During Season Eight of the Lighting Your Way podcast, I’ve been talking with actual patients about their individual journeys in the healthcare system. Their stories range from Les, the South Jersey patient who had a heart and kidney transplant to Linda, the Philadelphia Firefighter who has been living for more than three years with glioblastoma.
Last week, I spoke with Andrea Spector, one of my colleagues at Guardian Nurses. Andrea has been a nurse for more than 40 years so when she began experiencing blurry vision, she expected she needed a new eyeglass prescription.
What she didn’t expect was to be diagnosed with diabetes. More specifically, diabetes 1.5 or Latent Autoimmune Diabetes in Adults, LADA. As nurses, we know about Type 1 and Type 2 diabetes, but LADA? Not so much. Since November is Diabetes Awareness Month, we thought that introducing LADA was a good topic–for all of us!
After all, diabetes affects over 37 million Americans, with millions more at risk, making it one of the most pervasive and pressing health challenges in the U.S. today.
In this issue of The Flame, we’ll give a primer on LADA, but don’t worry, there is no quiz!
Happy Thanksgiving!
— Betty Long, RN, MHA, President/CEO, Guardian Nurses Health Advocates
Diabetes is a complex and multifaceted disease, historically categorized into Type 1 and Type 2. There is, however, a less commonly recognized form called Diabetes 1.5, also known as Latent Autoimmune Diabetes in Adults (LADA). Often misdiagnosed as Type 2 diabetes, LADA is a slow-progressing autoimmune condition that shares characteristics of both Type 1 and Type 2 diabetes.
What is Diabetes 1.5 (LADA)?
LADA is an autoimmune form of diabetes in which the body’s immune system mistakenly attacks insulin-producing beta cells in the pancreas. While this process mirrors Type 1 diabetes, the progression is much slower, and symptoms may not appear for months or even years. LADA typically develops in adults over 30, which differentiates it from the juvenile onset commonly associated with Type 1 diabetes.
How is it Different from Type 1 and Type 2 Diabetes?
Onset and Progression:
- Type 1 diabetes develops rapidly, often requiring immediate insulin therapy.
- Type 2 diabetes is primarily influenced by lifestyle factors and insulin resistance, progressing over time.
- LADA begins subtly, with patients often being initially misdiagnosed as having Type 2 diabetes because they can manage their condition without insulin for some time.
Treatment:
- While oral medications and lifestyle changes may work early on, patients with LADA eventually do require insulin as beta-cell destruction progresses.
Risk Factors and Symptoms
The exact cause of LADA is unclear, but certain factors may increase risk:
- Genetic predisposition: Variants in genes associated with autoimmunity.
- Age: Typically diagnosed in people over 30.
- Personal or family history: Other autoimmune diseases like rheumatoid arthritis, lupus or MS.
Symptoms of LADA can mimic those of both Type 1 and Type 2 diabetes:
- Increased thirst and urination.
- Fatigue and lethargy.
- Unexplained weight loss.
- High blood sugar levels.
Diagnosing LADA
Misdiagnosis is common with LADA, as many patients are initially treated as having Type 2 diabetes. However, certain tests can confirm its autoimmune nature:
- GAD Antibody Test: Detects antibodies targeting glutamic acid decarboxylase, a hallmark of autoimmune diabetes.
- C-Peptide Test: Measures the level of insulin production; low levels suggest beta-cell dysfunction.
- Additional Autoantibody Tests: These can identify other markers of autoimmune activity.
Why Early Diagnosis Matters
Proper diagnosis of LADA is critical for several reasons:
- Preventing beta-cell burnout: Early insulin therapy can help preserve remaining beta-cell function in the pancreas.
- Avoiding ineffective treatments: Oral medications for Type 2 diabetes may not address the underlying autoimmune process in LADA.
- Improved long-term outcomes: Tailored management reduces life-changing complications like neuropathy, kidney disease, and cardiovascular issues.
Treatment and Management
Treatment often evolves over time. Early stages may involve oral medications and lifestyle adjustments, but insulin therapy typically becomes necessary. A comprehensive approach includes:
- Insulin Therapy: Starting insulin earlier can preserve pancreatic function and improve glucose control.
- Diet and Exercise: Maintaining a balanced diet and regular physical activity supports overall health and reduces the risk of complications.
- Monitoring Blood Sugar: Frequent monitoring helps in managing fluctuations effectively.
- Patient Education: Understanding the nature of LADA empowers patients to take an active role in their care.
Living with LADA
Adjusting to a diagnosis of LADA can be challenging, but with proper management, individuals can lead full, active lives. (Just ask Andrea!) Support groups and counseling can help patients navigate the emotional aspects of living with a chronic condition. Advances in technology, such as continuous glucose monitors (CGMs) and insulin pumps, have also made diabetes management more convenient and effective.