Latent autoimmune diabetes of adults (LADA), sometimes called Type 1.5 diabetes is a slow-onset version of Type 1 diabetes in adults. 

Adults with LADA has been increasing over the past 10-12 years. Why is this happening? Because there are so many adults with Type 2 diabetes who have been taking diabetic medication for years, causing their pancreas to "wear out" and/or cause their immune system to become dysfunctional.

For Type 2 diabetics, their pancreas is working just fine -- but, it's overtime, producing 2 to 8 times more insulin than non-diabetics. In addition, the diabetic medication does absolutely nothing to stop this excess insulin production and the spread of the diabetes!

The diabetic drug focuses strictly on artificially lowering the person's blood sugar and possibly his/her hemoglobin A1C, while the diabetes continues to spread its damage from cell to cell. 

This artificial lowering of the diabetic's blood sugar gives Type 2 diabetics a false sense of security that the drug is actually working! But, the drug is only controlling the symptom of the disease, not the root cause! As a result, the disease continues to progress and cause more internal damage to the diabetic's cells, tissues and organs.

To make matters worse, the long-term use of diabetic drugs (e.g. metformin, glucotrol) may cause damage to the liver and or kidneys, especially if the liver fails to break down the drug into harmless chemicals.

In the meantime, the diabetic's doctor continues to increase the drug dosage and adds additional drugs until one day the doctor tells the diabetic that he/she has to go on insulin. And, this may eventually evolve into Type 1.5 diabetes (LADA).

In another scenario, a diabetic may take multiple medications for diabetes, high cholesterol (e.g. statin drug), and high blood pressure. This combination of drugs creates a toxic "drug cocktail" that causes harm to the liver, kidneys and especially the immune system. This harm to the immune system may create an immune system dysfunction, which can trigger an autoimmune response, which, in turn, can lead to an autoimmune disease such as Type 1 diabetes or Type 1.5 diabetes.

In a different scenario, as the diabetes progresses, the immune system may start to fail, causing an autoimmune dysfunction that can morph into a thyroid problem, lupus, Type 1.5 diabetes or some other autoimmune disease.

The bottom line here is that the reliance on drugs to lower one's blood sugar causes additional health problems that makes it even more difficult to control one's blood sugar or requires that the person go on insulin because the diabetic pills have lost their effectiveness.

In other scenarios, some Type 2 diabetics may be initially misdiagnosed as having Type 2 diabetes, but, they found out years later that have LADA. People with LADA do not have insulin resistance, which is a key characteristic of Type 2 diabetes. Also, people with LADA do have autoimmunity dysfunction, which is a key characteristic of Type 1 diabetes.

The National Institutes of Health (NIDDK) defines LADA as “a condition in which Type 1 diabetes develops in adults.” LADA is primarily a genetically-linked, hereditary autoimmune disease that results in the body mistaking the pancreas as foreign and responding by attacking and destroying the insulin-producing beta islet cells of the pancreas.

It is imperative that Type 2 diabetics struggling with LADA change their diet immediately to a plant-based nutritional program such as the Death to Diabetes program. The longer you delay, the more damage that will occur or is occurring.

In addition, it is imperative to address the autoimmunity before it gets out of control. Use the Death to Diabetes program in conjunction with the targeted foods and supplements identified on the Autoimmune Diseases web page.

From a medical perspective, LADA differs from Type 1 diabetes in that the disease progresses gradually. People with Type 1 diabetes are typically completely dependent on insulin within 12 months of diagnosis.

By contrast, many people with LADA still produce some insulin and may not require insulin injections for several years following diagnosis. They are often able to control their blood sugar through meal planning, oral medication, and lifestyle changes.

As the disease progresses and the beta cells are further damaged, the pancreas produces less and less insulin. There tends to be a gradual increase in insulin requirements, positive antibodies, and decreasing ability to make insulin as indicated by a low C-peptide.

People with LADA have increased levels of glutamic acid decarboxylase antibodies (GAD Ab), an autoimmune marker of an attack on the cells that produce insulin. Eventually this leads to an absolute lack of insulin. It is this insulin deficiency that identifies type 1 diabetes. This late-onset type of type 1 diabetes is known as 'latent autoimmune diabetes of adults', 'slow onset type 1', or 'type 1.5 diabetes'.

The National Institutes of Health estimates that 10 percent of people who have been diagnosed as type 2 diabetics may actually have LADA. A misdiagnosis of this nature can lead to months or even years of incorrect treatment, putting patients at a risk of further complications and frustrations as they attempt to find the best approach for controlling their diabetes.

If you’ve been diagnosed with type 2 but your ability to control your blood glucose with lifestyle changes and oral medications has diminished over time, you should first find an effective diet that will help you. Specifically, find a diet that addresses the cell inflammation, immune system dysfunction, and other biological root causes of the diabetes -- a diet that includes vegetables, juicing, detox, etc. and excludes grains, milk, flour, etc.

If the diet doesn't help you, it may be the wrong diet. Otherwise, you may want to ask your doctor to test you for LADA.

Depending on the aggressiveness of the immune attack on the insulin-producing beta cells of the pancreas, people with LADA progress to need insulin injections at varying rates. Most people with LADA will be on insulin within six years of the time of correct diagnosis.

However, although controversial, we believe that the early introduction of eating healthy plant-based foods and avoiding "trigger" foods may preserve the remaining insulin-secreting beta cells for longer.

Diagnosis of LADA

It is estimated that 20% of persons diagnosed as having non-obesity-related type 2 diabetes may actually have LADA. Islet cell, insulin, and GAD antibodies testing should be performed on all adults who are not obese that appear to present with type 2 diabetes. Not all people having LADA are thin, however—there are overweight individuals with LADA but who are misdiagnosed because of their weight.

Moreover, it is now becoming evident that autoimmune diabetes may be highly underdiagnosed in many individuals who have diabetes, and that the body mass index levels may have rather limited use in connections with latent autoimmune diabetes.

Also, many physicians or diabetes specialists don't recognize LADA or probably don't know the condition actually exists, and so LADA is misdiagnosed as or mistaken for Type 2 diabetes highly often.

C-peptide: This test measures residual beta cell function by determining the level of insulin secretion (C-peptide). Persons with LADA typically have low, although sometimes moderate, levels of C-peptide as the disease progresses. Patients with insulin resistance or type 2 diabetes are more likely to, but will not always, have high levels of C-peptide due to an over production of insulin.

Autoantibody panel: Glutamic acid decarboxylase (GAD) autoantibodies, radioimmunoassay (RIA) and insulin antibodies, radioimmunoassay, RIA are commonly found in diabetes mellitus type 1.

Islet cell antibodies (ICA) tests: Persons with LADA often test positive for ICA, whereas type 2 diabetics only seldom do.

Glutamic acid decarboxylase (GAD) antibodies tests: In addition to being useful in making an early diagnosis for type 1 diabetes mellitus, GAD antibodies tests are used for differential diagnosis between LADA and type 2 diabetes and may also be used for differential diagnosis of gestational diabetes, risk prediction in immediate family members for type 1, as well as a tool to monitor prognosis of the clinical progression of type 1 diabetes.

Insulin antibodies (IAA) tests: These tests are also used in early diagnosis for type 1 diabetes mellitus, and for differential diagnosis between LADA and type 2 diabetes, as well as for differential diagnosis of gestational diabetes, risk prediction in immediate family members for type 1, and to monitor prognosis of the clinical progression of type 1 diabetes. Persons with LADA may test positive for insulin antibodies; persons with type 2, however, rarely do.

Other characteristics of LADA that may aid in a proper diagnosis include:

  • Onset usually at 25 years of age or older
  • Initially mimics non-obese type 2 diabetes (patients are usually thin or of normal weight, although some may be overweight to minimally obese)
  • Oftentimes, but not always, a lack of family history for T2DM (family history for type 2 diabetes is sometimes involved regarding a latent autoimmune diabetic adult)
  • Persons with LADA are insulin resistant like, but at prevalence levels less than, Type 2
  • Human leukocyte antigen (HLA) genes associated with type 1 diabetes are seen in LADA but not in type 2 diabetes
  • Although some people having type 2 diabetes may inject insulin, this only rarely happens; in contrast, people with LADA require insulin injections around three to 12 years after so called type 2 diabetes diagnoses

Medical Treatment for LADA

LADA often does not require insulin at the time of diagnosis and may even be managed with changes in lifestyle in its early stages such as exercise, eating right, and, if optional, weight loss. However, some clinicians believe that insulin should be started at onset or as soon as possible, rather than using sulfonylureas or other diabetes pills for initial treatment.

Moreover, it is not clear whether early insulin therapy is of benefit to the remaining beta islet cells. Also, some studies now indicate that some of the diabetic drugs may lead to beta cell dysfunction.

Initially, a person with LADA may respond to oral diabetes medications, eating right and lifestyle changes, although beta cells continue to be damaged and LADA patients should be closely monitored.

Some studies have demonstrated that the use of sulfonylureas and the insulin-sensitizing drug metformin, may increase the risk of severe metabolic disorder and beta cell dysfunction in persons with LADA. When blood glucose can no longer be managed through lifestyle and medications, daily insulin injections will be required.

80% of persons initially diagnosed with type 2 but test positive for GAD (an indication of LADA) progress to insulin dependency within 6 years (some sources say between 3–12 years after diagnosis). Those who test positive for both GAD and IA2, however, will progress more rapidly to insulin dependence.

Living with any chronic illness is stressful, and patients with diabetes, let alone LADA, may be more prone to depression and eating disorders as a result. Counseling, therapy, and participation in support groups can play an important and positive role in the lives of persons with LADA.

Part of diabetes therapy should include patient education about diet, exercise, stress management, immune dysfunction, and handling their diabetes on "sick" days.

Patients need to understand how to manage their diabetes, as well as how to address their autoimmune dysfunction. In addition, patients need to understand how to recognize, treat, and prevent hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) and how to give injections of insulin and glucagon. Blood glucose levels should be checked at least 4 to 6 times per day if a patient wants to manage their diabetes more effectively.

Causes of Autoimmune and Beta Cell Dysfunction

Despite many of the scientific advancements that have been made in diabetes pathology, there is still a lack of understanding about how the immune system attacks healthy cells, causing various autoimmune diseases such as Type 1 diabetes, multiple sclerosis, lupus and celiac disease.

Some of the causes of autoimmune dysfunction include the following: 

  • Viruses
  • Bacteria, Fungi, Parasites, Other pathogens
  • Infections
  • Environmental/chemical toxins, e.g. heavy metals, pesticides
  • Chronic inflammation
  • Oxidative stress
  • Lack of sunlight (Vitamin D deficiency)
  • Nutrient deficiencies, e.g. Vitamin A, Omega-3s, iodine
  • Food intolerances, e.g. gluten, grain, cow's milk, dairy
  • Leaky gut syndrome
  • Stress and anxiety (stress hormone imbalance)
  • Heredity or genetics

Some of the causes of pancreatic beta cell (β) dysfunction include the following:

  • Diabetic drugs such as Glucophage, Glipizide, Glucotrol, and Amaryl either wear out the beta cells or cause damage to these cells.
  • High blood glucose levels and excessive oxidative stress damage a key enzyme that guards insulin-producing beta cells.
  • Chronic exposure to hyperglycemia can lead to beta cell dysfunction that may become irreversible over time, a process that is termed glucose toxicity.
  • A high-carb diet or a diet full of processed foods and fast foods may lead to beta cell dysfunction.

Note: There are 5 stages of progression associated with most cases of beta cell dysfunction. Refer to the Death to Diabetes Blog for details.

Alternative Health Strategy for LADA

In order to reduce and possibly eliminate the need for drugs, consume a plant-based diet that provides foods/nutrients that help to nourish and possibly regenerate the damaged beta cells or "wake up" the dormant beta cells.

Nutritional Strategy to Fight LADA

An effective nutritional strategy must address overall diabetes management, blood glucose control and autoimmune system dysfunction.

Follow a plant-based diet (such as the Death to Diabetes Diet) that includes green, leafy and bright-colored vegetables, such as broccoli, Brussels sprouts, spinach, kale. If possible, eat organic vegetables to reduce your toxic load exposure to pesticides and other chemical toxins.

Make sure that you add key foods and supplements that help to fight most autoimmune diseases (especially leaky gut) including: fermented vegetables, wheat grass, bone broth, extra virgin coconut oil, chlorella, spirulina, l-glutamine, collagen protein powder,and unprocessed cod liver oil.

In addition, include anti-inflammatory foods such as wild salmon, sardines, blueberries, and extra virgin olive oil.

Also, eat herbs, foods and use compounds with antiviral properties such as echinacea, licorice root,astragalus; garlic, onions, lemons, turmeric, extra virgin coconut oil, and medicinal mushrooms; and colloidal silver.

Maybe just as important, make sure that you avoid the "trigger" foods, drugs, toxins, and chemicals that may trigger autoimmune dysfunction and damage the beta cells, e.g. white flour (alloxan), wheat, gluten, grains, cow's milk, most dairy, vegetable oils, canola oil, legumes/nuts, some diabetic drugs, and possibly other OTC/prescription drugs.

Use raw juicing to help get key nutrients into your cells and to help strengthen and rebalance your immune system.

Perform a periodic cleanse and detox to help remove accumulated toxins within your cells that may contribute to chronic inflammation and excess oxidation.

In addition, use nutritional supplements to complement your nutritional program, e.g. l-glutamine, Vitamin D3, Vitamin B-Complex.

However, always try to obtain your vitamins and minerals from the food first before opting for a supplement.

As mentioned on the Type 1 Diabetes web page, use some of the following nutrients, which have been identified to possibly help regenerate the insulin-producing beta cells:

-- Arginine
-- Avocado
-- Berberine (found in bitter herbs such as Goldenseal and Barberry)
-- Biotin
-- Bitter Melon
-- Curcumin (from the spice Turmeric)
-- Gymnema Sylvestre (“the sugar destroyer”)
-- Niacinamide (Vitamin B3)
-- Nigella Sativa (“black cumin”)
-- Sulforaphane (especially concentrated in broccoli sprouts)
-- Swiss Chard
-- Vitamin D3

Next Steps to Wellness

Before you reach a point where you are totally relying on the drugs to manage your diabetes, get one or more of the following books to help you (the sooner, the better):

Use these books in order to address more effective diabetes management, proper blood glucose control and autoimmune system dysfunction without the need for diabetic drugs.

And don't forget: As long as you rely on the drugs, you will always be diabetic and your body will continue to deteriorate and rot from the inside out -- until one day you find yourself having to deal with one or more health problems with your eyes, kidneys, feet, nerves, heart, brain, etc.

And, those health problems will eventually evolve into one or more of the major diabetic complications, e.g. blindness, amputation, kidney failure, heart attack, stroke, etc.

Don't let this happen to you. Stop it now, while you can!

Diabetic Complications

References

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  3. ^ "Diabetes mellitus: a guide to patient care"; page 20; Lippincott Williams & Wilkins; August 1, 2006; ISBN 978-1-58255-732-8
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  15. ^ What is LADA, retrieved 2009-11-22
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  17. ^ Family History and LADA (Report). PubMed. Retrieved Jan 23, 2010.
  18. ^ Chiu HK, Tsai EC, Juneja R, et al. (August 2007). "Equivalent insulin resistance in latent autoimmune diabetes in adults (LADA) and type 2 diabetic patients". Diabetes Research and Clinical Practice 77 (2): 237–44. doi:10.1016/j.diabres.2006.12.013. PMID 17234296.
  19. ^ MD Consult Clinical Review, retrieved Nov 21, 2009
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