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Frequently asked question: What is LADA?

[27June96]

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LADA = latent autoimmune diabetes in adults 

LADA is a form of autoimmune diabetes that starts in adulthood instead 
of childhood. It is nothing more than type I diabetes (IDDM) starting 
slowly after the age of 30-35.

In general, LADAs are not overweight, have no family history of NIDDM, 
may or may not have a family history of IDDM, do not put on weight at 
the time of the diagnosis (as a matter of fact, some of them may even 
lose weight at that time), and they tend to have higher BGs from the 
beginning.

Doctors may try to control LADA with diet, but within a short period, 
from months to a few years, metabolic control fails. BGs start going up,
despite good diet and weight control, and they soon require insulin. 
Oral agents may be tried first, but subsequent progress to insulin 
dependency may be quite rapid. 

The mechanism of DM in LADA is mostly the failure of the beta cells in 
the pancreas to secrete insulin.

In the past, some of these patients were considered to have "primary 
failures" to oral agents because they did not respond to them or they 
respond for a short period of time.

Studies have shown the presence of markers of autoimmunity in LADA 
patients. The markers of autoimmunity that can be found in a person with 
LADA are the classic islet cell antibodies, or more precisely anti GAD 
antibodies, which can be found even more frequently.

15-20% of all diabetic adults may have LADA, and LADA may constitute as 
much as 50% of non-obese adult onset diabetes. This form of diabetes is 
sometimes known as "Type 1 1/2". 

LADA patients can be very confusing to doctors who are not aware of this 
possibility. The patients with LADA may look exactly the same as 
patients with NIDDM, and it becomes frustrating trying to control the 
BGs with diet and pills. The doctors may blame the patient for not 
following the diet well, or for not taking the pills as they should. The 
truth is that the islets of Langerhans are slowly being attacked by the 
autoimmune process and stopping their secretion of insulin.

In children, the autoimmune process is more acute and "explosive" with 
symptoms presenting over a short period of time and being more severe 
(thirst, urination, hunger, decreased weight). In adults, the autoimmune 
process that destroys the islets of Langerhans seems to be slower, and 
the decline in insulin production appears over several months instead of 
several weeks.

As soon as the diagnosis of LADA is made, it is better to start insulin 
right away. Putting the beta cells to rest by giving insulin exogenously 
and normalizing the BGs is good for the beta cells. It prevents the 
exhaustion of the beta cells, and it seems to decrease the autoimmune 
attack on the islets.