By the time Jessica Apple was thirty-five years old, she already was familiar with the signs and symptoms of diabetes: she had experienced her husband, Mike, being diagnosed with type 1 diabetes as an adult. But this time, she herself was the one experiencing problems. While Apple was petite and an extremely healthy eater, her blood sugars were swinging out of normal range – and yet she was still making a considerable amount of her own insulin. After testing and consultation with her doctor, Apple, who’s editor-in-chief of the diabetes site ASweetLife.org, was diagnosed with a sometimes misunderstood condition called LADA: latent autoimmune diabetes in adults, also known as type 1.5 diabetes.
In many cases, it’s fairly easy to tell whether you have type 1 or type 2 diabetes. In type 1 diabetes, your body kills the beta cells in the pancreas that produce insulin, and you require artificial insulin by shots or infusion in order to stay alive. The disease is caused by “autoantibodies,” immune cells that are incorrectly programmed so that they attack your own body’s cells (in this case, the ones that make insulin). Type 1 most often develops in children and teens, but can have its onset at any age; there is no known prevention.
Type 2 diabetes previously tended to develop in adults aged forty and over, but diagnoses among youngsters between the ages of ten to nineteen are currently on the rise. Often exacerbated by obesity and inactivity, type 2 develops when your body’s cells either do not produce enough insulin or they become resistant to insulin (meaning they don’t use it as efficiently as they should). Most people with type 2 diabetes don’t have autoantibodies against their insulin-producing cells, as seen in type 1. People with type 2 diabetes may eventually require insulin, but they also can often manage their blood sugar with exercise, diet, and oral medications (if prescribed).
Though LADA is classified as adult onset type 1 diabetes, unlike its classic siblings, LADA refuses to be clear-cut; instead, it blends qualities from both type 1 and type 2 diabetes into a form that often confuses both patients and experts alike. So here’s what is known about the condition so far:
According to information from both National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and JDRF, LADA tends to develop later than traditional type 1 diabetes: many LADA patients develop it after age thirty. More importantly, people with LADA often lose their insulin-producing beta cells at a slower rate than typically seen in type 1 patients. They do have existing autoantibodies in their blood, like people with type 1, but they still produce their own insulin (albeit in decreasing amounts as the disease progresses). “They tend not to have a family history of type 2 diabetes or to be insulin-resistant, which means that some of the drugs meant for type 2 diabetes may not be effective,” says Stanley Schwartz, MD, an emeritus professor at the University of Pennsylvania Department of Medicine who’s currently investigating LADA in an NIH-funded study.
Researchers seem to view a few characteristics as key to a LADA diagnosis such as the presence of autoantibodies in the blood and adult age at onset. Schwartz acknowledges that some experts think of LADA as a slow-moving form of type 1, but he considers it more of a fast-moving form of type 2. Other endocrinologists believe it’s its own class of diabetes altogether.
One thing that LADA does make clear, though, is the need to have a proactive diabetes care team – no matter what form of diabetes you may have, it is best to be seen by someone who’s going to base your treatment on your individual needs.
Catherine Price is a freelance journalist and type 1 diabetic who has written for The New York Times, Slate, Popular Science, and O Magazine, among others. She blogs about diabetes at asweetlife.org and you can follow her on Twitter @Catherine_Price. Catherine is currently working on a book about the history and science of vitamins, to be published by the Penguin Press. Price is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewee, and not of Sanofi US, its employees, agencies, or affiliates.
© 2013 The DX: The Diabetes Experience