LADA - precise definition?

[LittleGreyCat]

I've been trying to look up a precise definition of LADA.

The overall view seems to be that if you are of normal weight but still need medication, and your historical control is slowly worsening, then you are probably/possibly LADA.

However when you look more detail there are lots of "usually" and "probably" get out clauses.

The most confusing thing is that the honeymoon period can allegedly last for up to 15 years, which is a stark contrast to most diagnoses of T1 for young people where it can present almost overnight.
Then again, unless you are tested for T1 on first diagnosis and then regularly for that 15 years how do they know that you had a 15 year honeymoon period?
How do they know that you didn't have an autoimmune response at year 14?

The tests look for low/no insulin production combined with antibodies which suggest an autoimmune response (but which are not always present).

There is much speculation, including that up to 20% of people initially diagnosed as T2 are in fact T1/LADA.
This does sound suspiciously close to the "Not all T2s are overweight or obese. 20% are normal weight on diagnosis."

My personal situation is, as usual, confusing.

I was diagnosed when I had a rapid weight loss from 14 and a half stone to 14 stone.
Quick calculator says BMI of 27.5 pre diagnosis (14 stone 7 lbs) so overweight but nowhere near obese.
BMI of 26.5 immediately on diagnosis at 14 stone.
Fairly quickly down to 13 stone 7 lbs which is "mildly" overweight.
Target 13 stone 3 lbs on the BMI calculator.

It took me a good while to get an understanding of the diet part of diet and exercise (but remember this was over 11 years ago and understanding of LCHF has moved on a long way since then).

It took me a good long while to get my weight down in the 12 stone 7 lbs region and it is only recently that I have managed to really break through into 11 stone territory (been there before, but not consistently).

I had an IR test a couple of years back, and at that point I had "mild" IR. My insulin production was in the low part of normal and my BG was elevated. Thus IR. However not massive IR coupled with over production of insulin. Then again LCHF which suppresses insulin production.
However "honeymoon period" means that your pancreas is still producing insulin, n'est-ce pas?

So I seem to have low insulin production (which is presumably also slowly declining as I am having to increase my Metformin to the maximum dose) and mild Insulin Resistance but no absolute explanation of why my insulin production is declining.
Is it natural ageing?
Is it long term abnormal BG levels?
Is it an autoimmune response?
Does $DEITY hate me?

I assume a test for antibodies might confirm an autoimmune response of some kind, however also allegedly the lack of antibodies is not conclusive.

So I realise that I could possibly be LADA but does it make much difference?
Apart from adding to some statistics which point to T2 being long term degenerative when instead it could be T1 with a long honeymoon?
Whatever, I assume that the treatment pathway is the same.
So is there any practical benefit to being tested?

Most importantly, do I get to wear the cool T shirt?????

Edit: forgot to say 15 years? Well, so far. With a bit more effort you might find someone with a 20 year honeymoon period?

 

[michita]

A good topic :-D The definition of LADA is adult onset type 1 but should the condition continued to be called LADA when the honeymoon period is over ?

I was diagnosed with type 1 in my 40s with antibodies. On paper only type 1 is mentioned and never LADA. I suspect LADA is not an official term for diagnosis ?

it’s interesting to hear that type 1 and type 2 can be no so clear cut. I think that’s true. In japan where I’m from, for example, there are many people diagnosed with type 2 who are not overweight and not insulin resistant but insulin deficient.

 

[Member496333]

I think the whole thing gets very fuzzy when we try to apply labels. With the exception of very obvious autoimmune, I personally prefer to think of diabetes as sliding scales of deficiency and resistance. It's also possible to be deficient and resistant simultaneously.

 

[michita]

I think the whole thing gets very fuzzy when we try to apply labels. With the exception of very obvious autoimmune, I personally prefer to think of diabetes as sliding scales of deficiency and resistance. It's also possible to be deficient and resistant simultaneously.

All very confusing

 

[DCUKMod]

To be honest, I've said before that many diabetes type diagnoses are a diagnosis of best guess. So few are diagnosed with any tests to make the type clear. (Clearly a T1 diagnosis when presented with a patient in deep DKA is likely to be fairly cut and dried.)

Last I saw my Endo (for something not diabetes related), his parting shot was along the lines of "Mind that pesky LADA, it can sneak up on you when you're not watching". To be honest, I was thinking through the outcomes of the body meeting, and a bit surprised, so didn't turn on my heel to ask him to expand on things.

My take on it is, I can influence, but can't control aspects of the future, so all I can do is my best and ensure I am open minded, should things change for me.

I'm actually due to see him again on Friday, but I have a very focused agenda, and won't be deflecting from it, unless we're done super-fast, which I doubt.

 

[Scott-C]

So I realise that I could possibly be LADA but does it make much difference?

If you were to be re-dx'd as LADA, you'd get free strips, maybe free libre depending on area, and free insulin which allows much more leeway on food choices - carbs are back on the table.

 

[ert]

Type 2's can have diabetes for 10 to 20 years before being diagnosed. Studies suggest that it takes on average 20 years of uncontrolled blood sugars for a type 2 to end up producing as little insulin as a type 1. They will then need insulin to control their diabetes. But this doesn't make them type 1 or LADA. There are a lot of complications, especially amputations, in my clinic which are mainly type 2. My specialist said this was because type 2's can have diabetes for a long time before being diagnosed. The damage is done before they get a chance to control their blood sugars, including beta-cell destruction over time.

The LADA medical definition suggests requiring insulin within 6 years from diagnosis, low insulin on diagnosis and the presence of antibodies. https://www.consultant360.com/artic...ne-diabetes-adults-best-diagnosed-and-treated

 

[Daibell]

Hi. You are right that LADA is not easy to define. Even the definition that LADA is an autoimmune condition can be questioned as viruses can have the same result as specific antibodies. When you said you had an IR test was that a C-Peptide test or something else? There is an increasing view that antibody tests such as GAD are less useful than C-Peptide as you need to know the state of your beta cells and not what caused their degradation. If someone has cancer the tests are to find what it is and the right treatment not what caused it. With regard to honeymoon period mine was around 10 years which is why I was mis-diagnosed as T2. I have been slim all my life and suffered rapid weight loss before diagnosis but my beta cell death was slow and tablets worked for a few years. Following that, insulin has been essential.