LADA: Is Your Type 2 Diabetes Really Type 1 Diabetes?
Key takeaways:
- Previously referred to as “type 1.5 diabetes,” latent autoimmune diabetes in adults is now considered to be type 1 diabetes, according to the American Diabetes Association.
- Because LADA appears in adulthood and may not immediately require insulin, LADA may be mistaken as type 2 diabetes.
- Because of the eventual need for insulin therapy, it’s important LADA gets properly diagnosed.
Latent autoimmune diabetes in adults (LADA) is autoimmune diabetes, in other words, type 1 diabetes. LADA had previously been called “type 1.5 diabetes” because it appeared to have features of both type 1 and type 2 diabetes.
LADA is an autoimmune disease caused by the body’s immune system attacking and killing beta cells in the pancreas, which produce insulin. However, the “attacking and killing” of all the beta cells may take longer in adults compared to children or teens with typical type 1 diabetes. Research shows that the older you are, the longer your body can preserve its beta cells and insulin production. Because of this, LADA may initially be mistaken for type 2 diabetes.
It is not possible to predict how quickly people with LADA will need insulin. Commonly, individuals with LADA can produce enough for six months to multiple years before insulin therapy is required.
The dangers of misdiagnosis
“I struggled for seven years before being correctly diagnosed,” said Mike Durbin, who was misdiagnosed with type 2 diabetes in 2008. “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.”
Because LADA occurs in adults and typically doesn’t require insulin in the short term, it may be mistaken as type 2 diabetes. Notably, up to 15% of older adults diagnosed with type 2 diabetes may actually have type 1 diabetes. That's why type 2 diabetes medications that the body may initially respond to eventually stop working.
“I've learned that I'm certainly not unique in being misdiagnosed,” said Durbin. He shared how stigma 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 being a big guy with a family history of diabetes, who fits the mold of what my doctor and society at large believe a person with type 2 diabetes looks like.”
Being misdiagnosed puts individuals at risk for diabetic ketoacidosis (DKA) and long-term complications. Also, people who don’t know they have LADA means that they likely won’t be screened for other autoimmune conditions like thyroid or celiac disease, which are more frequent in people with LADA than in those with type 2 diabetes.
How is type 1 diabetes in adults diagnosed?
Healthcare professionals use blood tests to see if someone has LADA. Because LADA is an autoimmune condition, individuals may test positive for at least one islet autoantibody (a protein produced by the immune system).
John McCabe found out he had LADA at age 41 through a clinical trial study his youngest son (who had been recently diagnosed with type 1 diabetes) was enrolled in.
“After meeting with my primary care physician, I was referred to an endocrinologist who was adamant that I had type 2 diabetes only, despite the test results,” McCabe, now 52, said. “The endo kept wanting to try different type 2 diabetes treatments even though I was not feeling well and had some adverse reactions.”
“I finally had to put my foot down and demand that we start treating me like I had type 1 diabetes. At that point I started using insulin, which made a huge difference in how I felt and my overall management,” McCabe said. “We have often wondered when and how I would have found out that I had type 1 diabetes if not for my son’s diagnosis and the trial study.”
If you’re experiencing symptoms of type 1 diabetes or suspect you’ve been misdiagnosed with type 2 diabetes, it is important to get the appropriate blood tests so you get can the right treatment. It’s also important to note that family members of people with LADA may be more likely to also have type 1 diabetes, and should be screened differently than family members of people with type 2 diabetes.
LADA symptoms are the same as type 1 diabetes, which includes:
- Excessive thirst
- Frequent urination
- Fatigue
- Hunger
- Mood changes
- Weight loss
- Vision problems
- Tingling or numbness in the hands and feet
How to manage type 1 diabetes in adults
Initially, adults may be able to manage LADA through lifestyle modifications like diet, exercise, and weight loss. Because LADA is often mistaken for type 2 diabetes, a type 2 medication like metformin may be prescribed, which may work at first.
However, with time the pancreas gradually loses its ability to make insulin. As with anyone with type 1 diabetes, insulin therapy becomes necessary. Monitoring blood sugar levels with a continuous glucose monitor or blood glucose meter 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 (or insist) your healthcare professional start you on insulin therapy.
A personalized treatment plan is key to managing diabetes, so if you don’t feel seen or heard by your healthcare provider, search for someone willing to talk – and more importantly, listen – to you about your symptoms and the best course of treatment for you.
Learn more screening and diabetes diagnosis here: