Diabetes is a chronic disease characterized by elevated blood glucose levels. It is most commonly associated with two main types: type 1 diabetes and type 2 diabetes. However, there is also a lesser-known form of the disease, called Latent Autoimmune Diabetes in Adults(LADA).
LADA diabetes is sometimes called “type 1.5 diabetes,” because it combines features of both major types of diabetes. As in type 1 diabetes, in LADA there is an autoimmune destruction of the pancreatic beta cells that produce insulin. However, the process is slower and symptoms develop gradually, as in type 2 diabetes.
LADA diabetes mellitus: What are its characteristics?
LADA diabetes, as the name suggests, is an autoimmune disease. This means that the body’s immune system mistakenly identifies the beta cells of the pancreas as foreign and attacks them, leading to their gradual destruction. As a result of this process, the pancreas produces less and less insulin, which over time leads to the development of diabetes.
LADA’s main features:
- Late onset: LADA usually reveals itself after the age of 30, most often between 35 and 50.
- Slow development: LADA symptoms develop gradually, over months or even years.
- Presence of antibodies: Blood tests can detect the presence of antibodies characteristic of an autoimmune disease process, such as antibodies to glutamic acid decarboxylase (anti-GAD), antibodies to pancreatic beta cells (ICA) or antibodies to tyrosine phosphatase (IA-2).
- Initial good response to oral drugs: In the initial phase of the disease, oral glucose-lowering drugs can be effective, which can lead to a misdiagnosis of type 2 diabetes.
- Progressive loss of beta cell function: Over time, as beta cell destruction progresses, it becomes necessary to start insulin therapy.
- Slender or normal body build: Unlike type 2 diabetes, patients with LADA are often slim or normal weight.
LADA diabetes vs. type 1 and type 2 diabetes: Similarities and differences
Although LADA exhibits features of both type 1 and type 2 diabetes, there are key differences to distinguish it:
- Age of onset: Type 1 diabetes usually manifests itself in childhood or adolescence, while LADA is diagnosed in adults. Type 2 diabetes usually develops after the age of 40, but the age of onset of this type of diabetes decreases.
- Speed of disease progression: In type 1 diabetes, symptoms appear suddenly and abruptly, in LADA they develop slowly, and in type 2 diabetes they progress gradually.
- Presence of antibodies: Antibodies characteristic of an autoimmune disease process are present in LADA and type 1 diabetes, but not in type 2 diabetes.
- Body structure: Patients with type 1 diabetes tend to be slim, those with LADA are normal weight or thin, and those with type 2 diabetes often struggle with being overweight or obese.
- Initial response to treatment: In type 1 diabetes, insulin therapy is required from the outset; in LADA, oral medications may be effective initially; and in type 2 diabetes, treatment begins with diet, physical activity and oral medications.
LADA diagnosis: How to recognize this atypical form of diabetes?
The diagnosis of LADA can be difficult because the symptoms of the disease are nonspecific and can resemble both type 1 and type 2 diabetes. It is common for patients with LADA to be initially diagnosed as having type 2 diabetes.
Key elements of LADA diagnosis include:
- Medical history: Your doctor will ask about your symptoms, family history, lifestyle, and medications.
- Physical examination: The doctor will assess the patient’s general health, measure blood pressure, heart rate, height and weight.
- Laboratory tests:
- Determination of blood glucose levels: Elevated fasting or post-meal glucose levels indicate diabetes.
- Oral glucose load test (OGTT): Allows you to assess how your body is doing at metabolizing glucose.
- Determination of glycated hemoglobin level (HbA1c): Shows the average blood glucose level over the past 2-3 months.
- Determination of C-peptide levels: Assesses how much insulin the pancreas produces.
- Determination of the presence of antibodies: A key test in the diagnosis of LADA. Detection of anti-GAD, ICA or IA-2 antibodies confirms the autoimmune basis of the disease.
LADA treatment: how to control glucose levels?
The goal of treating LADA, as in other types of diabetes, is to maintain normal blood glucose levels to prevent complications of the disease.
Treatment options for LADA include:
- Diet: A healthy, balanced diet with restriction of simple carbohydrates and processed foods is the cornerstone of LADA treatment.
- Physical activity: Regular exercise helps lower blood glucose levels and improves insulin sensitivity.
- Oral medications: In the early stages of the disease, when the pancreas is still producing some insulin, oral medications such as metformin or sulfonylurea derivatives can be effective.
- Insulin therapy: As the destruction of pancreatic beta cells progresses, it becomes necessary to start insulin therapy. Insulin dosage is individually tailored to the patient’s needs. In LADA, insulin therapy is usually introduced earlier than in type 2 diabetes to protect the pancreatic beta cells from complete destruction.
- Self-monitoring of blood glucose: Regularly measuring blood glucose levels with a glucometer allows you to monitor the effectiveness of treatment and adjust medication doses.
Complications of LADA: Why is early diagnosis and treatment so important?
Untreated or poorly controlled LADA diabetes can lead to serious complications, such as:
- Diabetic retinopathy: Damage to the blood vessels of the retina, which can lead to vision loss.
- Diabetic nephropathy: Damage to the kidneys, which can lead to kidney failure.
- Diabetic neuropathy: Nerve damage, manifested by tingling, numbness, pain and muscle weakness.
- Cardiovascular disease: Increased risk of heart attack, stroke and atherosclerosis.
- Diabetic foot: A syndrome of foot complications including ulceration, infection and deformity.
Early recognition and appropriate treatment of LADA are key to preventing these complications and maintaining good health.
Living with LADA: How to cope with the disease on a daily basis?
A diagnosis of LADA can be a difficult experience, but with the right support and education you can learn to live with the disease and enjoy good health.
Important aspects of living with LADA:
- Education: Understanding the disease, its treatment and possible complications is key to self-management of LADA.
- Support: Support from family, friends, your doctor and others with diabetes can help you cope with the emotional and practical aspects of living with the disease.
- Self-monitoring: Measuring blood glucose levels regularly, taking care of diet and physical activity, and taking medications as prescribed by your doctor are essential for maintaining normal glucose levels.
- Regular follow-up visits: Regular visits to the doctor and check-ups allow you to monitor your health and detect possible complications early.
Summary
LADA diabetes is a specific form of diabetes that combines features of type 1 and type 2 diabetes. Early diagnosis and appropriate treatment are key to preventing complications and maintaining good health. If you have symptoms suggestive of diabetes or are in a risk group, consult your doctor for appropriate testing and a proper diagnosis. Remember, it is possible to live life to the fullest with LADA, provided you properly control the disease and take care of your health.
