Latent autoimmune diabetes in adults affects 10 percent of all people with diabetes
Adam Clark had already been living with type 2 diabetes when he started
losing control of his blood sugar, despite the oral medication he was
taking. Feeling run down and lethargic, the Tustin resident went to his
physician for a test, which revealed his body had stopped producing insulin
entirely. Clark's diabetes was no longer type 2, but it wasn't
officially type 1 either--he was in a different classification, called
latent autoimmune diabetes in adults (LADA).
Clark hadn't heard of LADA--which some people also call type 1.5 diabetes--and
odds are most people haven't, even though about 10 percent of all
people with diabetes fall into this category.
"It's an interesting entity," says
Priya Shah, MD, Clark's endocrinologist who is board certified in diabetes, endocrinology
and metabolism, and is affiliated with
St. Joseph Hospital, Orange. "LADA patients are usually diagnosed as type 2 diabetics. They may
make some insulin, and they can manage it with oral medication and diet
and exercise for about five to six years, sometimes less and sometimes
as many as 12 years, before they stop producing insulin. But with normal
type 2 diabetes, it can be controlled much longer, and with type 1 diabetes,
the need for insulin is immediate. LADA is a bridge between the two.”
There’s not one specific trigger for LADA, but there are some telltale
signs that a patient may have this form of diabetes. It usually presents
later in life, often after age 35, patients tend to be thin, and generally
tend to have antibodies to insulin producing cells within the pancreas.
They may also suffer from low energy and unexplained infections. Perhaps
the most important symptom is erratic blood sugar levels.
“Often I will have a patient reporting compliance with the treatment
program for type 2 diabetes, but it doesn’t seem to be working,”
Dr. Shah says. “Type 1 diabetes has significant blood sugar swings,
but type 2 doesn’t have that variability. When I see significant
swings I suspect the patient has a true need for insulin.”
While some LADA patients can continue using oral medications, insulin is
the treatment of choice. And that shift to insulin dependence can have
emotional repercussions, Dr. Shah says.
“I’ve encountered it personally in patients who are trying
to understand the disease and the diagnosis, and I try to be encouraging,”
she says. “With type 2 patients, I stress diet and exercise can
reverse a lot of the disease, but LADA patients don’t have that same potential because it’s
an autoimmune issue. Therein lies the challenge--patients don’t
have as much power to control the disease with lifestyle changes, but
with insulin their diet doesn’t have to be as strict because they
have the insulin to combat it. Type 2 patients can’t indulge in
carbs because their blood sugar would go up. So there are pluses and minuses
on both ends of the spectrum. And some patients don’t want to be
on insulin but others are encouraged because with the insulin, they are
finding something that works well for them.”
Clark is part of the latter group. After his LADA diagnosis he started
insulin injections and about three years later he switched to an insulin
pump. “It’s been life changing for me,” says Clark,
who turns 50 next month. “It gave me the freedom to do the things
I want to do. I’m still very active; I will not let this hold me
down.” That includes everything from enjoying a glass of wine in
moderation to cycling to removing a large tree stump from his yard with
a pickax and shovel.
Clark counsels others who are diagnosed with LADA to be a participant in
their health care. “I am my own advocate--I will challenge and question,”
says Clark, adding that his doctor-patient relationship with Dr. Shah
is strong. “You have to learn about the diagnosis and understand
Clark also points out that LADA doesn’t have to be a death sentence.
“There’s a new normal that you find. It’s a change in
lifestyle but it doesn’t have to change the quality of life. Honestly,
where I am at right now compared to type 2, life is better now. I’ve
got more control over my blood sugar; I’m no longer chasing it.”
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