LADA - CASE STUDY

LADA - TYPE 1.5 DIABETES

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune endocrine disorder in which despite the presence of pancreatic islets antibodies( like Type 1 diabetes) inside the body, the progression to beta-cell secretory insufficiency stage is slow. Still, it is only a matter of time before it progresses into an insulin dependent phase ( usually from 6 months - 2 years). So, to summarize , basically it's Type 2 diabetes getting rapidly deteriorated into Type 1 diabetes , hence giving it the fancy name of Type 1.5 diabetes.

Because of its rarity and time dependent change in pathogenesis, It's often confused with others types of diabetes and consequently, the control is often insufficient.

Studies have shown that identifying LADA patients early and initiating insulin therapy helps preserve beta cell function. The following case report will demonstrate the progression of a person who was initially identified as having DM2, but eventually was correctly diagnosed with LADA.

LADA vs T1DM vs T2DM

CASE STUDY

At Dr Anirban Biswas clinic for Diabetes (ABCD), we recently dealt with a patient named Varun ( name changed to maintain confidentiality), a 23-yr-old guy with the diagnosis of type 2 diabetes ( made elsewhere) due to the fact that since 6 months , he was having poorly controlled blood sugar levels with a sulfonylurea ( glimepiride).

Initially Varun, was having symptoms of polyuria, polydipsia, some itching around private parts and 6 kg weight reduction. There was no records of any significant past history, or family members suffering from any type of diabetes . But, his mother had been taking treatment for hypothyroidism for the past 12 years and he had a distant relative ( mausa ) who had developed high blood sugar levels after being treated with steroids during his COVID infection. But, now he was doing fine.

There had been no pathologic findings on the bodily examination and laboratory exams have been as follows: 
body mass index (BMI) = 23.6 kg/m,
 Fasting and postprandial sugar = 108, and 276 mg/dL respectively,
HbA1c( glycated haemoglobin) = 9.9%,
Fasting l C-peptide (2 hours) = 1.9 ng/mL,
 HOMA- B(homeostasis model assessment of beta-cell feature): 87.5%, 
HOMA-IR(homeostasis model assessment of insulin resistance): 1.6

The diagnosis of LADA was kept on presumptive analysis and patient was put on insulin therapy with strict SMBG protocol.

Subsequently, LADA was confirmed with the presence of GAD65 autoantibodies.

At the time of prognosis, people with LADA present an onset age <40 (median age ~ 25 years), BMI <25 kg/m2, low - medium postprandial and basal hyperglycemia ( ranging from 150-250 mg/dl), highly variable low normal to close to regular C-peptide values ( 0.9-3.2), and thus not often present with acute hyperglycemic crises.

Initial Insulin therapy preserves pancreatic b-cell function, at the point that finally prescribed insulin doses may need to be reduced.

Studies have shown that identifying LADA patients early and initiating insulin therapy helps preserve beta cell function.

The Warning Signs YOU May Have LADA

1. You are diagnosed with Type 2 diabetes while at a normal weight.

2. Whatever your weight, either you or a member of your family has some other autoimmune disease such as thyroid disease, rheumatoid arthritis, lupus, or multiple sclerosis.

3. You lower your carbohydrate intake shortly after diagnosis to no more than 15 grams a meal and still have a fasting blood sugar over 110 mg/dl and blood sugars that rise 40 mg/dl or more after each meal.

4. No matter what your weight, you do not see a dramatic drop in your blood sugar when you take metformin, and other antidiabetic oral medications in combination with a lowered carbohydrate intake.

5. Your blood sugar deteriorates significantly over the period of a year despite treatment with oral drugs and carbohydrate restriction.

Are you a young Diabetic? Look out for LADA