Recently, Lance Bass, an NSYNC vocal group personal and surprising revelation. Lance was misdiagnosed with type 2 diabetes, only to later discover that he has type 1.5 diabetes. This type of diabetes is also known as Latent Autoimmune Diabetes in Adults (LADA). This disclosure has brought attention to a relatively lesser-known form of diabetes that blurs the lines between type 1 and type 2. This article will delve deeply into what type 1.5 diabetes is, its pathophysiology, symptoms, diagnosis, and management. We will also analyse how it stands apart from other forms of diabetes.
What is Type 1.5 Diabetes (LADA)?
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Type 1.5 diabetes, or LADA, is a form of diabetes that occurs in adults over the age of 30. The term “1.5” reflects its mixed nature as the condition has characteristics in both type 1 and type 2 diabetes. Medically, LADA is often described as a slowly progressing form of type 1 diabetes. However, it initially resembles type 2 diabetes due to its gradual onset and adult presentation.
LADA is an autoimmune condition. This is the opposite of type 2 diabetes, which primarily occurs as a result of insulin resistance and is associated with lifestyle factors like obesity. In LADA, the body’s immune system mistakenly attacks the insulin-producing beta cells in the pancreas.
This leads to a gradual decline in insulin production. This process occurs more slowly than in classic type 1 diabetes and therefore individuals with LADA may go years without requiring insulin therapy. This is what causes frequent misdiagnosis among people suffering from LADA.
Pathophysiology of Type 1.5 Diabetes
Understanding LADA’s pathophysiology requires exploring both autoimmune mechanisms and the role of insulin in glucose metabolism. LADA develops through the following mechanisms:
1. Autoimmune Attack on Beta Cells
Just like Type 1 diabetes, the hallmark of LADA is an autoimmune attack on the insulin-producing beta cells in the pancreas. It begins with the immune system mistakenly identifying beta cells as foreign invaders. Beta cells produce insulin, a hormone that is responsible for controlling blood glucose (a type of sugar).
The attack of beta cells is carried out by three specific antibodies including glutamic acid decarboxylase antibodies (GADAs), islet cell antibodies (ICAs), and insulinoma-associated antigen-2 antibodies (IA-2As). Unlike type 1 diabetes, where this autoimmune destruction occurs rapidly and typically manifests in childhood or adolescence, LADA progresses more slowly.
This slower progression is thought to be due to a different immune response or the presence of less aggressive autoantibodies. As a result, individuals with LADA may retain some beta-cell function for a longer period, allowing them to initially manage their blood glucose levels without insulin.
2. Gradual Decline in Insulin Production
The autoimmune destruction of beta cells in LADA leads to a progressive decline in insulin production. Insulin is a hormone crucial for regulating blood glucose levels by facilitating the uptake of glucose into cells for energy production.
As beta cells are destroyed, insulin levels decrease. This makes the glucose accumulate in the blood, leading to hyperglycemia (elevated blood sugar levels). Initially, in people with LADA, not all beta cells are damaged. Some of the body’s remaining beta cells may compensate for the loss by producing more insulin.
However, as the autoimmune activity continues, the number of functional beta cells reduces. This means that insulin production becomes insufficient to regulate blood glucose effectively. This stage is when symptoms of diabetes become more pronounced, pushing individuals to require insulin therapy.
3. Insulin Resistance vs. Autoimmunity
One of the main challenges in diagnosing LADA is distinguishing it from type 2 diabetes, which is primarily characterized by insulin resistance. In type 2 diabetes, the body’s cells become less responsive to insulin, leading to elevated blood glucose levels. While insulin resistance can occur in LADA, it is not the primary cause of the disease.
The key difference between LADA and type 2 diabetes lies in the underlying cause of hyperglycemia. In LADA, hyperglycemia occurs mainly due to the autoimmune destruction of beta cells. On the other hand, in type 2 diabetes, hyperglycemia occurs primarily as a result of insulin resistance. Unless medical professionals are key in understanding this distinction, chances of misdiagnosis and wrong treatment approaches remain high.
Symptoms of Type 1.5 Diabetes
The symptoms of LADA are similar to those of other forms of diabetes, but they tend to develop more slowly and may be milder in the early stages. Understanding these symptoms can help in identifying LADA and distinguishing it from type 2 diabetes. They include:
1. Increased Urination (Polyuria)
One of the most common symptoms of diabetes, including LADA, is increased urination, also known as polyuria. This occurs because the kidneys filter excess glucose from the blood, leading to an increase in urine production. Individuals with LADA may notice that they need to urinate more frequently, especially at night (nocturia).
2. Excessive Thirst (Polydipsia)
As a result of increased urination, individuals with LADA may experience excessive thirst, known as polydipsia. The body loses more water through urination, leading to dehydration and a constant need to drink fluids. This symptom is often one of the first signs of diabetes.
3. Unexplained Weight Loss
Unexplained weight loss is another hallmark symptom of LADA and other forms of diabetes. When there is no sufficient insulin production, the body is unable to use glucose for energy. As a result, the body begins to break down fat and muscle tissue for fuel, leading to weight loss. This weight loss occurs despite an increase in appetite.
4. Fatigue and Weakness
Fatigue and weakness are common symptoms in individuals with LADA. Without adequate insulin, the body’s cells cannot effectively absorb glucose, leading to a lack of energy. This can result in persistent tiredness and a general feeling of weakness, even with sufficient rest.
5. Blurred Vision
High blood glucose levels cause changes in the lens of the eye, leading to blurred vision. This symptom is often temporary and can improve once blood glucose levels are brought under control. However, prolonged hyperglycemia can lead to more serious eye problems, such as diabetic retinopathy.
6. Tingling in the Feet (Neuropathy)
Diabetic neuropathy, or nerve damage, can occur in individuals with LADA. This happens particularly if blood glucose levels remain elevated for an extended period. Diabetic neuropathy manifests as tingling, numbness, or a burning sensation in the feet and hands. Neuropathy can become severe if left untreated and may lead to more serious complications, such as foot ulcers.
7. Slow Onset of Symptoms
One of the distinguishing features of LADA is the slow onset of symptoms. Unlike type 1 diabetes, which can develop rapidly over weeks or months, LADA symptoms may progress over several years. This gradual onset can make it difficult to recognise the condition early, leading to misdiagnosis as type 2 diabetes.
Diagnosing Type 1.5 Diabetes
Diagnosing LADA correctly is crucial for effective treatment. However, due to its similarities with type 2 diabetes, LADA is often misdiagnosed. Understanding the diagnostic process can help healthcare providers and patients identify LADA accurately. It is diagnosed through:
1. Clinical Clues for LADA
Several clinical clues may indicate a person has LADA rather than type 2 diabetes:
Lack of Obesity or Insulin Resistance. Individuals with LADA are often not overweight or obese, which is a common characteristic of type 2 diabetes. Additionally, they may not exhibit signs of insulin resistance, such as acanthosis nigricans (dark, velvety patches of skin).
Family History of Autoimmune Diseases. A family history of autoimmune conditions, such as type 1 diabetes, celiac disease, or thyroid disorders, can increase the likelihood of LADA. This suggests a genetic predisposition to autoimmune diseases.
Poor Response to Type 2 Diabetes Medications. Individuals with LADA may not respond well to oral medications typically used to treat type 2 diabetes, such as metformin. This is because these medications target insulin resistance rather than the underlying autoimmune process in LADA.
2. Laboratory Tests for LADA
To confirm a diagnosis of LADA, healthcare providers may perform several laboratory tests:
Pancreatic Auto-Antibodies. The presence of pancreatic auto-antibodies, such as GADAs, ICAs, and IA-2As, is a key indicator of LADA. These antibodies are markers of an autoimmune attack on beta cells and can help differentiate LADA from type 2 diabetes.
C-Peptide Levels. C-peptide is a byproduct of insulin production and serves as a surrogate marker for insulin levels. Low C-peptide levels indicate reduced insulin production, which is consistent with LADA. In contrast, individuals with type 2 diabetes typically have normal or elevated C-peptide levels due to insulin resistance.
Glucose Tolerance Test. This test measures how the body responds to a glucose load. In LADA, the test may reveal impaired glucose tolerance or elevated blood glucose levels, even in the absence of significant insulin resistance.
3. Challenges in Diagnosing LADA
Diagnosing LADA can be challenging due to its overlap with type 2 diabetes and the slow progression of symptoms. As a result, many individuals with LADA are initially treated with oral medications for type 2 diabetes, which ends up being ineffective. Delayed diagnosis also leads to poor blood glucose control and an increased risk of complications.
To improve diagnostic accuracy, healthcare providers should consider LADA in adults with diabetes who do not fit the typical profile of type 2 diabetes. Any person who is not overweight and has a family history of autoimmune diseases should be screened for LADA as opposed to treating type 2 diabetes.
Early testing for pancreatic auto-antibodies and C-peptide levels can help identify LADA and ensure it is diagnosed early and proper management established. Here are more uncommon types of diabetes: https://www.webmd.com/diabetes/mody-lada-diabetes-symptoms-treatment
Managing Type 1.5 Diabetes (LADA)
Managing LADA requires a comprehensive approach that includes lifestyle modifications, regular monitoring, and, eventually, insulin therapy. The goal is to maintain blood glucose levels within a target range to prevent complications and preserve beta-cell function for as long as possible. Check the management options below:
1. Lifestyle Modifications
Diet: A balanced diet is essential for managing LADA. Focus on whole grains, lean proteins, healthy fats, and plenty of vegetables. Limiting refined sugars and carbohydrates can help control blood glucose levels.
Exercise. Regular physical activity improves insulin sensitivity and helps manage blood glucose levels. Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, cycling, or swimming.
Weight Management. Maintaining a healthy weight is important, especially in the early stages of LADA, when insulin resistance may be present. Even a modest weight loss can improve blood glucose control.
Stress Management. Stress can affect blood glucose levels, so incorporating stress-reducing activities like meditation, yoga, or deep breathing exercises is beneficial.
2. Blood Glucose Monitoring
Monitoring of blood glucose regularly is critical for managing LADA. Monitoring allows individuals to track their blood glucose levels, identify patterns, and make necessary adjustments to their treatment plans. This may include checking blood glucose levels before and after meals, as well as before and after exercise.
3. Oral Medications
In the early stages of LADA, oral medications commonly used in type 2 diabetes may be prescribed to help control blood glucose levels. These may include:
- Metformin. This drug helps improve insulin sensitivity and reduces glucose production in the liver.
- Sulfonylureas. This group of drugs works to stimulate the pancreas to produce more insulin.
- DPP-4 Inhibitors. These medications help to increase insulin production and decrease glucose production by inhibiting the enzyme DPP-4.
However, these medications may become less effective as beta-cell function declines, necessitating a transition to insulin therapy.
4. Insulin Therapy
As beta-cell function declines and the LADA condition progresses, insulin therapy becomes necessary. Insulin therapy helps regulate blood glucose levels and also prevents complications. There are different types of insulin available, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin.
- Basal Insulin. This is a long-acting insulin that provides a steady level of insulin throughout the day and night.
- Bolus Insulin. Rapid-acting or short-acting insulin is taken before meals to manage blood glucose spikes after eating.
Insulin therapy may require multiple daily injections or the use of an insulin pump, depending on individual needs.
5. Early Insulin Therapy
Research suggests that initiating insulin therapy early in individuals with LADA may help preserve remaining beta-cell function. By reducing the workload on the pancreas, early insulin therapy can help in slowing the progression of beta-cell destruction. When this happens, it improves long-term health outcomes.
6. Regular Monitoring and Follow-Up
Regular follow-up appointments with a healthcare provider are essential for managing LADA. These visits allow for adjustments to the treatment plan, monitoring of blood glucose control, and screening for complications. Monitoring may include.
HbA1c. This is a blood test that provides an average of blood glucose levels over the past 2-3 months. The target HbA1c level is typically below 7% for most individuals with diabetes.
Blood Pressure and Cholesterol. Monitoring and managing blood pressure and cholesterol levels are crucial in reducing the risk of cardiovascular complications.
Screening for Complications. Regular screening may help in ruling out of diabetic complications such as retinopathy, neuropathy, and nephropathy. This is also essential for managing the disease effectively. Prevent LADA in the following ways: https://www.healthline.com/health/type-1-5-diabetes
Commonly Asked Questions (FAQs).
1. What is Latent Autoimmune Diabetes in Adults (LADA)?
LADA is a form of autoimmune diabetes that occurs in adults and shares characteristics with both Type 1 and Type 2 diabetes. Unlike Type 1 diabetes, which typically presents in childhood, LADA develops more slowly and is often initially mistaken for Type 2 diabetes.
2. What are the symptoms of LADA?
Symptoms of LADA include frequent urination, excessive thirst, unexplained weight loss, fatigue, and blurred vision. These symptoms are similar to those of Type 1 and Type 2 diabetes but tend to progress more gradually in LADA.
3. How is LADA diagnosed?
LADA is diagnosed through a combination of blood tests, including the presence of autoantibodies (such as GAD antibodies) and tests for insulin production. Misdiagnosis as Type 2 diabetes is common, making specialized tests essential.
5. Does LADA have a cure?
Currently, there is no cure for LADA. The condition is managed through lifestyle changes, oral medications, and eventually insulin therapy. Ongoing research is exploring potential treatments, but managing blood sugar levels is key to living well with LADA.
Palene Health 