Just when you thought you knew what type of diabetes you had, along comes something else.  There is a new diabetes in town that you’re going to start hearing more and more about.  It’s called LADA- Latent Autoimmune Diabetes in Adults.  Other terms for this type of diabetes that you might hear are ‘slow onset Type 1’, and ‘Type 1.5’ (type one-and-a-half) diabetes.

Background

Most people with diabetes fall into the categories of Type 1 diabetes (insulin-dependent) and Type 2 diabetes (the body still makes some insulin).  Typically, Type 1 diabetes occurs in people under the age of 30 and Type 2 diabetes develops after age 30.  People with Type 1 diabetes test positive for antibodies to GAD (glutamic acid decarboxylase).  GAD in simple terms, is an enzyme that normally helps our body get rid of wastes, like ammonia, that we don’t need.   The antibodies to GAD are thought to be responsible for destroying the insulin-producing cells of the pancreas, leading to Type 1 diabetes.  Researchers are now finding these antibodies present in some people with Type 2 diabetes who are not yet treated with insulin.  These are falling into the LADA category. 

Characteristics of LADA

Some common characteristics of LADA include:

• Non-obese Type 2 diabetes
• Occurs over age 25
• Glucose is initially controlled with a meal plan and with/without oral medications
• No family history of Type 2 diabetes
• Low C-peptide levels
• Abnormal GAD antibody levels
• Becomes dependent on insulin within 4 years of diagnosis of Type 2 diabetes instead of the typical 10 years.

It is estimated that as many as 20% of the population who are diagnosed with Type 2 diabetes actually have LADA.  Their diabetes responds to oral medications first, but they can quickly lose their ability to make insulin and end up on exogenous (outside) insulin. 

Since these people are not insulin-resistant, they do not respond to medications that improve insulin resistance, such as rosiglitazone maleate (Avandia) and pioglitazone HCl (Actos).  Medications that stimulate the pancreas may also only work short term (suflonylureas such as Amaryl (glimepiride), Diabeta and Micronase (glyburides), Glucotrol (glipizide).  Insulin may be required earlier rather than later.

How do I know if I have LADA?

1. Ask your doctor about a C-peptide test.  While GAD antibody tests may not be used by many physicians and health care providers, C-peptide can be used in its place to assess the possibility of LADA.  C-peptide is a test that indicates low insulin levels and decreased production of insulin.
2. Look at your lipid (blood fat) levels.  In true type 2 diabetes, the HDL is usually too low and the LDL is usually too high.  In LADA these can tend to be normal.
3. Is your blood sugar controlled by diet, exercise and oral medications alone?  Remember that normal fasting levels (first thing in the morning) are 80-120mg/dl.  Two hours post meal levels should be 80-140mg/dl.
4. Look at your body type.  Are you slim or heavy?  If you are slim with Type 2 diabetes, but still do not have control of your glucose levels, you may have LADA.

Your doctor may not have misdiagnosed your Type 2 diabetes, you just may fall between 1 and 2; diabetes Type 1.5!!

Need more information on LADA? Check out these articles:

http://www.diabetesnet.com/diabetes_types/diabetes_type_15.php

http://www.diabetesvoice.org/issues/2003-12/Latent_autoimmune_diabetes_in_adults_(LADA).cfm

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