This is the story of me and my LADA. No, not the car: LADA is “Latent Autoimmune Diabetes of Adults”. It isn’t very well known. Sometimes it’s called Type 1.5, or adult-onset Type 1. It’s something that people need to be more aware of, because a lot of people diagnosed with Type 2 diabetes, actually are suffering from LADA. Which is unfortunate, because the treatment is different, and the right treatment might make a real difference if you’re diagnosed with LADA early enough. I was very lucky (or maybe just pushy), but I was diagnosed with LADA five years ago, and my condition is still stable.
Here’s the story.
About six years ago, I had a couple of routine fasting blood sugar test that were above 100 mg/dl (5.6 mmol/L). No big worry. My BMI was fine, my lipids fine. Next routine test: 110. My GP wasn’t too happy and sent me for a glucose tolerance test – the one where you drink a cup of vilely sweet water and they measure your blood glucose at 30 minute intervals. Crucially, I also asked for them to measure not just glucose, but also insulin levels. My glucose curve was “pre-diabetic”, and my GP would have been happy to diagnose Impaired Glucose Tolerance; except that my insulin levels were low, and also late (i.e. the insulin didn’t start to rise straight after the drink). I was lucky enough to contact a top diabetes endocrinologist and he agreed to see me. A regular doctor who sees plenty of new IGT cases each day might just have rubber stamped me “Type 2 pre-diabetic”. Fortunately, there are also doctors who see the whole range of presentations of diabetes, and are familiar with the subtle complexities of the disorder.
After taking a detailed history, and looking at my test results, he explained it to me like this. “You’re a young man [I was 41], and you’re healthy. You want to lead a long healthy life. One day, your pancreas will stop producing insulin, and you’ll have to control your blood sugar all by yourself. That could happen when you’re 42, or it could happen when you’re 60. That’s partly up to you… If you don’t mind taking medication, even though you feel fine, and if you control your diet like you’re diabetic, you can put this off 5, maybe 10 or even 20 years.”
Now as we know, in Type 1 diabetes, you don’t produce insulin, whereas in Type 2, you can’t use the insulin that you make (eventually, poor blood glucose control means that you lose the ability to produce insulin also in Type 2). The difference between regular “juvenile” Type 1 and LADA is that the loss of the ability to produce insulin takes a lot longer – many years – so that it doesn’t appear until adulthood. As the insulin-producing cells in the pancreas begin to die off, you start to show impaired glucose tolerance and higher fasting blood sugar. Of course, most people who develop glucose intolerance as adults are automatically diagnosed with “pre” (Type 2) diabetes. They are advised to change their lifestyle, and maybe take medication like metformin to lower the blood glucose.
But here’s the LADA catch. Your pancreas is still producing insulin, albeit not enough. Slowly, the insulin producing cells are dying off from the stress – they’re working flat out and not keeping up with the amount of insulin your body needs.
One day – and it will inevitably happen one day – your body won’t be able to produce any more insulin, and you need to treat it like full Type 1 diabetes. But by looking after your pancreas, giving it an easier time, a bit of a rest, you might be able prolong the life of those beta cell and put off that day when you need to go on a pump, or regular insulin injections. So that’s why some doctors propose small doses of insulin to relieve the pancreas and hopefully to keep insulin capacity going for as long as possible.
For me, it was an easy choice. Once I started looking at my glucose levels at home, it became clear how much my pancreas was struggling. I was regularly peaking at over 300 mg/dl (16.7 mmol/L) after meals, even though my fasting glucose was steady around 110. So I started with small doses of insulin: just 3 units of Lantus daily. That’s enough to keep the postprandial peaks under control, and give my pancreas the holiday it needs. Five years on, and my fasting glucose is still 110. Another interesting benefit of the low-dose insulin treatment is that it gives you the opportunity to get used to controlling blood sugar, at a time when it’s not that critical to get the control right. I’m not going to go into DKA because of a peak of 300, and any hypos I get are going to be mild. So it’s good training for later life – not to mention the getting used to a diabetic diet.
I know people who were suddenly diagnosed with full-blown Type 1 diabetes in middle age. They were probably LADA for years, but never knew it until their pancreas shut down completely. Perhaps with a low dose insulin treatment they could have put off that day by a few more years. In fairness, not all doctors are convinced that insulin treatment improves the prognosis for LADA, but I for one am happy to take the chance.
So if you’re an adult with impaired glucose tolerance, not obese, and with no family history of Type 2 diabetes, I recommend you ask your doctor to be tested for LADA. There’s more information on this link: here