LADA

What is LADA?

Latent Autoimmune Diabetes in Adulthood (LADA) is a form of type 1 diabetes that develops later in adulthood. As a form of type 1 diabetes, LADA is an autoimmune disease. This means that the body’s immune system attacks and kills insulin producing cells.

LADA is diagnosed amongst people aged between 30 and 50 years with antibodies to GAD (glutamic acid decarboxylase). Sometimes, LADA is referred to as type 1.5 diabetes. Though this isn’t an official term, it does illustrate that it’s a form of type 1 diabetes that shares certain characteristics with type 2 diabetes.

Symptoms of LADA

It is important to know the first set of symptoms of LADA, because later diagnosis increases the risk of developing complications:

  • Constantly feeling tired or regularly feeling tired after meals.

  • Foggy headedness.

  • Experiencing hunger soon after meals.

As LADA develops, insulin production will gradually decrease, and this will lead to further, more advanced symptoms:

  • A hard to quench thirst.

  • Needing to frequently urinate.

  • Blurred vision.

  • Tingling nerves. This symptom could be a sign of neuropathy (nerve damage) which is a long-term complication of diabetes. If this appears regularly, consult a doctor.

Diagnosis

According to the UK Prospective Diabetes study, anti-bodies that are specific to LADA cases have been found in between 6% and 10% of diabetes cases. Amongst people that are diagnosed at an age younger than 35, LADA cases account for up to 25%.

Following an initial diagnosis of diabetes, if your doctor suspects LADA it will be determined by examining the presence of elevated levels of pancreatic autoantibodies amongst patients who have been recently diagnosed with diabetes, but don’t require insulin. After this, a GAD (Glutamic Acid Decarboxylase Autoantibodies) antibodies test can measure the presence of these antibodies, thus identifying LADA. Additionally, the rate of progression towards insulin dependency can be estimated and appropriate action can be taken from there.

A C-peptide test can also be performed however, it may not always draw conclusive results in people with LADA at an earlier stage of the condition’s development.

Misdiagnosis

LADA can appear rather similar to type 2 diabetes. The condition develops over a long period of years when compared to children and young adults who have type 1 diabetes that can develop in a matter of days. As a result, doctors often misdiagnose LADA as type 2 diabetes. Misdiagnosis could lead to inappropriate treatment methods that could lead to poor diabetes management. As a result, this could quicken the loss of insulin production.

There are warning signs that can give away the presence of LADA instead of type 2 diabetes. A lack of metabolic syndrome features like obesity, high blood pressure and cholesterol levels is a significant indicator. There is also incident of uncontrolled hyperglycemia despite a person taking any oral medications. There is also evidence of other autoimmune diseases including Graves’ disease and anemia.

Treatment

Because LADA develops slowly, someone with the condition may be able to produce enough of their own insulin to keep their blood glucose levels under control without requiring external insulin for a number of months or even years after the initial diagnosis. Nevertheless, insulin treatment will be essential and almost certainly needed at some point in the future. Additionally, medications like metformin and thiazolidinediones can also be used.

Regular, daily blood glucose testing is advised for people with LADA in the same way people with type 1 diabetes are advised to manage their condition. These tests would need to be completed before each meal and before sleep.

Like any form of diabetes, the focus of treatment is controlling hyperglycaemia and preventing the onset of any complications. It is essential to preserve the beta cell function amongst LADA patients for as long as possible. Anything that can restore beta cell function should always be considered.

Complications

The risk of long-term complications of diabetes will be similar to the risks faced by people with type 1 and type 2 diabetes:

  • Heart disease and stroke

  • Retinopathy (retinal disease)

  • Nephropathy (kidney disease)

  • Foot problems

  • Ketoacidosis becomes a long-term problem once insulin dependence develops.

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