What is LADA?

[Cluck]

I'm not sure I understand the requirements for 1.5 at all. I looked it up and found the following characteristics:

Adult age at diagnosis (usually over 25 years of age)
Initial presentation masquerades as non-obese type 2 diabetes (does not present as diabetic ketoacidosis)
Initially can be controlled with meal planning with or without diabetes pills
Insulin dependency gradually occurs, frequently within months
Positive antibodies
Low C-peptide levels.
Unlikely to have a family history of type 2 diabetes.


I was 37 (+1), I was too thin but did have ketoacidosis (-1), I required insulin right away (-2), I had positive GAD (+1) and low C-peptides (+1), at the time noone in my family had Type 2 (-1), but my mother has since been diagnosed Type 2 (+1).

So on this basis I'm Type I I guess. It's hard to know.

Any advice or info.?

[foxl]

LADA is a form of autoimmune, Type 1, Diabetes.

I think it can occur in a wide age group -- my MD initially said I could not have LADA, because I was over 50! There are a lot of weird criteria published out there. If you have GAD antibodies, and slower-than-typical onset of insulin dependency, odds are you have LADA.

[Subby]

The only way it really matters for you in your treatment, as far as I can see, is being aware that you might still be producing and that you might either have oscillation of insulin requirements, or a long steady decline. So things like diet and exercise might have more total effect, and there might be less emphasis on insulin, might be the case. Your current usage looks like you are pretty dependent. Do you know what happen if you accidently skip a basal dose? What about if you get a bolus wrong - does your BG go flying off, or does it tend to come back down anyway?

Your C-pep could be useful, if you are really interested you could get another one at some stage to see if there is a decline or trend to observe. If it's really low, you "may as well" be classic type 1, as far as I can tell.

[sarahspins]

After a point, once the auto-immune beta cell destruction is complete, the distinction between T1 and LADA is not important.. LADA is simply a slower developing form of T1... you end up in the same place.

The distinction between the two really, is the presence of ICA antibodies, along with GADA.. if you have both (or all 3 of the antibodies commonly tested for in T1) then you are most likely a classic T1, and not something more complicated... even if the process of going from neeing little insulin, or more, to replacing what your body wasn't making 100% took a while.

I had a relatively LONG honeymoon myself, and not counting when I was pregnant, even when I didn't do a very good job of counting carbs, or even if I missed a meal bolus, I rarely had #'s above 200 (I did go over 200 a lot while pregnant with my first).... once I was out of my honeymoon (18 months after initial Dx), whoa... I knew it, and within literally a couple of months, starting seeing #'s in the 400+ range if I wasn't careful and I needed much more insulin (not enough to suggest IR, but more than the smallish doses I'd been on)... I had to tighten up my management a LOT.

That said though.. I don't seem to be prone to ketosis if I am just running "a little" high.. I have to be high for quite some time and well above 300 to see ketones, or sick (in which case I see ketones at any BG, even normal levels). I've never been in DKA. Some T1's seem to be highly prone to DKA.. while others don't seem to be.

[Cluck]

Thanks for the information. I think you guys are right; guess it doesn't really matter if I was LADA or not. By the time I was Dx I did not make enough of my own insulin to control my BG levels at all and as soon as the antibody results came back I was on Lantus/Humalog. My HbA1c was >13.0. It is possible that I had a slow autoimmune response over a year or so when I was undiagnosed.

My basal insulin requirements haven't really changed that much either over 7 years. I've gone from 7 units of Lantus AM and PM to 9 units of Levemir AM and 8 units PM. My bolus insulin has increased but I also weigh 30lbs more so that is expected.

[foxl]

One other caution -- if your MD ever decides to supplement your insulin with oral meds (ie to lower your TDD of insulin), you DO NOT want to take Sulfonylureas because they might burn out your beta cells more rapidly.

Preserving that beta cell mass as long as possible not only makes therapy much easier, it could mean you have your own cells, if the day ever comes that technology catches up to us.