LADA - Type 1.5 Diabetes
Latent autoimmune diabetes of adults
From Wikipedia, the free encyclopedia Diabetes type 1.5 redirects here. For the other kind of intermediate diabetes, see ketosis-prone diabetes. Latent autoimmune diabetes of adults (LADA), often also late-onset autoimmune diabetes of adulthood or aging, slow onset type 1 diabetes or diabetes type 1.5 is a form of diabetes mellitus type 1 that occurs in adults, often with a slower course of onset. Adults with LADA may initially be diagnosed as having type 2 diabetes based on their age, particularly if they have risk factors for type 2 diabetes such as a strong family history or are obese.
The diagnosis is based on the finding of high blood sugar together with the clinical impression that islet failure rather than insulin resistance is the main cause; detection of a low C-peptide and raised antibodies against the islets of Langerhans support the diagnosis. It cannot be treated with the usual oral treatments for type 2 diabetes, and insulin treatment is usually necessary, as well as long-term monitoring for complications. The concept of LADA was first introduced in 1993.
It is estimated that between 6-50% of all persons, depending on population, diagnosed with type 2 diabetes might actually have LADA. This number accounts for an estimated 5%-10% of the total diabetes population in the U.S. or, as many as 3.5 million persons with LADA. Treatment LADA often does not require insulin at the time of diagnosis and may even be managed with changes in lifestyle in its early stages such as exercise, eating appropriately, and, if indicated, weight loss. However, some clinicians believe that insulin should be started at onset or as soon as possible, rather than using sulfonylureas or other diabetes pills for initial treatment. Moreover, it is not clear whether early insulin therapy is of benefit to the remaining beta islet cells.
Initially, a person with LADA may respond to oral diabetes medications, eating appropriately and lifestyle changes, although beta cells continue to be destroyed and LADA patients should be closely monitored. Some studies have demonstrated that the use of sulfonylureas and the insulin-sensitizing drug metformin, may increase the risk of severe metabolic disorder in persons with LADA. When blood glucose can no longer be managed through lifestyle and medications, daily insulin injections will be required.
80% of persons initially diagnosed with type 2 but test positive for GAD (an indication of LADA) progress to insulin dependency within 6 years (some sources say between 3–12 years after diagnosis). Those who test positive for both GAD and IA2, however, will progress more rapidly to insulin dependence.
Living with any chronic illness is stressful, and patients with diabetes, let alone LADA, may be more prone to depression and eating disorders as a result. Counseling, therapy, and participation in support groups can play an important and positive role in the lives of persons with LADA.
Part of diabetes therapy should include patient education about diet, exercise, stress management, and handling their diabetes on “sick” days. Patients need to understand how to manage their diabetes, as well as how to recognize, treat, and prevent hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) and how to give injections of insulin and glucagon. Blood glucose levels should be checked not less than 3-4 times per day when a patient is insulin dependent and, often, at least once during the night. Comparison LADA is slow-onset Type 1 autoimmune diabetes in adulthood (NIDDK – National Institute of Diabetes and Digestive and Kidney Diseases ).
- Onset: Type 1 diabetes onsets rapidly and at a younger age than does LADA.
- Family history: There is often a family history of autoimmune conditions (for example, Hashimoto’s Disease (autoimmune hypothyroidism) and Celiac Disease, etc.).
- Autoantibodies: Persons with type 1 diabetes and LADA usually test positive for certain (same) autoantibodies (GAD, ICA, IA-2, ZnT8 ) that are not present in type 2 diabetes. Studies have reported an association of Type 1 diabetes/LADA with high risk genes, HLA-DR3, HLA-DR4.
- GAD autoantibodies: Persons with LADA usually test positive for GAD antibodies, whereas in type 1 diabetes these antibodies are more commonly seen in adults rather than in children.
- Lifestyle and weight: People with LADA typically have a normal BMI or may be underweight due to weight loss prior to diagnosis. But some people with LADA may be overweight to mildly obese. LADA (Type 1 diabetes) is an autoimmune disease that cannot be prevented.
- Prognosis: About 80% of all persons initially misdiagnosed with type 2, who have GAD autoantibodies, will become insulin dependent within 3 to 12 years (according to differing LADA sources). Those with both GAD and IA2 antibodies, however, will become insulin dependent sooner. LADA occurs more slowly than classic rapid-onset Type 1 diabetes, but progresses towards insulin dependency.
- Treatment: The treatment for Type 1 diabetes/LADA is exogenous insulin, to control glucose levels, prevent further destruction of residual beta cells, reduce the possibility of diabetic complications, and prevent death from diabetic ketoacidosis (DKA). Although LADA may appear to initially respond to similar treatment (lifestyle and medications if needed) as type 2 diabetes, it will not halt or slow the progression of beta cell destruction, and people with LADA will eventually become insulin dependent.
Symptoms Most latent autoimmune diabetes in adults are initially diagnosed with type 2 diabetes
and may have some or all of these symptoms:
- Unusual thirst
- Frequent urination
- Weight loss despite an increase in appetite
- Blurred vision
- Nausea and vomiting
- Extreme weakness and fatigue
- Irritability and mood changes
- Frequent bladder and skin infections that don’t heal easily
- High levels of sugar in the blood when tested
- High levels of sugar in the urine when tested
- Dry, itchy skin
- Tingling or loss of feeling in the hands or feet
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