LADA – Debunking a Common Type 2 Diabetes Misdiagnosis
By Kara Miecznikowski and Divya Gopisetty
What is LADA? How is it diagnosed and treated? Read on to learn more and hear from people living with LADA
Just like type 1 diabetes, LADA is a form of autoimmune diabetes. This means that the body’s own immune system attacks and kills the beta cells in the pancreas that produce insulin. However, the “attacking” of all the beta cells takes longer in people with LADA than in people with type 1 diabetes.
It is not possible to predict how quickly people with an autoimmune form of diabetes become insulin dependent. Individuals with LADA can generally produce enough insulin for six months to multiple years before insulin therapy is required. Research has shown that age plays an important role – the older you are, the longer your body can preserve its beta cells and insulin production. For example, a 5-year-old diagnosed with autoimmune diabetes will typically require insulin sooner than a 30-year-old.
Studies suggest that LADA is the most common form of adult autoimmune diabetes. Because LADA typically does not require insulin in the short-term and occurs in adults, it is often misdiagnosed as type 2 diabetes. Notably, up to 15% of people diagnosed with type 2 diabetes may actually have LADA. Being misdiagnosed puts individuals at risk for diabetic ketoacidosis (DKA) and long-term complications. Also, not knowing that the person has autoimmune diabetes means that they will not be screened for other autoimmune conditions such as thyroid or celiac diseases, which are more frequent in people with LADA than in those with type 2 diabetes. Finally, family members of someone with LADA can also have autoimmune diabetes (e.g., type 1 diabetes or LADA) and should be screened differently than family members of those with type 2 diabetes.
How is LADA diagnosed?
Healthcare professionals use a blood test to see if someone has LADA. Because LADA is an autoimmune condition, individuals with LADA usually test positive for at least one islet autoantibody (a protein produced by the immune system). Your healthcare professional can use a blood test to check for autoantibodies to GAD, IA-2/ICA512, insulin, and ZnT8. These tests vary in cost depending on your insurance coverage.
T’ara Smith of Beyond Type 2 recounts, “Before my LADA diagnosis, I noticed my metformin and long-acting insulin treatment weren’t as effective as, let's say, months before. Several weeks before my official diagnosis, my blood sugar spiked to over 400 mg/dl – the highest number since I was diagnosed with type 2 diabetes a couple of years earlier.” Accordingly, she said, “I saw an endocrinologist who guessed I had a form of type 1 diabetes. She ran an autoantibody test to confirm that I had LADA.”
Mike Durbin, who was misdiagnosed with type 2 diabetes in 2008 said, “I've learned that I'm certainly not unique in being misdiagnosed. A lot of people who live with LADA are initially diagnosed with type 2 diabetes and go through a similar success and decline phase before being diagnosed correctly. And it's not uncommon for the misdiagnosis to go on for years. I struggled for seven years before being correctly diagnosed.”
Mike shared at length about how stigmas and stereotypes about type 2 diabetes contributed to his incorrect diagnosis. “The phrase ‘Your Diabetes May Vary’ has never been more true when it comes to life with LADA. I attribute my situation to my being a big guy with a family history of diabetes, who fit the mold of what my doctor and society at large believe a person with type 2 diabetes looks like.”
How should I manage LADA?
LADA can usually be initially managed through diet, exercise, weight loss if appropriate, and taking a typical first-line type 2 diabetes medication, such as metformin.
Regardless, as LADA progresses, the pancreas gradually loses its ability to make insulin. Insulin therapy becomes necessary, as with type 1 diabetes. Continued monitoring of blood glucose levels is important to determine when insulin therapy should be started. Once managing your blood sugar becomes difficult despite oral treatments, exercise, and diet plans, ask your healthcare professional about starting insulin therapy.
Cherise Shockley, diaTribe’s very own Community Manager, was lucky to have a doctor who recognized LADA early on. In reflecting on her own diagnosis in 2004, Cherise’s endocrinologist told her, "I cannot tell you when you will require insulin, but you will need it. You might need it six months from now or four years from now; I do not know." Cherise said that she knew she needed to be on insulin when she was taking a full dose of metformin, walking for long periods, and eating salads for dinner, and yet her blood sugar would not drop below 200 mg/dl.
A personalized treatment plan is key to managing your diabetes! Share this article with your healthcare professional if you think you may have been misdiagnosed.