Reviewed by endocrinologist Stanley S. Schwartz, MD, emeritus Associate Professor of Medicine at the University of Pennsylvania and George Grunberger, MD, FACP, FACE, Chairman of the Grunberger Diabetes Institute, Clinical Professor of Internal Medicine and Molecular Medicine & Genetics at Wayne State University School of Medicine and President of the American Association of Clinical Endocrinologists.
Up to 10%1 of people with type 2 diabetes may actually have a form of diabetes known as latent autoimmune diabetes in adults, or LADA, where the immune system slowly destroys insulin-producing beta cells. That’s the conclusion of a string of studies that have looked at this mysterious high blood sugar problem since it was first recognized by Scottish endocrinologists in the late 1970s.2 Yet 39 years later, most of the estimated 3 million or more Americans with LADA think they’ve got type 2 diabetes. That misdiagnosis can cause frustration, misunderstandings and even health problems, says endocrinologist Stanley S. Schwartz, MD, an emeritus Associate Professor of Medicine at the University of Pennsylvania.
“If your doctor is not thinking about the possibility of LADA, he or she may not prescribe the diabetes drugs early on that could help extend the life of your insulin-producing beta cells,” Dr. Schwartz says. “With LADA, you lose the ability to produce insulin much more quickly than the typical type 2. But a doctor who believes you’re a type 2 may hesitate to prescribe insulin when your blood sugar levels rise, thinking that a healthier lifestyle and higher doses of other medications will work.”
As a result, your blood sugar could skyrocket, increasing your risk for diabetes complications, says George Grunberger, MD, FACP, FACE, Chairman of the Grunberger Diabetes Institute, Clinical Professor of Internal Medicine and Molecular Medicine & Genetics at Wayne State University School of Medicine and President of the American Association of Clinical Endocrinologists.
“If you suspect your type 2 diabetes might be LADA, talk to your doctor,” Dr. Grunberger advises. “The only way to diagnose LADA is to test for the antibodies that show there’s an autoimmune attack on your beta cells,” he says.
Here are 6 signs you might have LADA instead of type 2:
#1. You’re thin. While 90% of type 2s are overweight or obese, those who actually have LADA are often slimmer.3 In fact, some experts have called LADA “slim type 2.” When researchers from Mt. Sinai Hospital in Toronto compared 3,960 typical type 2s with 187 type 2s who tested positive for antibodies found in LADA, the LADA group on average weighed a little less and had slightly smaller waistlines, too.4 And in a 2009 comparison study from The Walter and Eliza Hall Institute of Medical Research in Australia comparing 102 people with LADA to 111 with type 2, 32% of those with LADA were slim (a Body Mass Index below 25) versus 13% with type 2.5
“I generally see two body types in people with LADA,” Dr. Schwartz notes. “Some look like type 1s—they’re quite slim—and may present with diabetic ketoacidosis [a life-threatening condition in which the blood sugar can’t enter cells and levels of damaging ketones in the blood rise] as adults. In my experience, they need insulin sooner to control their blood sugar compared to the second group who are more overweight people with LADA. This second group can often control their diabetes with drugs other than insulin for several years, but may need more of these medications and higher doses as time goes by. Their bodies may produce more insulin for a longer period of time. But carrying extra weight can increase their resistance to insulin, which makes blood sugar control more difficult.
#2. You don’t have metabolic syndrome. Classic type 2 usually comes with other signs of heart-threatening metabolic syndrome such as low levels of protective HDL cholesterol, high levels of blood fats called triglycerides, high blood pressure and belly fat. But that’s not always the case with LADA. When researchers from the UK’s Institute of Cell and Molecular Science in London compared 117 people with LADA to 1,247 with type 2 for a 2009 study, they found that 88% of type 2s had metabolic syndrome compared to 41% of those with LADA. People with LADA were less likely to have low HDLs, high blood pressure and high triglycerides. And their average waist size was 36 inches, compared to 42 for type 2s.6
#3. You’re eating right, exercising and watching your weight but it’s not helping. A healthy lifestyle is always worthwhile, of course. “But if you’re doing everything to take care of your diabetes and your blood glucose levels are rising steadily, this could be a signal that your beta cells are producing less and less insulin,” Dr. Schwartz says. “This can be frustrating and confusing if you think you have type 2 diabetes, but makes more sense if you understand that it’s LADA.”
#4. You’re taking two or even three type 2 medications, your doses are increasing…but your blood sugar is still climbing higher. When you have LADA, your immune system slowly destroys insulin-producing beta cells. This may take as little as 6 months or as long as 12 years. 7 But chances are, you’ll need insulin sooner than someone with classic type 2, whose beta cells survive longer despite assaults from high blood sugar, high levels of blood fats and inflammation. In a 2014 multicenter Italian study of 220 people with LADA and 212 with type 2, 56% of the LADA group needed insulin within seven years of their diabetes diagnosis compared to 20% of type 2s. 8
“If you and your doctor think you’re a type 2, you may spend longer trying out non-insulin medications. Your doctor may suspect that you’re not working hard enough on a healthy lifestyle or don’t take your medications as prescribed. Or, you may not want to move to insulin because it feels like a failure or don’t want to give yourself daily injections or deal with an insulin pump,” Dr. Grunberger says. As a result, you miss out on good blood sugar control for several months or even years, raising your risk for diabetes complications like vision problems and nerve damage. “Understanding that its LADA helps people understand that they will need insulin,” Dr. Grunberger says.
#5: You’re really thirsty, run to the bathroom frequently and are losing weight without trying. In that Australian study, 61% of volunteers with LADA reported frequent urination and/or extreme thirst before their diagnosis compared to 26% with type 2. And 37% reported losing weight without intending to, versus 5% of type 2s. If you have LADA and your blood sugar rises quickly despite treatments aimed at type 2 diabetes, those symptoms may return. People with LADA are also at higher risk than type 2s for diabetic ketoacidosis—a serious condition that can develop when cells cannot absorb glucose due to low insulin levels.9 Call your doctor immediately if you suddenly feel very tired or lethargic, have sudden vision changes, breath that smells sweet or fruity or difficulty breathing. 10
#6. You or someone in your family has an autoimmune disease. Researchers are finding that compared to type 2s, people with LADA are more likely to have autoimmune conditions like Celiac disease, hypothyroidism or rheumatoid arthritis—or to have those diseases or cases of type 1 diabetes in their family.