What Is Latent Autoimmune Diabetes in Adults?
We have a very good understanding about the symptoms, diagnostic tools and standards of medical care for Type 1 diabetes, Type 2 diabetes and gestational diabetes.
Type 2 diabetes encompasses the majority of diabetes cases (90% to 95% of all diagnosed cases) while Type 1 diabetes affects 5% to 10% of the diabetes diagnoses, and a smaller proportion of the diabetes population are women who develop gestational diabetes during their pregnancy. But … what if you were diagnosed with Type 2 diabetes and working hard to manage the condition and things just weren’t lining up? You weren’t overweight, your blood pressure was low, your cholesterol was in range, but you also know that one of your parents had an autoimmune condition.
Could it be that you have been misdiagnosed with Type 2 diabetes? It can happen.
When Diabetes Is Misdiagnosed
Meet CJ Walker. She was diagnosed with Type 2 diabetes in 2019 but didn’t have the typical characteristics. She was underweight, her blood pressure was low, her cholesterol was in target range and there was no family history of diabetes. Her mother had, however, an autoimmune condition of her thyroid, which eventually became an important clue. (Other examples of autoimmune health conditions include rheumatoid arthritis, Type 1 diabetes, pernicious anemia and multiple sclerosis.)
To treat CJ’s diagnosis of Type 2 diabetes, she was prescribed Metformin, a diabetes medication had been the first line of treatment for Type 2 diabetes. She changed her lifestyle behaviors to include exercise and a very restricted low carb diet. The restrictive low carb diet had a very negative effect on her health as she became malnourished and underweight.
But she also was feeling leery about her Type 2 diabetes diagnosis, She hadn’t experienced any of the common symptoms associated with Type 2 diabetes except for blood sugar readings that were not improving even with her diligence in following an exercise routine, a low carb diet and taking her oral medications as prescribed. She turned to an online diabetes community and heard several stories that resonated with her health journey. Her Type 2 diabetes diagnosis just felt wrong.
Others were sharing similar stories about their Type 2 diabetes misdiagnosis, which eventually was diagnosed as LADA: latent autoimmune diabetes in adults. She did some additional research, noting that she had the majority of the characteristics for LADA. She asked her endocrinologist to order a test for LADA. The tests confirmed that she had LADA instead of Type 2 diabetes.
So, what was happening in CJ’s health story, and what is LADA?
What Is LADA?
Let’s start with some definitions of terms associated with diabetes. Autoantibodies play a big role in identifying a diagnosis of diabetes. Autoantibodies remind me of one of the first video games called Pac-Man. In the game, you would direct a circular animation figure with a big mouth through a maze to gobble up the little dots. In our bodies, antibodies are usually the good guys – we need their help in attacking potentially harmful foreign objects like viruses and bacteria.
Autoantibodies are bad guys. They attack our own cells by mistake causing an autoimmune disorder. Say hello to Type 1 diabetes. LADA is also an autoimmune disorder, in which autoantibodies attack healthy, insulin-producing pancreatic cells that eventually stop producing insulin. LADA is actually a form of diabetes that progresses more slowly. Sometimes LADA is called Type 1.5 diabetes.
People who are diagnosed with LADA typically are over 35 years of age and their antibody blood test will reveal positive autoantibodies to the cells that help with production of insulin. Initially, for the first six months after diagnosis, people with LADA will not require daily insulin injections but will require it as the condition progresses.
Symptoms of LADA
The symptoms of LADA are similar to the symptoms of Type 1 diabetes, but they worsen at slower pace. It could happen over months or even years. Symptoms include:
- Frequent urination.
- Excessive thirst.
- Unexplained weight loss.
- Extreme hunger.
- Blurry vision.
- Lack of energy.
Who’s at Risk for LADA?
The following are typical risk factors or signs of LADA:
- People who are diagnosed with LADA tend to be lean and have a lower body weight.
- They sometimes have unintended weight loss.
- They have a fasting blood sugar level of 270 mg/dl or higher. (The target blood sugar for people diagnosed with diabetes is 130 mg/dL or less at fasting.)
- A hemoglobin A1C that is 10% or higher even though they are following the doctor’s orders. (A target A1C is 7% or lower for people diagnosed with diabetes.)
- A personal or family history of autoimmune disease.
Steps to Diagnosing LADA
There are two blood tests that are generally used for diagnosing LADA: a test for C-peptide (a byproduct of natural insulin) and glutamic acid decarboxylase antibody (GADA). These blood tests are used to distinguish LADA from Type 2 or Type 1 diabetes. In someone with LADA, we will find islet autoantibodies that are common to Type 1 diabetes. People with Type 1 diabetes will have more than one diabetes-related autoantibody, whereas people with LADA will have only one autoantibody present.
For CJ, the GADA test confirmed that she had the antibody present in her system. Her levels were over 25,000 IU/mL; the normal range is 0.0-5.0 IU/mL.
Knowing Your Correct Diagnosis
Her doctors continue to monitor her, and I’m certain that CJ will speak up if her blood sugars go awry. CJ has turned her diagnosis into being an advocate for people with Type 2 diabetes and people diagnosed with LADA. No doubt there is a need to re-boot your lifestyle behaviors when you receive a diagnosis of Type 2 diabetes. And if you find out you have been living with the wrong diagnosis for several years, you’ll require a second re-boot to get on track with your diabetes management. Thankfully, CJ has been her own health advocate when she felt the Type 2 diagnosis wasn’t correct. She shares important words of encouragement for all of us.
You should see your health care professional if you’re not seeing results, your blood sugar numbers are climbing or you’re experiencing symptoms consistent with LADA. Early detection of concerns can prevent complications. Always seek a second opinion when in doubt.