Thirty-three-year-old Bengaluru-based IT professional, Sohail Verma (name changed) was under treatment for type 2 diabetes and was responding well to the treatment for over a year and a half.
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As per doctor’s advice, he had reduced the number of pills after his HbA1c levels came down to 6.5 per cent. But five months ago, he developed the symptoms of diabetes again — immense weight loss, increased thirst and frequency of urination. Upon investigation, it was found that his sugar on fasting was more than 200 mg/dL, and after food, it had shot up to over 400 mg/dL. His HbA1c level was 11.5 per cent. Even after taking three pills, his sugar levels remained above 350 mg/dL.
That was when an autoantibodies test was conducted and he was diagnosed with latent autoimmune diabetes in adults (LADA) or type 1.5 diabetes.
What is LADA?
According to Diabetes UK, the British diabetic association, LADA is a type of diabetes that seems to straddle type 1 and type 2 diabetes. And that is why it is often referred to as type 1.5 diabetes. In latent autoimmune diabetes, the decline of the beta cell function of the pancreas which secretes insulin is a bit slow compared to type 1 diabetes.
It is caused by autoimmune antibodies like anti-glutamic acid decarboxylase (GAD) that are present in the body. Dr Mahesh DM, consultant endocrinology, Aster CMI Hospital, Bengaluru, says, “The presence of this antibody affects the pancreatic beta cells that make insulin and so, the body’s ability to make insulin is lost. LADA can initially present itself as type 2 as people usually respond to medicines for a year or two.”
Dr Anjali Bhatt, a diabetologist and endocrinologist, and founder and chief consultant of Endoclinic, Pune, explains, “Earlier, diabetes was classified as type 1 and type 2 diabetes but with increasing awareness, we realised that many develop diabetes similar to type 1, but they are diagnosed later in their life – [when they are] around 30 years. And that is not very typical of type 1. That is why this concept of type 1.5 diabetes or LADA came in.”
LADA diabetes diagnosis
Dr Mahesh says, in latent autoimmune diabetes, usually patients will not be obese. “That is one of the reasons why we suspect LADA,” he adds. There is no specific reason as to why the antibodies react this way and cause LADA. Dr Anjali says, “The reason is unknown but there are many theories like genes or some antibodies getting triggered after some viral infections.”
As people living with LADA respond to medications for a few years since the onset of diabetes, Dr Anjali says, they are jokingly referred to as being in their ‘honeymoon period’.
If LADA is left untreated, one can develop diabetes ketoacidosis (DKA), a condition in which fat gets converted to ketones (a chemical that the liver produces), causing high acidity in the blood. This can cause breathlessness, abdominal pain and coma, says Dr Mahesh.
Rohan Arora, a designer and user experience researcher in Delhi, suffered from DKA due to a delayed diagnosis of LADA. He too was misdiagnosed as type 2 diabetic at the age of 19. But despite increasing the dosages of medications, his sugar levels were never normal. The doctor advised him to do a C-peptide test and it was found that the beta cells of his pancreas were slowly deteriorating.
“The doctor told me that I have LADA. He put me on Lantus (long-acting insulin) and some pills for a couple of years. Then I got DKA again. The C-peptide test showed that insulin production had become almost zero. After five years of LADA, my condition progressed to type 1 diabetes,” he says, adding that he was relieved as he could find the reason for his high sugar levels. But the challenge of living with LADA, he says, is that one is not aware of how slow the insulin production takes place in the body. “So, it was a challenge to figure out the dose of insulin I had to take during different phases of LADA,” he says. Rohan had another episode of DKA at the age of 25, but he’s now learned to manage it with the help of support groups like Blue Circle Diabetes and participating in marathons and walkathons.
LADA diabetes research
The study titled, ‘Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel’ published in 2020 in Diabetes, a journal by the American Diabetes Association, states that people with LADA account for two to 12 per cent of all patients with diabetes.
The study further states that people with LADA tend to have lesser major cardiovascular risk factors as they are leaner, with better lipid and BP profiles.
But Dr Mahesh says they will be at higher risk of other autoimmune disorders like hyperthyroidism and rheumatoid arthritis. Dr Anjali adds that LADA is more likely to affect the retina of the eye than any other organs, but they are also at equal risk of similar complications of type 1 and 2 diabetes. She says general autoimmune disorders are not a risk factor for LADA. “Not everyone who has autoantibody will develop LADA. We right now do not have a way to identify and prevent it,” she adds.
Living with LADA diabetes
Diet and lifestyle modifications are needed in all people with diabetes, says Dr Mahesh. “They should exercise regularly – walk for half hour every day and reduce the intake of carbs in their diet. The only thing is that they need to take insulin and frequently monitor their glucose levels, more frequently than people with other forms of diabetes as the risk of low blood sugar is slightly high in people with LADA,” he adds.
Takeaways
According to Diabetes UK, LADA is a type of diabetes that seems to straddle type 1 and type 2 diabetes. And that is why it is often referred to as type 1.5 diabetes. In latent autoimmune diabetes, the decline of the beta cell function of the pancreas which secretes insulin is a bit slow compared to type 1 diabetes. LADA can initially present itself as type 2 diabetes as people usually respond to medicines for a year or two. If LADA is left untreated, one can develop diabetes ketoacidosis (DKA), a condition in which fat gets converted to ketones (a chemical that the liver produces), causing high acidity in the blood. Diet and lifestyle modifications help manage the rare disease.
2 Responses
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