How does LADA differ from the first and second types
According to the mechanism, LADA is closer to type 1 diabetes: behind the destruction of beta cells there is an autoimmune process, and characteristic antibodies are found in the blood. In terms of onset and age, it resembles the second type: it develops smoothly, without a rapid increase in symptoms and without ketoacidosis at the onset, so a person is often treated with pills for several months or years. The difference from the second type is that your own insulin continues to decrease and does not remain sufficient with reduced tissue sensitivity. Hence the unofficial name - type one and a half diabetes.
- Autoimmune nature, as in the first type
- Onset age usually after thirty years
- Slow development without a sharp debut
- Normal or reduced weight in many patients
- Rapid loss of effect from tablets
- Insulin requirements over several years
When to suspect LADA
Several signs occurring together help to suspect this form. The person is not overweight, he does not have the usual companions of type 2 diabetes - severe obesity, high blood pressure, high cholesterol. Sugar-lowering pills help at first, but the effect quickly weakens, and glycated hemoglobin continues to increase. Personal or family history of autoimmune diseases: thyroiditis, vitiligo, celiac disease, rheumatoid arthritis. Each sign in itself is not conclusive, but their combination is a reason for additional examination.
- Normal body weight in newly diagnosed diabetes
- Absence of pronounced metabolic syndrome
- Rapid weakening of the effect of tablets
- Autoimmune diseases in the patient or relatives
- Age from thirty to fifty years
- Tendency to ketosis during illness
What tests confirm the diagnosis?
The key study is antibodies to glutamic acid decarboxylase; their detection in diabetes in an adult indicates the autoimmune nature of the disease. Additionally, other islet antibodies are determined. The second important indicator is C-peptide, which reflects the production of your own insulin: with LADA it is reduced or gradually decreases with repeated measurements. Glycated hemoglobin and fasting glucose are also assessed. The full set and timing of repetitions is determined by the endocrinologist, focusing on the course of the disease.
- Antibodies to GAD and other islet antigens
- C-peptide in dynamics
- Glycated hemoglobin
- Glucose on an empty stomach and after meals
- Ketones for worsening control
- Examination of the thyroid gland if an autoimmune process is suspected
Treatment
The approach differs from that usual with the second type. Drugs that force the tired pancreas to secrete more insulin are undesirable for LADA: they accelerate the depletion of beta cells. Many doctors recommend switching to insulin earlier to unload the remaining cells and keep sugar at target levels. The specific regimen, doses and timing are determined only by an endocrinologist, taking into account the level of C-peptide and the course of the disease. Nutrition and physical activity remain an essential part of treatment, as with any type of diabetes.
- Early initiation of insulin therapy according to the doctor's decision
- Avoidance of drugs that deplete beta cells
- Regular self-monitoring of sugar
- Balanced diet including carbohydrates
- Regular physical activity
- Monitoring glycated hemoglobin several times a year
Observation and prevention of complications
Complications with LADA are the same as with other forms of diabetes and depend primarily on the quality of sugar control. Therefore, the follow-up plan is standard: regular assessment of glycated hemoglobin, annual fundus examination, monitoring of kidney function, examination of the feet, assessment of lipids and blood pressure. Given the autoimmune nature of the disease, the endocrinologist additionally checks the thyroid gland, since autoimmune thyroiditis is more common in such patients. Training is also important: understanding how to act in case of illness, physical activity and dietary changes.
- Glycated hemoglobin several times a year
- Annual ophthalmologist examination
- Monitoring urine albumin and creatinine
- Foot examination and sensitivity assessment
- Thyroid function test
- Illness and hypoglycemia training