Lada vs T1

[SB2015]

I was wondering what the difference between being diagnosed at an older age with T1 and being you told you have LADA. Someone suggested that they are the same. Any views?

 

[Mini-Vicki]

My understanding is that they are essentially the same thing 🙂
My consultant said that those classified as LADA seem to have a more chronic onset, and often misdiagnosed as T2 first before being rediagnosed as T1 / LADA.

 

[Robin]

When I was first diagnosed, I was assumed to be type 2, then when my GAD test came back positive, my notes were relabelled LADA. Then I was just labelled 'Autoimmune, type 1' as the hospital said they didn't find LADA a very helpful classification, they preferred just to distinguish whether you were autoimmune or not.

 

[trophywench]

This is the basic difference, isn't it? T1 knocks you off your perch pdq and gets worse throughout every day untreated , whereas LADA builds up more gradually, but not as gradually as T2 - so the person doesn't wake up and go to bed every single day, always feeling worse than yesterday.

 

[zx10pilot]

This is how it was explained to me -
"Classic" T1 comes on within days and results in DKA quickly (within days).

LADA is a bit different although it's autoimmune (the gad test confirms that) it typically takes a fair few months for symptoms to become severe enough to really affect you. And because it's a relatively slow onset you generally don't realise quite how bad (or ill) you've become even though you may be in the first stages of DKA. Often people will be admitted with full blown DKA simply because the lengthy timescales mean the initial symptoms have almost become normal 😱
I was extremely lucky with my diagnosis - immediate treatment with insulin helps protects any remaining cells and prevents the "burnout" of being given the wrong (T2) treatment.

So LADA & T1 are both very similar, but the definition as such is more of a statement of the progress of the condition. Both are autoimmune but due to slowish onset of LADA you don't lose all your cells so quickly either so the honeymoon period goes on quite a bit longer.

I am still making enough insulin to make a difference a year after diagnosis and according to my consultant that could go on for some time.

 

[Amberzak]

I've been involved in some research with Exeter university and it is their belief that there is no LADA. They have found some evidence that the attack on the beta cells is more aggressive the younger you are. So LADA is just type one but just a slower onset because you're older. They say that because there's no specific line (I was ill for about 2 weeks before getting diagnosed), and because the cause is exactly the same, LADA is just the name that the doctors give it because they so often misdiagnose as type 2.

 

[pottersusan]

The way you wrote Lada in the title made me think of the ?Russian cars, @SB2015 !

 

[zx10pilot]

@Amberzak that makes sense and I'm glad to hear Exeter are looking into it.
So, diagnosed at 45 means my rubbish immune system isn't aggressive...
That's reassuring - it can be as passive as it wants and I'd even buy it flowers if it could slow down even more!

 

[Robin]

I've been involved in some research with Exeter university and it is their belief that there is no LADA. They have found some evidence that the attack on the beta cells is more aggressive the younger you are. So LADA is just type one but just a slower onset because you're older. They say that because there's no specific line (I was ill for about 2 weeks before getting diagnosed), and because the cause is exactly the same, LADA is just the name that the doctors give it because they so often misdiagnose as type 2.

I think that was basically the reasoning behind the Oxford Radcliffe hospital trust dropping the name. They didn't feel it added anything to the diagnosis, and as you say, people develop auto immune conditions at different rates, I believe rheumatoid arthritis is another case in point, in children the symptoms often come on a lot faster than in adults.

 

[mikeyB]

The main reason for getting LADA off your notes and substituting Type1 is that you'll never get a pump if you are LADA. or at least, it makes it very difficult. It's bad enough for pancreatic T1s ( the no pancreas gang) to be labelled 3c. These are just labels - they show the aetiology (cause) but the effect is Type 1. (With knobs on for the pancreatic gang).

 

[Northerner]

Looks like I managed to tame my immune system. I had symptoms (obvious with hindsight!) for about 18 months prior to getting a virus that overwhelmed my system and put me in hospital with DKA. Four years after diagnosis I stopped needing basal insulin, but I definitely still need bolus insulin. I think that the bolus insulin also covers some of my basal needs when I'm up and about, but isn't needed at night when sleeping - presumably much to do with the behaviour of my liver. Haven't used basal for 5 years now.

So, what does that make me? I'm down as Type 1, definitely not Type 2, and I went through a decline in insulin production then a recovery, rather than a continued decline. As long as the treatment I'm given does the job it doesn't really matter, I suppose 🙂 I'm not unique, as I have encountered maybe half a dozen others here who share similar experiences 🙂

 

[DaveB]

This is how it was explained to me -
"Classic" T1 comes on within days and results in DKA quickly (within days).

LADA is a bit different although it's autoimmune (the gad test confirms that) it typically takes a fair few months for symptoms to become severe enough to really affect you. And because it's a relatively slow onset you generally don't realise quite how bad (or ill) you've become even though you may be in the first stages of DKA. Often people will be admitted with full blown DKA simply because the lengthy timescales mean the initial symptoms have almost become normal 😱
I was extremely lucky with my diagnosis - immediate treatment with insulin helps protects any remaining cells and prevents the "burnout" of being given the wrong (T2) treatment.

So LADA & T1 are both very similar, but the definition as such is more of a statement of the progress of the condition. Both are autoimmune but due to slowish onset of LADA you don't lose all your cells so quickly either so the honeymoon period goes on quite a bit longer.

I am still making enough insulin to make a difference a year after diagnosis and according to my consultant that could go on for some time.

Not all beta cell loss is due to an auto-immune effect. Viruses and pancreatitis can cause the same effect so I believe the c-peptide test is more useful than GAD in defining T1.