LADA and what it means

E

EmmaL76

Well-Known Member
Relationship to Diabetes
Type 1.5 LADA
What are peoples thoughts on LADA (particularly those with the diagnosis themselves) the general vibe on here is that it’s no different to type 1, just slower but most literature I read says it is a hybrid and shares a similar amount of insulin resistance to type 2. So in a way I supposed the risks associated with both. Does anyone with LADA struggle with insulin and feel insulin resistance may be to blame? Or do we all have IR at some level. Oh I don’t know, sometimes I’m so full of confusion maybe I overthink stuff… but this LADA sounds like a bit of a bum deal to me why have one when you can have both 🙄
 
EmmaL76 said:
What are peoples thoughts on LADA (particularly those with the diagnosis themselves) the general vibe on here is that it’s no different to type 1, just slower but most literature I read says it is a hybrid and shares a similar amount of insulin resistance to type 2. So in a way I supposed the risks associated with both. Does anyone with LADA struggle with insulin and feel insulin resistance may be to blame? Or do we all have IR at some level. Oh I don’t know, sometimes I’m so full of confusion maybe I overthink stuff… but this LADA sounds like a bit of a bum deal to me why have one when you can have both 🙄
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I think the problem with LADA is that it’s an unofficial term that’s grown up piecemeal. In some places it was used to describe people with a mix of insulin resistance and beta call death, for whatever reason, and in others it was just used to signify Type 1 in an adult which had a slower onset than was normally seen in children.
I went through various classifications at our main teaching hospital. I was first misdiagnosed as Type 2, then referred to as LADA for about a year after a positive GAD test and failure to respond to Type 2 meds, then the hospital said they found the term LADA unhelpful, and dropped it for Type 1. Then they decided 'Typing' wasn't patient based enough, and it just said ‘Autoimmune' in my notes. Then they went back on that and my notes from the hospital now just say Type 1.
No wonder people are confused, if the medical profession can’t decide what it actually means.
 
I agree with @Robin, that there isn't any clear definition and the medical profession use the term in different ways, which just adds to the confusion. I think using the term Type 1.5 makes it even more confusing because sometimes this is tied to LADA and seen as the same thing and sometimes it is used to refer to Type 1 diabetics who also have significant insulin resistance.

I think the term insulin resistance is also confusing. It is easy for us all to think we have a bit of insulin resistance when in fact we are just needing more insulin to deal with liver output..... So for instance, on a morning I need more insulin to deal with FOTF and that insulin takes a long time to work because it has to overcome that flow of glucose. If we were not diabetic, our body would be producing insulin to deal with that liver dump and we would be none the wiser about what we needed and when. This is not insulin resistance in my opinion although I have referred to it as insulin resistance before.
To me the way to tell insulin resistance is if we are needing substantial amounts of insulin (large doses) not how long it takes to work. My gut feeling is that if your carb ratio is 1:10 or greater, then you are not insulin resistant. As a LADA where your body is still producing some insulin this may slowly reduce over time and could easily lead someone to think they might be developing insulin resistance, but I have a feeling that 1:10 is probably about the norm, but exercise and illness will impact this of course.

I know a lot of people talk about a low carb diet causing insulin resistance but to me again I feel this is misunderstood and it may just be that the slow release of glucose from fat and protein makes it look like insulin needs are increasing hence IP developing but I think the liver may store and release more, as a result of this diet, particularly if not enough exercise is done. I do not see this as insulin resistance. To me IR is the reluctance of the cells to accept glucose from the blood stream and if your ratio remains more or less the same for meals then it isn't IR because post meal is the time when IR will be more obvious and much larger doses will be needed to cope with a normal amount of carbs.

The time it takes insulin to work is just a factor of our metabolism and not not related to IR but again I think it is easy to believe it is. As you now I use Fiasp and I need 45 mins most mornings prebolus before I eat. This seems really excessive and I have done a lot of thinking about it, but the fact of the matter is that it is working quite quickly because my BG levels stop rising after I inject it, but it is dealing with a strong tide of glucose from the liver so it looks like it isn't doing anything when in fact it may be working quite hard but I am just not seeing that reflected in my levels.

I still work on a 1:10 ratio but in the morning I often need an extra 1.5-2 units of bolus insulin to deal with FOTF. I don't see this as a ratio change because I need those extra units whether I have breakfast (and a bolus) or not, so I see it as a very separate factor and is actually a top up to my basal insulin at that point in the morning when the evening dose (if I took one) is tailing off and my morning dose hasn't kicked in yet but my liver is churning out glucose as it does on a morning. Those units don't have a bearing on what I eat.

What I do find is that I need more or less basal insulin depending upon exercise, my weight and illness. If I don't do enough exercise I need more Levemir, if I get fatter, I need a bit more Levemir and if I am ill, I need more Levemir. Exercise seems to make the biggest difference for me and is why I love Levemir so much. Again I don't see this as IR when I need more because I am not exercising, it is just that my muscles are not sucking it out of my blood stream more readily. If I need more insulin because I am ill, this is because my liver is chucking out extra glucose to help me fight the infection rather than that my cells are not responding to it which to me is IR.

Not sure how much of what I have written makes sense but I think there is a lot of misunderstanding about IR because we can't see it or measure it or know what is truly IR and what is just a ramp up of glucose release from our liver for a variety of reasons.

My guess is that you are not insulin resistant at all, but are misinterpreting liver dump and perhaps sluggish bolus insulin for IR when it isn't. I would be surprised if you are needing large doses of insulin which would indicate IR.
 
I agree with the discussion about insulin resistance and Type 1 diabetes.
You could be diagnosed as a slim child (so there will be little argument about type). Then, later in life get some insulin resistance. Has your Type 1 changed to LADA? Not in my mind because the diabetes is not late onset. However, we should all be aware that Type 1 diabetes does not protect us from other conditions, including insulin resistance (type 2).
 
People with LADA are usually misdiagnosed first. I have a feeling type 2 develops into type 1.5.

Hyperglycemia stresses the pancreatic beta cells, which then make mistakes that trigger an auto immune response, which for whatever reason is more likely to happen in people with relatively lower BMI’s.

LADA: Time for a New Definition​

"Patients with LADA and low GAD65 titers were not different from T2D patients in sex, age at diagnosis, HbA1c, β-cell function reserve, or components of the metabolic syndrome. On the other hand, all of those features were different in LADA with high GAD65 titers and T2D (1). One possible interpretation is that the pathogenesis of diabetes with low GAD65 titers is not truly different from that of T2D."
 
Wonderful input as usual guys.
I recently had a conversation with a lady who told me that she got type 1 when she was 40 but didn’t take insulin straight away, I said oh a LADA, she was very defensive and so No … im type 1. Then another friend of a friend has low positive antigad, takes insulin but insists she’s type 2. In connection to what @Bubbleblower said I’ve seen many articles stating that low positive antigad should be treated as a type 2 and there is no difference between the two. Studies show they have the same metabolic issues, but that wasn’t true of me but then who knows, my problems started nearly 25 years ago when my antigad could of been >2000 and over the decades after the initial attack they dwindled. I suppose the antigad is only correct on the day you take them and it’s any bodies guess what they are either side of that. I’m still confused but I’m pretty sure endos everywhere are too!
 
EmmaL76 said:
What are peoples thoughts on LADA (particularly those with the diagnosis themselves) the general vibe on here is that it’s no different to type 1, just slower but most literature I read says it is a hybrid and shares a similar amount of insulin resistance to type 2. So in a way I supposed the risks associated with both. Does anyone with LADA struggle with insulin and feel insulin resistance may be to blame? Or do we all have IR at some level. Oh I don’t know, sometimes I’m so full of confusion maybe I overthink stuff… but this LADA sounds like a bit of a bum deal to me why have one when you can have both 🙄
Click to expand...

My consultant isn’t fond of the term. When she does use it, she differentiates between LADA and Type 1.5 whereas often the two are conflated. Type 1.5 is somewhere between Type 1 and Type 2, hence the name. LADA is a slow-onset form of Type 1 that develops in adulthood. I’ve noticed some people here with what my consultant would call Type 1.5 referring to themselves as LADA, so the whole terms just seem to be muddled. To me, I’d say LADA was ‘just’ slow-onset Type 1 with no/little insulin resistance.
 
Inka said:
My consultant isn’t fond of the term. When she does use it, she differentiates between LADA and Type 1.5 whereas often the two are conflated. Type 1.5 is somewhere between Type 1 and Type 2, hence the name. LADA is a slow-onset form of Type 1 that develops in adulthood. I’ve noticed some people here with what my consultant would call Type 1.5 referring to themselves as LADA, so the whole terms just seem to be muddled. To me, I’d say LADA was ‘just’ slow-onset Type 1 with no/little insulin resistance.
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I’ve seen an array of consultants, each one with quite different opinions. This is a real grey area. It would be interesting if it wasn’t quite so confusing
 
EmmaL76 said:
I’ve seen an array of consultants, each one with quite different opinions. This is a real grey area. It would be interesting if it wasn’t quite so confusing
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I think there could probably be types and sub-types of diabetes than we have. Which is, interesting, of course, but also a bit annoying! The main thing is that you’re managing ok x
 
I was diagnosed in my 30s. There was no mention of GAD tests, c-peptide or LADA.
I was diagnosed as Type 1. The reason given was that I was too slim to have type 2. I was lucky. I now know it is not that simple.
But, I think I was lucky because I didn’t have to deal with the uncertainty. The day after my diagnosis, I was at the hospital clinic and was using insulin.
Looking back, I had some symptoms for a while and my honeymoon period lasted about eight years. I was diagnosed before I experienced DKA. This sounds like slow on-set. So, in today’s language, I could have LADA. My insulin dose is relatively low so I have no insulin resistance. So, I wouldn’t consider that I have a half way between Type 1 and type 2 so not type 1.5.
Despite that consideration, I don’t care about the label. I care about the right treatment. That is partially about having access to the tools (insulin, Libre, etc.) but it also means understanding how to use it.
 
helli said:
Despite that consideration, I don’t care about the label. I care about the right treatment. That is partially about having access to the tools (insulin, Libre, etc.) but it also means understanding how to use it.
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Totally agree with you on that.

Similar to a lot of others on here I was misdiagnosed for years as T2 and only had my diagnosis changed last year to T1. But labels aside, I have been on MDI insulin from the beginning, well after a short while of Metformin which had no effect for me.

It’s a real shame access to some care is based on type instead of being dictated by the patient’s needs and what works or would be beneficial for them, but I guess that is all part of the NHS having to budget and manage limited resources.

@EmmaL76 , I think the most important thing to focus on is how you manage your BG and not get hung up on how much insulin you need, whether there’s IR or not. Easier said than done I know as I have struggled a bit over what type I have.
 
Have come late to your post @EmmaL76, but interesting to read these observations. In the end I have been guided by the clinical judgment that I am a type 1, but that reflects what the local healthcare team do - they don't bother with the term 'LADA' or type 1.5 or the various confusions that clearly surround them. Given that I was diagnosed at the age of 62, my subsequent reading led me to conclude I must be a 'LADA'. And then one hospital doctor told me I had to be a type 2 because there was no way it could come on gradually otherwise and anyway I was way too old. I said my BMI wasn't very high because I conformed to the same thinking, and she shrugged - it seems that there are several variations on the simplistic interpretation that @helli faced. My team have concluded I am a T1 who is producing some insulin naturally but responding well to MDI treatment.

But while my experience with my local healthcare team has been very positive, they clearly perceive a type 1/2 cliff edge. There is an obvious danger of an incorrect - or blurred - diagnosis leading to less positive care. It highlights how unhelpful the whole type distinction is, especially since there seems to be a continuum and there is so much confusion about late onset cases and 'LADA' and type 2s who don't seem to 'fit'.
 
From another late starter (aged 53) Once I was in hospital with DKA I was tested for GaD antibodies and as I was positive declared Type 1. I am glad that it was clear and that appropriate treatment was started straight away with MDI. Looking back it is likely that things had started to develop a lot earlier but I had not noticed until an extreme situation tipped me over, as I need more insulin than was then available. I may be LADA/Type 1/ …My consultant does not seem to worry about the label of LADA and I am treated as T1. Having read through this thread I had not realised the nuances of LADA, I had just thought it was slow onset of T1 in adults.

The priority is finding the appropriate treatment for each of us, and a T1 label certainly helps when accessing tech.
 
Thread unlocked at the request of @CliffH
 
EmmaL76 said:
What are peoples thoughts on LADA (particularly those with the diagnosis themselves) the general vibe on here is that it’s no different to type 1, just slower but most literature I read says it is a hybrid and shares a similar amount of insulin resistance to type 2. So in a way I supposed the risks associated with both. Does anyone with LADA struggle with insulin and feel insulin resistance may be to blame? Or do we all have IR at some level. Oh I don’t know, sometimes I’m so full of confusion maybe I overthink stuff… but this LADA sounds like a bit of a bum deal to me why have one when you can have both 🙄
Click to expand...
I've only just joined the Forum, so I'm late to this particular thread! I was diagnosed with LADA eight years ago: I'm now in my early 60s. It's well controlled with insulin. However, it doesn't seem to be getting worse over time and in fact I need less insulin now than when I was first diagnosed. So, it seems rather different to 'traditional' Type 1.
 
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