Latent Autoimmune Diabetes in Adults (LADA) could be the reason a person diagnosed with Type 2 diabetes does not respond as expected to lifestyle changes or treatment. Most of us are familiar with two types of diabetes: Type 1 and Type 2. But there’s another option that is lesser known and sometimes overlooked.
LADA shares features of both Type 1 and Type two diabetes mellitus. It is a specific form of autoimmune diabetes that is characterized by slower evolution towards β-cells failure and insulin dependence. The fact that a newly diagnosed adult may not require insulin can make it appear that a patient has Type 2 diabetes, especially if no screening is done for islet-cell autoantibodies.
The other day, I ran into someone I haven’t seen in years. When I asked how things were going, he mentioned that he is a recovered Type 2 diabetic. If that same person were suffering from LADA, the lifestyle changes he made that allowed him to no longer be insulin dependent would not have the same effect. Once he reached a point at which he needed insulin, it would most likely not be reversible.
It’s easy to read this and think, okay so no big deal. Your doctor will treat you based on blood glucose levels and it doesn’t really matter whether you’re misdiagnosed or not. To some degree that may be true in the early stages of LADA.
But even if a patient is medically stable for a time, the respect with which they are initially treated may wane as the disease progresses in spite of their best efforts and eventually may be lacking entirely. A patient who is not respected is rarely heard or believed meaning that the level of care they receive could decrease.
I’ve been down that road more than once when I had difficult to diagnose conditions. At some point, multiple medical professionals decided that if they couldn’t find the problem, I must be the problem. That’s human nature I suppose, but it didn’t benefit me medically or psychologically. It turned difficult physical circumstances into traumatic events and presented me with an exhausting job of research while trying to survive and function.
Since most diabetics in the US diagnosed as an adult receive a Type 2 diagnosis, identification of those with LADA is dependent on further testing. Past initial diagnosis, an overweight adult African American female may have difficulty obtaining screening for LADA. The same is true of overweight white females in many southern states.
Without further testing, a physician may come to believe a patient who continues to struggle with blood sugar fluctuations is not adhering to a recommended plan. This can lead to misunderstandings and frustration. It can also mean that patients with LADA do not receive treatment to preserve insulin-secreting capacity.
Due to the heterogeneous nature of LADA characteristics, there is no across the board treatment consensus at this time, but there is a push for large randomized controlled studies to gather data that can inform treatment plans.
There is also ongoing research looking at the effects of continuous glucose monitoring in patients with elevated A1C. Perhaps the data being gathered will reveal a way to design future studies to identify potential LADA patients using CGMs.
In the meantime, if you have been diagnosed as an adult with Type 2 diabetes, have not been screened for islet-cell autoantibodies, and have continued to struggle despite following doctor’s orders, it may be time to request further testing.
https://www.cooking2thrive.com/blog/i-dont-want-to-doctor-myself/
