Latent autoimmune diabetes in adults affects 10 percent of all people with diabetes
Adam Clark had already been living with type 2 diabetes when he started losing control of his blood sugar, despite the oral medication he was taking. Feeling run down and lethargic, the Tustin resident went to his physician for a test, which revealed his body had stopped producing insulin entirely. Clark's diabetes was no longer type 2, but it wasn't officially type 1 either--he was in a different classification, called latent autoimmune diabetes in adults (LADA).
Clark hadn't heard of LADA--which some people also call type 1.5 diabetes--and odds are most people haven't, even though about 10 percent of all people with diabetes fall into this category.
"It's an interesting entity," says Priya Shah, MD, Clark's endocrinologist who is board certified in diabetes, endocrinology and metabolism, and is affiliated with St. Joseph Hospital, Orange. "LADA patients are usually diagnosed as type 2 diabetics. They may make some insulin, and they can manage it with oral medication and diet and exercise for about five to six years, sometimes less and sometimes as many as 12 years, before they stop producing insulin. But with normal type 2 diabetes, it can be controlled much longer, and with type 1 diabetes, the need for insulin is immediate. LADA is a bridge between the two.”
There’s not one specific trigger for LADA, but there are some telltale signs that a patient may have this form of diabetes. It usually presents later in life, often after age 35, patients tend to be thin, and generally tend to have antibodies to insulin producing cells within the pancreas. They may also suffer from low energy and unexplained infections. Perhaps the most important symptom is erratic blood sugar levels.
“Often I will have a patient reporting compliance with the treatment program for type 2 diabetes, but it doesn’t seem to be working,” Dr. Shah says. “Type 1 diabetes has significant blood sugar swings, but type 2 doesn’t have that variability. When I see significant swings I suspect the patient has a true need for insulin.”
While some LADA patients can continue using oral medications, insulin is the treatment of choice. And that shift to insulin dependence can have emotional repercussions, Dr. Shah says.
“I’ve encountered it personally in patients who are trying to understand the disease and the diagnosis, and I try to be encouraging,” she says. “With type 2 patients, I stress diet and exercise can reverse a lot of the disease, but LADA patients don’t have that same potential because it’s an autoimmune issue. Therein lies the challenge--patients don’t have as much power to control the disease with lifestyle changes, but with insulin their diet doesn’t have to be as strict because they have the insulin to combat it. Type 2 patients can’t indulge in carbs because their blood sugar would go up. So there are pluses and minuses on both ends of the spectrum. And some patients don’t want to be on insulin but others are encouraged because with the insulin, they are finding something that works well for them.”
Clark is part of the latter group. After his LADA diagnosis he started insulin injections and about three years later he switched to an insulin pump. “It’s been life changing for me,” says Clark, who turns 50 next month. “It gave me the freedom to do the things I want to do. I’m still very active; I will not let this hold me down.” That includes everything from enjoying a glass of wine in moderation to cycling to removing a large tree stump from his yard with a pickax and shovel.
Clark counsels others who are diagnosed with LADA to be a participant in their health care. “I am my own advocate--I will challenge and question,” says Clark, adding that his doctor-patient relationship with Dr. Shah is strong. “You have to learn about the diagnosis and understand it.”
Clark also points out that LADA doesn’t have to be a death sentence. “There’s a new normal that you find. It’s a change in lifestyle but it doesn’t have to change the quality of life. Honestly, where I am at right now compared to type 2, life is better now. I’ve got more control over my blood sugar; I’m no longer chasing it.”
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.