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When you hear about diabetes, you probably think about types 1 and 2. But have you ever heard of “type 1.5” diabetes? This term is sometimes used to describe latent autoimmune diabetes in adults (LADA), which shares many aspects of type 1 and type 2 diabetes. However, there are some key differences to know.
This article will cover the basics of LADA, including who’s at risk of developing it, its symptoms, and its treatments. To learn more about LADA and whether you may have it, talk to your doctor or endocrinologist (hormone specialist).
LADA is a type of diabetes caused by the immune system attacking the beta cells of the pancreas. These beta cells make the hormone insulin. Other cells in your body use this insulin like a key to a lock to “open” the door to your cells to let in blood glucose (sugar). Glucose is your body’s preferred form of energy.
In people with type 1 diabetes and LADA, the pancreas can’t make enough insulin to keep up. Type 2 diabetes develops when you don’t make enough insulin or your cells don’t know how to properly use insulin (called insulin resistance). Glucose can’t get into your cells without insulin, so it builds up in your bloodstream. Eventually, people with diabetes develop dangerously high blood sugar levels.
LADA is known as type 1.5 diabetes because it shares causes and symptoms with types 1 and 2. We’ll explore these more in detail below.
Your immune system helps protect you from bacteria and viruses. Sometimes, it makes mistakes that lead to autoimmune diseases. In LADA, your body makes specialized proteins known as autoantibodies. These proteins recognize your own healthy cells as foreign invaders and attack them.
People with LADA have autoantibodies that target the beta cells in their pancreas. These cells make and release insulin. Type 1 diabetes is also linked to beta cell antibodies. However, people with LADA have lower autoantibody levels compared to those living with type 1 diabetes. In people with LADA, it also takes longer for the immune system to attack and destroy the beta cells. People with LADA still produce some insulin when initially diagnosed.
Research shows that most people with LADA have only one diabetes autoantibody present — most commonly glutamic acid decarboxylase (GAD) antibodies. Less common autoantibodies found in people with LADA include those that target:
Certain groups of people are more likely to develop LADA than others. Remember that LADA and type 1 diabetes are similar to one another. Doctors diagnose a large portion of type 1 diabetes cases in children and teenagers. However, since the damage to beta cells is slow in LADA, it tends to start in adults between ages 30 and 50. This is why LADA is known as a latent form of diabetes.
Your genetics also play a role in your risk of LADA. Everyone inherits DNA with genes (instructions) from each parent. Some of these genes affect how your immune system tells your cells apart from foreign invaders. As with type 1 diabetes, a person with LADA may inherit certain genes from a parent that predisposes their body to attack their own pancreas cells. Researchers are still learning more about the exact connection between LADA and genetics.
Type 2 diabetes tends to develop in people with certain risk factors, including:
Some studies show that a person may be more likely to develop LADA if they have these risk factors. Others show that a person with LADA may have a BMI that’s not considered to be in the obese or overweight range.
Many of the symptoms of LADA overlap with those of type 1 and type 2 diabetes. At first, you may notice that you’re feeling more fatigued than usual. Your fatigue can get worse after eating. You might also still feel hungry even after eating a large meal. This is because your body can’t use glucose for energy, so your brain tells you that you’re running low on fuel.
As your LADA progresses, you may start urinating more often. Your body gets rid of the extra blood sugar in your urine. However, the sugar also takes water along with it. You’ll start to feel extremely thirsty as a result. Some people also experience blurry vision and brain fog (trouble thinking or concentrating).
It’s also common to lose weight with LADA. Your body can’t use food as fuel, so you begin breaking down fat and muscle for energy instead. You may start to notice you’re becoming thinner — even without trying.
If you start experiencing symptoms of diabetes or LADA, call your doctor’s office. They’ll run tests to measure your blood sugar levels. LADA is difficult to diagnose — often, doctors accidentally diagnose people with type 2 diabetes instead. This is because the pancreas can still make insulin in the early stages of LADA.
As the disease progresses and your blood sugar levels keep rising, your doctor may want to check your treatment plan or do additional testing. They’ll likely order a blood test to measure your autoantibody levels. People with type 2 diabetes don’t have autoantibodies, so this test will help confirm that you have LADA.
Doctors are still looking for the best way to treat LADA. Your treatment plan will depend on how high your blood sugar levels are. You’ll also need to check your blood sugar levels throughout the day to keep them in a healthy range. Be sure to work closely with your health care team to stay healthy and prevent diabetes complications.
When living with LADA, it’s important to make healthy lifestyle changes. Your doctor may recommend losing weight or eating a healthier diet as the first treatment. While these changes can’t prevent your immune system from attacking your pancreas, they can help control your blood sugar levels for some time.
After being diagnosed with LADA, many people don’t need insulin initially because their pancreas still works. You’ll likely need to start insulin therapy as the immune system destroys more beta cells. Most people with LADA will need treatment at some point in their disease. Many start insulin injections sooner than they would if they had type 2 diabetes.
Oral medications like metformin may also help treat LADA. Metformin commonly treats type 2 diabetes. It makes your cells more sensitive to insulin and can lead to weight loss. Depending on your diabetes risk factors, autoantibodies, and markers like C-peptide, your doctor can decide a line of treatment for you. Sticking with your metformin treatment can also lower your risk of complications related to diabetes.
Keep in mind that the U.S. Food and Drug Administration (FDA) hasn’t approved metformin specifically for treating LADA. However, a consensus statement by an international expert panel discusses the use of metformin and other hypoglycemic drugs in certain people living with LADA. Your doctor may prescribe it off-label (outside of its approved use).
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Sarika Chaudhari, M.D., Ph.D.
completed her medical school and residency training in clinical physiology at Government Medical College, Nagpur, India.
Learn more about her here.
Emily Wagner, M.S.
holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology.
Learn more about her here.
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