It's got the rather ungainly name of Latent Autoimmune Diabetes of Childhood (LADA) but many people call it Type 1.5 diabetes. It's a "rather common and often underrecognized form of diabetes whose clinical presentation falls somewhere between Type 1 and Type 2," says S.J. Appel who published a paper on the topic in the Journal of the American Academy of Nurse Practitioners.
A diagnosis of LADA should be strongly considered by doctors in patients who are of normal weight, have hardly any family history of diabetes and who show little evidence of insulin resistance, according to Appel.
LADA starts out very slowly, like type 2, explains Dr. Louis Amorosa, an endocrinologist at Robert Wood Johnson Medical Center in New Jersey. "But these patients are actually developing a type 1 diabetes mechanism," he says.
The typical case, he says, is a thin, active 14-year-old girl who starts losing weight and feeling thirsty and fatigued. Or, it could just as easily be a 35-year-old man with no diabetes in the family. "He or she has an acute loss of insulin production from the pancreas," Amorosa explains. "Here you have a healthy person with little family history who is gradually becoming a diabetic as if he is a type 2, but has the same autoimmunity as we see in a child with type 1."
In contrast to type 2 diabetes, in which the right diet could be therapeutic and prolong quality of life, Amorosa says, the person with LADA will "burn out."
"Despite your efforts with intervention of diet, exercise and medication, the medications are ineffective," Amorosa says. "So then you say to the patient, the only way to improve your blood sugar is to administer insulin. So this patient has burned out right in front of you in about 18 months."
Though LADA is not widely recognized and treated in the United States, according to Amorosa, nothing can be done to prevent its onset anyway.
"You can look at certain proteins in the blood and find a protein that is a marker of the destructive autoimmune process against the beta cells of the pancreas, like type 1," he says. "We don't know how to turn off the immune attack so it is almost academic to find it."
However, it's good to get the diagnosis. "Knowing the patient's exact diabetes type can give the nurse practitioner a much greater understanding of the natural history of the patient's disease, the changes that may occur as the patient ages, and how to optimally manage their diabetes to minimize complications," says Appel. He concluds, "When a patient is correctly diagnosed, they can be empowered to manage their diabetes with appropriate therapies."
