What is Latent Autoimmune Diabetes in Adults (LADA)?

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What is Latent Autoimmune Diabetes in Adults (LADA)?

Learn what latent autoimmune diabetes in adults is, LADA signs and symptoms, and how to manage your type 1.5 diabetes with continuous glucose monitoring.

Latent autoimmune diabetes in adults, also known as LADA, describes a form of diabetes that develops over many years and shares similarities with both type 1 and type 2 diabetes.¹ LADA is sometimes referred to as “type 1.5 diabetes” because it’s an autoimmune condition like type 1 diabetes (T1D) but it’s diagnosed later in adulthood, which is typically associated with type 2 diabetes (T2D). Diabetes Canada includes LADA in its definition of T1D rather than considering it a separate condition.

LADA is a nuanced condition, and its treatment will vary by person and their symptoms for both T1D and T2D treatments. Understanding what makes it different from T1D and T2D can help provide a little clarity about what’s going on in your body so you can have a productive conversation with your doctor about what you’re experiencing when seeking a diagnosis and developing a treatment plan.

What makes LADA different from type 1 and type 2 diabetes?

LADA sometimes appears to be T2D at first, but it ultimately has the same underlying cause as T1D. Like T1D, LADA is caused by an autoimmune event that destroys the cells in the pancreas, called beta cells, that produce insulin.^1,2 Insulin is the hormone in the body that regulates how glucose, or sugar, is used for energy in the body. Without beta cells, the pancreas can’t produce the insulin the body needs so it can absorb and use glucose from food.³

T1D is most often diagnosed in children and adolescents, with peaks in diagnosis typically occurring between the ages of 4 and 7 or between 10 and 14.⁴ Those who experience LADA are usually around or over the age of 30.⁵

On the other hand, in T2D, the pancreas can still produce insulin, but it is unable to make enough insulin to effectively regulate glucose or the body isn’t able to use the insulin that’s available, which is known as insulin resistance.^6,7 T2D is not an autoimmune condition. A variety of factors contribute to the development of T2D and, similar to LADA, it progresses over time, which is one of the reasons why people with LADA might be diagnosed with T2D at first.⁷

When individuals are diagnosed with LADA, they have the same autoimmune response as in T1D, but they usually do not yet require insulin treatment when they are diagnosed, a circumstance that’s more common with people diagnosed with T2D.7 Individuals living with LADA typically need to start depending on insulin about six months after their initial diagnosis as their beta cells are depleted. A healthcare provider must test for the antibodies (the proteins in the immune system that protect the body ) that destroy beta cells to confirm whether an individual is experiencing LADA or T2D.^7,8

Common Symptoms of LADA

The first symptoms of LADA can include:¹⁰

Feeling more fatigued than usual, especially after eating
Brain fog
Getting hungry soon after eating

As insulin production slows down, you might experience other symptoms that look more like undiagnosed T1D. A non-exhaustive list of these symptoms includes:^8,10

Feeling very thirsty and being unable to quench your thirst
Urinating frequently
Experiencing blurred vision
Experiencing tingling nerves
Losing weight

A doctor might also look at whether you or your family has a history of other autoimmune conditions to diagnose LADA.⁸

How do know if you have LADA and not T2D?

Everyone living with diabetes experiences it differently. If you’ve been recently diagnosed with T2D, you’re likely adapting to your treatment plan and shifts in your lifestyle. It’s a good idea to keep checking in with yourself and your doctor about whether your treatment is working for you and whether you’re feeling better than before you started treatment.

It’s critical to continue to communicate with your doctor about your symptoms even if you have been diagnosed with T2D because the treatments that work for T2D (such as diet or lifestyle changes) will not be effective if your pancreas is not producing insulin anymore. If you have developed LADA, getting treatment with insulin in addition to lifestyle changes may be a vital part of maintaining your health.⁸

The Immunology for Diabetes Society (IDS) has three specific criteria that can help healthcare providers determine whether someone is experiencing LADA:⁸

The individual is in their 30s
They are positive for the antibodies that attack beta cells
They did not need to depend on insulin for at least 6 months after the initial diagnosis of T2D

Discussing your symptoms and talking to your doctor about being tested for T1D-related antibodies can help you get an accurate diagnosis so that you and your doctor can determine the right treatment options.

Taking the First Steps on Your Diabetes Journey

Receiving a LADA diagnosis may come as a complete shock, especially because it’s diagnosed later in life. Living with diabetes requires lifestyle changes and it’s important to acknowledge that it can be stressful to implement those changes. However, there are plenty of tools and resources that you can lean on to empower you to take control of the way you manage diabetes.

Your doctor is your guide and will collaborate with you to develop a diabetes management plan that will address your unique needs. They can provide you with more information about diabetes and help you understand how to support yourself through your diabetes journey.

In addition to your doctor, you can build a network of care that might include a dietitian that specializes in diabetes as well as other healthcare professionals who can help you manage both the physical and emotional aspects of living with diabetes.

There is also a thriving community of other individuals living with diabetes, including our Dexcom Warriors, and plenty of diabetes education resources online that can light the path along the way. A few great educational resources to get started with include:

Managing Glucose When You’re Living with LADA

A major part of living with any type of diabetes is regulating your glucose levels and making sure that you limit the amount of time you experience hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). There are many factors that influence changes in blood sugar, and they include diet, activity, and sleep. You and your doctor will work together to determine your ideal glucose levels, which is known as your target glucose range (generally defined as being between 3.9–10.0 millimoles of glucose per litre of blood, or mmol/L¹¹).

Your doctor will keep an eye on whether your glucose is within a healthy range using a blood test called an A1C test which measures your average glucose levels over the three previous months.¹²They will work with you to determine an A1C goal to guide your diabetes management plan. For most adults, Diabetes Canada recommends an A1C below 7.0%.¹¹ Part of your A1C goal might be setting a target glucose range you’ll aim to stay within on a daily basis. Spending more time in range (TIR) is associated with an improvement in A1C levels. To increase your TIR, you need to understand what affects your glucose levels throughout the day so that you can make adjustments to your habits and discuss changes to your insulin doses with your doctor.

One of the ways to measure your glucose levels on your own outside of appointments is with a continuous glucose monitoring (CGM) system. CGM systems use a sensor inserted just below the skin to measure glucose levels in the body on a continuous basis, day and night, so you don’t need to perform routine fingersticks to see where your glucose is at.*

The Dexcom G7 CGM System makes it easy to view your glucose levels in the palm of your hand on a receiver or compatible smart device using the Dexcom G7 app.^† This can be especially helpful when you’re keeping an eye on whether T2D treatments are working to stabilize your glucose levels over time or if you might need to explore the possibility of LADA with your doctor.

To ensure that you’re effectively managing your glucose levels, you can also set up notifications to tell you when you’re outside your target range and be alerted up to 20 minutes before you’re likely to head into serious hypoglycemia (≤3.1 mmol/L). Dexcom G7 also has a built-in alarm that lets you know when you’ve dropped below 3.1 mml/L. This can help give you greater peace of mind that you’ll be able to take proactive action to stay in range as often as possible.

Dexcom CGM can help you increase the time you spend in your target range and reduce your A1C.^14,15 Learn more about how Dexcom CGM can support your glucose management as you move through your diabetes journey.

1 Punthakee Z, et al. Diabetes Canada Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42(Suppl 1):S10-S15. doi:10.1016/j.jcjd.2017.10.003
2 Type 1 diabetes. Diabetes Canada. Accessed January 25, 2023. https://www.diabetes.ca/about-diabetes/type-1
3 What is diabetes? Diabetes Canada. Accessed January 25, 2023. https://www.diabetes.ca/about-diabetes/what-is-diabetes
4 Type 1 diabetes: Symptoms and causes. Mayo Clinic. Updated July 7, 2022. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/
5 Buzzetti R, et al. Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes. 2020;69(10):2037–2047. doi:10.2337/dbi20-0017
6 Type 2 diabetes. Diabetes Canada. Accessed January 30, 2023. https://www.diabetes.ca/about-diabetes/type-2
7 Understanding Insulin Resistance. American Diabetes Association. Accessed January 30, 2023. https://www.diabetes.org/healthy-living/medication-treatments/insulin-resistance
8 Rajkumar V, et al. Latent Autoimmune Diabetes. StatPearls Publishing. Updated June 21, 2022. https://www.ncbi.nlm.nih.gov/books/NBK557897/
9 Antibodies. Cleveland Clinic. Updated May 6, 2022. https://my.clevelandclinic.org/health/body/22971-antibodies
10 Diabetes LADA. Diabetes.co.uk. Updated June 10, 2022. https://www.diabetes.co.uk/diabetes_lada.html
11 Imran AS, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Targets for Glycemic Control. Can J Diabetes. 2018:42(S42–S46). doi: 10.1016/j.jcjd.2017.10.030
12 All About Your A1C. Centers for Disease Control and Prevention. Accessed January 30, 2023. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
13 Vigersky RA, et al. The Relationship of Hemoglobin A1C to Time-in-Range in Patients with Diabetes. Diabetes Technology & Therapeutics. 2019;21(2):81-85. doi: 10.1089/dia.2018.0310
14 Beck RW, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA. 2017;317(4):371-378. doi: 10.1001/jama.2016.19975
15 Welsh JB, et al. Accuracy, Utilization, and Effectiveness Comparisons of Different Continuous Glucose Monitoring Systems. Diabetes Technol Ther. 2019;21(3):128-132. doi: 10.1089/dia.2018.0374

Learn what latent autoimmune diabetes in adults is, LADA signs and symptoms, and how to manage your type 1.5 diabetes with continuous glucose monitoring.

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