LADA vs. Type 1?

gavin86 said:

Is there anything different about LADA other than the age of diagnosis?

Forgive me for the basic question, I've heard/seen next to nothing about LADA since I was diagnosed as T1 and I've been doing pretty much nothing but read since finding out!

I'm 30.. they say LADA is for over 30s, and they say t1 is for younger people... does that make me Type 1.25?

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LADA generally comes on more slowly and some people with LADA can treat it with diet early on.

My consultant doesn't really use the term and just prefers "Type 1".

If you're concerned, you could ask your DSN or doctor but just being diagnosed over the age of 30 doesn't necessarily mean you're LADA.

I can't comment about LADA but I was diagnosed in my 30s with T1.
And, I believe they are very slowly changing the definition of T1 away from something that is diagnosed as a child.
The term Juvenile Diabetes is very much out of a fashion (apart from within a certain Type 1 charity).
As this (https://blogs.diabetes.org.uk/?p=5184) explains, 57% people with diabetes are diagnosed over the age of 20.
(Sorry, I couldn't find the original research.)

It's quite slow onset. My endo currently defines me as a Type 1 but was previously diagnosed with LADA, but I had positive GAD antibodies with a low HBA1C and fasting BG of 6-9mmol for 3 years before I was started on insulin

LADA and type 1 are the same thing.

There is no clinical diagnosis of LADA/1.5. It's just autoimmune type 1 diabetes.

The thing that may make you LADA or type 1.5, rather than just referring to yourself as type 1, is a particularly long and strong honeymoon period. Most type 1 diabetics will have a honeymoon period, that is a time when they have residual insulin production going on. The honeymoon period can make blood sugar control a bit easier because your pancreas still makes some insulin in response to food, or it can make it more unpredictable because the endogenous insulin production happens in fits and starts. Those diagnosed as infants/children tend to have a short lived honeymoon period and they stay on insulin treatment throughout, those diagnosed older may have a longer honeymoon period and still stay on insulin. Some people with LADA may have such a strong honeymoon that they are able to come off insulin for a while - but this will only be temporary as with type 1 your immune system is geared up to kill off your insulin producing beta cells and it will kill them off, even if it takes a while.

So if you're over 30, diagnosed with type 1 and commenced on insulin straight away you're not really LADA or type 1.5, you're just type 1. Even those who do refer to themselves as LADA are type 1, just with a stronger honeymoon period. Age of diagnosis doesn't make you LADA it would be the honeymoon period that would determine whether there's any point in thinking of yourself or referring to yourself as LADA - if you're on mdi with a basal bolus regime there probably isn't.

I am just thinking: should there be a separate LADA forum?

@cz_dave , there is. This thread is in the LADA/type 1.5 diabetes forum

Alison Campbell said:

@cz_dave , there is. This thread is in the LADA/type 1.5 diabetes forum

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I know there is. But shouldn't it be merged with the. Type 1 forum? Just a thought...

cz_dave said:

I know there is. But shouldn't it be merged with the. Type 1 forum? Just a thought...

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The good thing about it being separate is that until the NHS and DUK recognise Late onset T1 (LADA) as a reality (and hence actually the same as T1) then it enables Newbies to find an area that matches their position many having been wrongly told they are T2 as they are 'too old to be T1'

Good point, @Daibell

catapillar said:

LADA and type 1 are the same thing.

There is no clinical diagnosis of LADA/1.5. It's just autoimmune type 1 diabetes.

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In broad terms, this is largely correct. Genetically, there are differences between type 1 and LADA so it's not technically correct to say they're identical.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928363/
http://www.diabetes.co.uk/news/2017...netic-features-of-lada-diabetes-99442364.html

That's not to say it's not basically type 1 with a different approach (my medical ID bracelets all say T1 in part because it is recognized as a form of T1) but these genetic differences might, one day, indicate a different way of diagnosing, different treatments more tailored to LADA needs etc. It's worth recognizing they're not 100% the same for the future of diabetes treatments.

cz_dave said:

I know there is. But shouldn't it be merged with the. Type 1 forum? Just a thought...

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Probably not, if only because treatment for LADA can be enormously different from the fast onset type 1. There are lots of ways LADA is different as it progresses to full insulin dependency - I would have had no place in the T1 forum at first, I spent several years on oral medication before insulin which is not how T1 is typically treated after all. There are also subtle differences in how the condition expresses itself that don't fully line up with regular T1, enough to warrant a more specialized approach (the extended honeymoon period being one of them).

Very much agree with the previous post.
The biomarkers for Type 1.5 differ from those for Type 1.
This means the diagnosis can be different before onset, at onset, under medication and under insulin therapy.
I have seen the good work on relevant biomarkers published only in the last 18 months or so. Before then it was mostly hypothesis and exploration (even going back to 60s, 70s and 80s).
The first challenge is to resilve the differences that matter. That us not a simple issue.
The next challenge is to cinsidet long term therapies that effectively and measurably work on the things that generate testable biomarkers.
Then there is the challenge of framing so that GPs and endos can manage it.
When i went through those early days / years after late onset it was clearly too hard and if only of vague interest even to the venerable experts.
Now i know better what blood tests to order. Different focus from that for classic type 1.

I was diagnosed at 4 (Type1) my sister at 50 (LADA) - Although the causes may be different or take longer to manifest, watching her progress, you would swear that we had the exact same condition - we're even on the same insulin even though we live about 1500 KM apart and I have a much easier time with it - likely because of the years I've spent figuring out the best approach for me. I remember when she was diagnosed - I was really surprised - I fugured I'd be the only one to have to deal with it. Wonder how that makes my brother feel - he's still in the clear.

MangosteenElbow said:

Very much agree with the previous post.
The biomarkers for Type 1.5 differ from those for Type 1.
This means the diagnosis can be different before onset, at onset, under medication and under insulin therapy.
I have seen the good work on relevant biomarkers published only in the last 18 months or so. Before then it was mostly hypothesis and exploration (even going back to 60s, 70s and 80s).
The first challenge is to resilve the differences that matter. That us not a simple issue.
The next challenge is to cinsidet long term therapies that effectively and measurably work on the things that generate testable biomarkers.
Then there is the challenge of framing so that GPs and endos can manage it.
When i went through those early days / years after late onset it was clearly too hard and if only of vague interest even to the venerable experts.
Now i know better what blood tests to order. Different focus from that for classic type 1.

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I read this thread with great interest. I was dx T1 in April, I haven't yet met with endocrinologist, and have been struggling to match approach/expectations of DSNs with my experience of managing the condition (esp around diet and what constitutes an acceptable bg profile-think I need to write a separate post seeking advice and ideas on this),. MangosteenElbow, I'd be grateful if you could clarify which blood tests you are referring to in your post, and any other tips on management in the early period, esp. diet. Thank you! Hannah

Saw your request.
Will do.
It's potentially a big topic. I too started with the question: what tests? Then, what goals? Then, how to improve the things that lead to the test results? How relevant are the tests and their rsults to (i) me as I am (genes age sex any ailments family history ifailmenrs ...) and (ii) the true risks for me?
All of that circles back to what should have been the first question: why am I testing?

I'll take a few days to work out how to post without giving medical advice or opening up to trolls.

MangosteenElbow said:

Saw your request.
Will do.
It's potentially a big topic. I too started with the question: what tests? Then, what goals? Then, how to improve the things that lead to the test results? How relevant are the tests and their rsults to (i) me as I am (genes age sex any ailments family history ifailmenrs ...) and (ii) the true risks for me?
All of that circles back to what should have been the first question: why am I testing?

I'll take a few days to work out how to post without giving medical advice or opening up to trolls.

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Dear MangosteenElbow, thank you so much for taking the time to formulate a reply. I look forward very much to reading. Apologies Gavin86 for hijacking your post in this way, but hopefully you will find it interesting reading too. Thanks all, and be well, Hannah

Daibell said:

The good thing about it being separate is that until the NHS and DUK recognise Late onset T1 (LADA) as a reality (and hence actually the same as T1) then it enables Newbies to find an area that matches their position many having been wrongly told they are T2 as they are 'too old to be T1'

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Just a thought I was diagnosed with type 1 at the grand old age of 72 so hey there you go I just say I'm type1 didnt even know what LADA meant, till I read some posts about it.