma-associated antigen 2 autoantibody (IA-2A)
- Zinc transporter 8 autoantibody (ZnT8Ab)
If you can only get one test, the most important one to get is the GAD, which signals that your immune system is attacking the insulin-producing beta cells in the pancreas.
Another indicator is the C-peptide test, which measures how much insulin your body is still making. People with LADA typically still produce some insulin at diagnosis, but levels drop off over time.
It’s possible for someone with type 1 diabetes to test negative for autoantibodies. Obviously this makes their LADA diagnosis more complicated, but it does happen in about 15% of cases.
Who Is Most at Risk for Developing LADA?
People with other autoimmune conditions such as celiac disease, or thyroid disorders like hyperthyroidism (Graves’ disease) and hypothyroidism (Hashimoto’s thyroiditis), are also at increased risk.
Screening for type 1 diabetes is fairly straightforward – a blood test at your doctor’s office can detect the markers that indicate whether type 1 diabetes is developing.
The Silver Lining of LADA…There Really Is One!
Since beta cell function declines gradually with LADA, many people have a “honeymoon phase” when their body is still producing some insulin.
This extra runway of time can help in several ways:
- It gives you some breathing room to learn about diabetes without needing full insulin therapy right away
- Even small amounts of your own insulin can help decrease glucose variability (the ups and downs of blood sugar levels)
- It allows you to be a little less precise with insulin dosing and counting carbs
- It can make the transition to insulin feel less abrupt and overwhelming
- It provides an opportunity to explore the latest technologies and treatment options
- It provides an opportunity to explore clinical trials that are being done
Being diagnosed as an adult can translate to fewer years with elevated blood sugar levels and fewer years with glycemic variability, potentially reducing the risk of acute and chronic complications.
Latent Autoimmune Diabetes in Adults (LADA): Frequently Asked Questions
🧐 If you’ve recently been diagnosed with latent autoimmune diabetes in adults (LADA), can you preserve the beta cells you still have?
Tzield is a medication that’s approved for people in stage 2 of type 1 diabetes, and it has been shown to preserve beta cells and delay the onset of clinical T1D by several years.
Most of the time, when someone is diagnosed with LADA, they’re not eligible for Tzield because they are in stage 3 type 1 diabetes and past the eligibility requirements for this medication (as it stands now). They also would not be eligible for Tzield if they’ve ever been treated with insulin.
Ongoing research is exploring whether treatments like Tzield can help preserve beta cell function in people who have already been newly diagnosed (stage 3) with type 1 diabetes.
👵 What is LADA diabetes life expectancy?
You can tell your kids that they’ll have to wait a while to cash in on your life insurance policy. With a timely diagnosis, the right treatments, and access to technologies like CGMs and insulin pumps, people with LADA can live long, healthy lives.
🩺 What will it take to start diagnosing LADA correctly?
This is a big ship to turn around, but here’s what could help:
- Ditch the mindset that type 1 diabetes = kids: Shifting this way of thinking through medical education, clinical guidelines, and awareness is step one.
- Give primary care providers better tools and training: PCPs diagnose the majority of diabetes cases, so they need better training on adult-onset type 1 and knowledge of the proper tests to run.
- Increase public awareness: The more people know that type 1 diabetes can happen at any age, the more likely people will be to advocate for themselves and ask about testing.
Latent Autoimmune Diabetes in Adults (LADA): Key Takeaways
The bottom line is that anyone can be diagnosed with type 1 diabetes at any time and at any age. People have even been diagnosed well into their 90s!
We need to move past the outdated idea that type 1 diabetes is a childhood condition. Recognizing that sooner will make a huge difference in getting people the right diagnosis and the right treatments at the right time.
If you have been diagnosed with type 2 diabetes but wonder if you may actually have LADA, talk to your healthcare provider about getting tested. Advocate for yourself (show your doctor this article!) so you can get the answers you need.
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