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LADA a pending epidemic

Ian DP

Ian DP

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712
Location
Suffolk
Type of diabetes
LADA
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Insulin
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Just found this interesting article on LADA on the web.

......What Is LADA Diabetes and Why is it Being Called a Pending Epidemic? And why there may well be more LADA people than type 1s.
http://timesulin.com/theblog/what-is-lada-diabetes/
........the main problem with LADA – it can be very hard to diagnose by a physician who hasn’t seen it before, and the treatment it requires is quite different from Type 1 OR Type 2

Apologies if this article has been discussed on this forum before.
Ian
 
Interesting article. I might question one or two points. The trouble is LADA is effectively a state somewhere between T1 & T2 and the causes will vary. I question that insulin resistance may be involved; I would suggest it is less likely as this would be nearer to a T2. Some say that all diabetics go thru an insulin resistance phase but I have to disagree with that and await valid research results. Various NHS reports confirm 15%-20% of those diagnosed as T2 are not overweight and a good proportion are probably LADA. GAD antibodies, viruses, pancreatitis and so on can cause a falling pancreas so one shouldn't assume the GAD test alone is the right test although it may well pickup most? There are several known islet cell anti-bodies and most are not tested for but rarer. The c-peptide test is to me an excellent test as T1s will have low insulin and T2s high-insulin. The c-peptide test is a bit problematic and there are arguments on the degree of fasting to be used. It was the test that confirmed my own LADA diagnosis whilst my GAD was negative. I don't know whether starting insulin early makes a difference but I was started up to 2 years too late so had to starve myself. In many way treatments for T1,T1.5 & T2 are similar i.e. low-carb diet, tablets then insulin with very different timings.

It will be nice if one day DUK , as the UK's national organisation for diabetes, recognises LADA but I'm not holding my breath.
 
I agree there must be 1000's of LADA out there being treated as T2. Lots of GP's don't understand it and don't routinely do the GAD test.


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You might find this blog post interesting.. It's not written by a professional (ie just another person with LADA) but it's a well researched article.. She also has some other very useful blog posts for people newly diagnosed with LADA.
Latent Autoimmune Diabetes Myths: Separating Fiction from Fact
http://www.tudiabetes.org/profiles/...e-diabetes-myths-separating-fiction-from-fact

I think that that it poses a real dilemma. How does a GP,by definition a non specialist, distinguish between someone with T2 and the early stages of LADA given that it can occur in thin and overweight people and that thin people may also have T2 or MODY or perhaps their diabetes could be caused by something else entirely.

edit here's 2 sets of criteria given by different researchers from a Canadian document I think that they probably don't fit all people either though.

http://www.diabetes.ca/documents/for-professionals/DC--MayJune_2008--McInnes,_M.pdf
• age 25 to 50 years;• higher fasting glucose, HDL-C and A1clevels;• lower BMI, waist circumference, total cholesterol, uric acid and triglyceride levels;• a higher frequency of associated thyroid disease; • a lower prevalence of the metabolic syndrome than in patients with type 2diabetes

Fourlanos and colleagues compared to type 2 patients with LADA and found that LADA patients had at least 2 of the following features:
age of onset <50 years of age, acute symptoms before diagnosis, BMI <25 kg/m2 and a personal or family history of autoimmune disease at diagnosis(11).
However, others found no acute symptoms at diagnosis (1).


Personally, I had 3 of the second set and some of the first though my lipids were up the creek with DKA, they were normal after though (and at diagnosis it was a family history of autoimmune disease, now I've also got antibodies to my thyroid)
 
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I now believe I had many symptoms of lada for many years before being diagnosed. Thing is there were no obvious results in the various blood tests I had, not even considered diabetes. By the time anything was visible.by testing I was already in dka. skipped the lada bit, straight to type 1. Maybe if right tests were done initially could of controlled the lada and had some natural insulin production prolonged.

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I have repeatedly asked different Drs at my practice for a c peptide test and they refuse. I went from diagnosis through medication to insulin in 18 months. Each increase or addition in meds took 3-4 weeks to work then ok for about 2 months and then BG levels would start rising again. Drs argument is that now I am on insulin MDI there is no need to test as treatment is the same. I said I would be happier for a proper diagnosis in case of hospitalisation at any time as I believed Type 2s treated less well. This idea was rubbished!!
 
I don't think that it's a C peptide test that you need ,since nearly all T1s, LADAs and late stage T2s will have reduced C Peptide, not nill since even people with T1 for 50+ years will have detectable C Peptide.
What you need are antibody tests. So far people with LADA have been found to have a variety of antibodies including glutamic acid decarboxylase autoantibodies (GAD, ICA, IA-2, IAA, and ZnT8). Many have 2 or more antibodies but by far the most prevalent type in LADA are GAD antibodies so those and ICA are usually the ones to be tested (the last antibody on the list was only discovered a few years ago and I've never heard of anyone being tested for that)
One of the main arguments that I would give for a correct diagnosis is that in the UK you won't be eligible for a pump or for a DAFNE course if you are considered to be T2.
Don't give up. I know of a lady on another forum ( though she is a past member of this one so she might see this ) She successfully argued her case and several years after going on to insulin has been antibody tested, been re classified and is now using an insulin pump.
 
Hi Phoenix. I might question a couple of your points. On the basis of probability a person who presents as thin and /or has lost weight quickly before diagnosis is much more likely to be LADA than someone who is overweight hence GPs should be prepared to do the two tests on the thinner patient and not just label them T2 by default. Also although a very late stage T2 person may by then have knackered pancreas it is more likely that many will still have reasonable pancreatic function but be insulin resistant hence the c-peptide test should help distinguish. It helped define me to myself after 8 years as a 'T2'. It's all about probability but as GPs already guess 'T2' by default they could at least try to improve the probabilities and test accordingly
 
I disagree that LADA is between type 1 and 2, I don't think it has anything to do with type 2 at all and don't believe there is any insulin resistance at all really in a LADA unless they are overweight (or put on weight due to insulin use) as well which is not the norm as usually LADA patients lose weight prior to diagnosis. This is just my opinion though from the medical journals and research I have read as I'm not a doctor.

That being said, my consultant told me that c-peptide is actually MORE important than a GAD test because GAD antibodies can be present in non-diabetics and can occur due to completely unrelated issues... It is problematic though as it's not actual insulin and so can only really show so much...

With regard to that blog mentioned above where they say that early introduction to insulin can preserve beta cells...that's interesting because I asked my consultant about this and he said there is no empirical evidence that going onto insulin earlier prolongs ur beta cells and he showed me a study that was carried out where half of the sample of LADAs were started on insulin and and half weren't and there was no significant difference in the condition of the two halves of the sample by the end of the study... Perhaps they have looked into this further though recently or enhanced the study.

I also hate the attitude of some HCPs who say the treatment is the same so the diagnosis doesn't matter. That's ridiculous. For research reasons alone they should be giving everyone diagnosed as diabetic (whichever type!) these tests and I would encourage anyone who has concerns to push the matter and say they expect a correct diagnosis, not an assumption.


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.
 
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Re C pep, it might very well help earlier, but the previous poster is already on insulin so one would assume a low level of endogenous insulin.(' A person with new type 2 diabetes often has a normal or high level of C-peptide in the blood.(but) Over time, a person with type 2 diabetes may develop a low level of C-peptide.' )
http://www.cigna.com/healthwellness/hw/medical-tests/c-peptide-tu2817

I'm not sure that all people who are thinner necessarily have LADA as I said before there are other possibilities other than LADA. (and I'm sure some of those haven't been defined yet so end up in the diagnosis of T2 ie no other known cause.)

In the 'clinical screening ' study from Fourlanos quoted above ( ie where 2 out of five criteria were predictive), the BMI of those confirmed to have LADA was lower than with T2 but ranged from 24.6–32.5 with a median of .27.9 so most were overweight .
If only those patients with a BMI <25 were screened, it would have missed 70% of those that had antibodies.

Not al those with 2 or more of the criteria would actually have LADA when antibody tested , many wouldn't but if the criteria were correct it should 'catch' most of those that had it. The criteria worked very well in reverse. They found that those who had none or only one of the criteria had a 99% chance of not having LADA ( ie negative for GAD or islet cell antibodies )
http://care.diabetesjournals.org/content/29/5/970/T1.expansion.html

This was a retrospective study .It would have been interesting to see the criteria used in a predictive study to see if the 'tool' worked at diagnosis,

.
 
Ian DP said:
Just found this interesting article on LADA on the web.

......What Is LADA Diabetes and Why is it Being Called a Pending Epidemic? And why there may well be more LADA people than type 1s.
http://timesulin.com/theblog/what-is-lada-diabetes/
........the main problem with LADA – it can be very hard to diagnose by a physician who hasn’t seen it before, and the treatment it requires is quite different from Type 1 OR Type 2

Apologies if this article has been discussed on this forum before.
Ian
Click to expand...
Thanks for this link. No need for apologies as I'm sure that there are many people like me who wondered what on earth Type 1.5 was! It was mentioned on another forum a month or so ago and I didn't know it existed. I've just read the article and its really enlightening and not too long.

Thanks again Phoenix
 
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