In this article I want to provide a general breakdown of LADA/Type 1.5 diabetes, so that there is increased awareness around this often overlooked and poorly managed condition.
Introduction to Type 1.5 diabetes
Type 1.5 diabetes, also known as Latent Autoimmune Diabetes in Adults (LADA), is a unique and often misunderstood form of diabetes that combines characteristics of both type 1 and type 2.
Like type 1 diabetes, LADA is an autoimmune condition, but it typically develops in adulthood and progresses more slowly.
Because it shares some features with type 2 diabetes, LADA is frequently misdiagnosed as type 2 diabetes and can lead to a lot of frustration when an individual is not seeing the expected results from medications, lifestyle and body composition changes.
However, on numerous occasions I have picked up on this misdiagnosis with patients that clearly do not fit the typical type 2 diabetic! It seems to me that quite often a practitioner can be too focused on specific test results that they fail to see or hear the patient in front on them.
When someone does not fit your classic type 2 diabetes picture, for example, they are lean, eat well, exercise regularly and still have out of control HbA1c levels, you must start asking why. Not simply telling them to do more, eat less, take more meds!
What Is Type 1.5 Diabetes?
Type 1.5 diabetes occurs when the immune system mistakenly attacks the insulin-producing cells in the pancreas, much like type 1 diabetes. However, LADA typically appears later in life, often between the ages of 30 and 50, and progresses more gradually.
Initially, individuals with LADA still produce some insulin, allowing them to manage blood sugar levels without insulin therapy, which can make it seem like type 2 diabetes, especially if they fit other typical criteria, like having excessive body fat.
The autoimmune component of LADA differentiates it from type 2 diabetes. While type 2 is often related to lifestyle and insulin resistance, LADA involves an immune attack on insulin-producing cells, leading to a gradual loss of insulin production. This difference in cause and progression underscores the importance of early and accurate diagnosis to ensure effective treatment.
Causes and Risk Factors of Type 1.5 Diabetes
The exact causes of LADA are not entirely understood, but both genetic and environmental factors play a role, as is the case with any autoimmune condition, the triggering events can be challenging to establish with any sense of clarity.
Like type 1 diabetes, LADA is an autoimmune condition where the immune system attacks the pancreas, marked by the presence of GAD (glutamic acid decarboxylase) antibodies in the blood. People with a family history of autoimmune diseases or type 1 diabetes may be more susceptible.
Certain environmental factors, like viral infections, food reactivity, gastrointesitynal imbalances/infections, exposure to specific toxins, past acute trauma or ongoing stress, may also contribute to the onset of LADA.
Adults diagnosed with diabetes but who struggle with typical type 2 treatments may want to explore further testing, as LADA requires a very different management approach than type 2 diabetes.
Symptoms of Type 1.5 Diabetes
The symptoms of LADA often resemble those of both type 1 and type 2 diabetes, including increased thirst, frequent urination, fatigue, unintended weight loss, vision disturbaces, more frequent infections and slower healing.
Unlike type 1 diabetes, where symptoms appear suddenly, LADA develops gradually, often leading to a misdiagnosis as type 2 diabetes.
Over time, people with LADA lose the ability to produce insulin, and their symptoms become more severe. If you have diabetes symptoms and find that diet, lifestyle change, achieving a lean physique, or medications aren’t effectively managing your blood sugar, it may be worth considering LADA.
Diagnosis of Type 1.5 Diabetes
Diagnosing LADA can be challenging because of its gradual progression and its resemblance to type 2 diabetes. Since LADA usually appears in adults, healthcare providers often overlook the autoimmune aspect and treat it as type 2 diabetes.
Key Diagnostic Tests for Diagnosing Type 1.5 Diabetes include:
Antibody Tests
People with LADA often have GAD antibodies, which signal an immune attack on the pancreas. Testing for these antibodies can confirm the autoimmune nature of LADA. I may also run an Islet cell antibody test as well.
C-Peptide Test
This test measures how much insulin the pancreas is producing. Lower levels of C-peptide in people with LADA reflect the autoimmune damage, unlike type 2 diabetes, where insulin production might initially be higher. I run this as a fasting test, along with other cardiometabolic markers and potentially a body composition assessment to build a more complete picture of that individuals cardiometabolic health.
Glucose and Insulin Challenge Test
This test can provide further insights into insulin production capabilities. Individuals with LADA may show a lower insulin response, helping differentiate LADA from type 2 diabetes, where insulin resistance is the main factor.
Early diagnosis allows for a tailored treatment approach and may give a change of maintaining/restoring natural insulin function before all is lost and there is complete reliance on self management through insulin injections.
Treatment Options
Because LADA progresses differently than type 1 or type 2 diabetes, a personalised treatment plan is essential. Initially, lifestyle modifications and blood glucose monitoring might be sufficient, but insulin therapy usually becomes necessary as the body’s insulin production declines.
Insulin Therapy
As LADA progresses, individuals often require insulin therapy, especially if the autoimmune process continues to destroy the cells of the pancreas.
Early introduction of insulin can help preserve remaining pancreatic function. Insulin needs may start low but will likely increase over time if pancreatic function is lost.
Lifestyle Modifications and Blood Sugar Monitoring
Diet
Using diet to help manage blood sugar levels and lower the demands of insulin is beneficial. Equally, diet can be used to help manage autoimmune conditions, helping to slow or even stop their progression.
Exercise
Physical activity improves insulin sensitivity, aiding in blood sugar control and meaning you require less insulin to be secreted when depositing glucose into muscle cells in the body.
Stress Management and Sleep
Both stress and poor sleep can affect blood glucose and worsen autoimmunity, so incorporating stress-reducing practices and prioritising adequate rest are essential.
Oral Medications
Some people with LADA may respond to oral medications, such as metformin, in the early stages. However, as LADA progresses and the pancreas loses its ability to produce insulin, these medications often become less effective, and a shift to insulin therapy is required.
Regular Monitoring and Adjustments
Regular monitoring, including blood glucose checks and periodic lab tests like HbA1c and C-peptide, helps track how well treatments are working and when adjustments are needed.
Living with Type 1.5 Diabetes
Living with LADA involves adapting to the condition’s gradual progression. Self-management, including blood glucose monitoring and a balanced lifestyle, is key. These days, the continuous glucose monitors can be very useful for a condition like type 1.5 diabetes.
Building a support system with knowledgeable healthcare providers relating to LADA is important. The challenge is, I am not sure how many healthcare providers are aware of LADA and therefore it is often overlooked.
Conclusion
Type 1.5 diabetes, or LADA, is a unique and complex form of diabetes that requires a tailored approach to management.
From recognising the symptoms to obtaining an accurate diagnosis and finding the right treatment plan, individuals with LADA benefit from a proactive, informed approach.
By understanding LADA and working closely with healthcare providers, individuals can maintain stable blood glucose, prevent complications, and lead a full, healthy life.
To learn more about our approach and how we can help you manage your glucose or indeed your immune system, visit our Functional Medicine page.
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