Understanding LADA: A Slowly Progressing Form of Diabetes

October 30, 2023

At Risely, we have been seeing more and more people come through coaching who are diagnosed with diabetes as adults, and many of them have been on quite a journey to get their T1D diagnosis.

This is, in part, because latent autoimmune diabetes latent autoimmune diabetes in adults aka LADA (sometimes referred to as type 1.5), develops most commonly in people over 30 years old, which is why it’s often misdiagnosed - because many health care providers still believe type one diabetes only develops during childhood.

In an article for Beyond Type 1, Ginger Vieria explains the increasingly common situation more and more of our clients are going through:

When misdiagnosed as type 2 diabetes, it can eventually leave you feeling frustrated for years while taking non-insulin medications. (Although research has found that certain diabetes medications can help preserve insulin production in people with LADA.)
Medications and lifestyle changes used to treat type 2 diabetes can be effective for a handful of years in managing LADA—whether or not it’s been diagnosed properly. But as your insulin production declines, these treatment options will not work, leaving you with stubborn high blood sugars.
At this point, insulin becomes just as important to your daily health and management as it is for a person with traditional type 1 diabetes.
Fighting for the correct diagnosis can be frustrating, scary, and exhausting as you struggle with higher blood sugars.
As a person with LADA who hasn’t been properly diagnosed, you may be overwhelmed by feelings of failure, because you’re doing everything you can to manage your blood sugars but nothing seems to be working.

So how do you know if you have been misdiagnosed with T2D or pre-diabetes but actually fall into the LADA category?

The signs and symptoms of LADA include symptoms similar to both type 1 and type 2 diabetes. While LADA is a form of type 1 diabetes, the earliest symptoms are different:
- Brain fog, difficulty concentrating
- Dry, itchy skin
- Tired and lethargic, often after eating
- Constant feelings of hunger, even after eating
The higher blood sugars rise while your insulin production declines, the more you’ll develop the classic symptoms of type 1 diabetes:
- Feeling constantly thirsty
- Needing to urinate frequently
- Changes in your vision
- Tingling in your hands, feet, legs
- Feeling tired and exhausted
- Unexpected weight-loss
- Recurring yeast infections (women)

As you can see, it can be easy to initially overlook the distinction between LADA and type 2. But if you…

  • are not overweight or obese
  • have lost weight without effort
  • do not have metabolic syndrome conditions including high blood pressure and high cholesterol.
  • do not have a family history of type 2 diabetes. (Although, beware, your family members with type 2 could potentially be LADA and never diagnosed properly.)
  • are physically active
  • have made dietary changes and still struggle with high blood sugars

Then you might want to advocate for further testing to ensure the proper diagnosis.

As Ginger writes:

Don’t be surprised if it takes a great deal of coercing your healthcare team to get further testing and a proper diagnosis. Many people with LADA report having to fire their existing healthcare team altogether in order to get a proper diagnosis from a new provider.
With the right testing—and the right healthcare team—getting a LADA diagnosis isn’t actually that difficult.
Research has determined several clear factors to make a LADA diagnosis:

- The patient is over 30 years old.
- The patient tests positive for at least one out of four types of diabetes-related autoantibodies.
- The patient does not need insulin for at least six months after their initial diagnosis (assuming you’re diagnosed properly within the first year of elevated blood sugar levels).
- The potential presence of other autoimmune diseases, including Grave’s disease, celiac, or Hashimoto’s.

Ginger breaks down exactly which tests to request from your doctor to help you get an accurate LADA diagnosis: 

There are a variety of blood tests that can rule out type 2 diabetes and confirm a LADA diagnosis. But the two tests that offer the clearest and most immediate diagnosis of LADA are:

- Glutamic acid decarboxylase (GAD)
- Islet cell antibodies (ICAs)
GAD and ICA testing is looking for autoantibodies—which are the result of your immune system attacking the cells in your pancreas that produce insulin. A person with type 2 diabetes would not test positive for these autoantibodies. (You can also order an at-home autoantibody test-kit from the JDRF for $55.)
While autoantibody testing should be adequate for a LADA diagnosis, other testing can include:

- Hemoglobin A1c test (HbA1c)
- Fasting plasma glucose test (FPB)
- Oral glucose tolerance test (OGTT)
- Random plasma glucose test (RPG)
- Ketone test (performed through blood or urine)
While this list can feel overwhelming, the first two tests should lead your healthcare team to a clear diagnosis very quickly.

Once you have an official LADA diagnosis, what can you expect for treatment? Your insulin production will gradually decline and you will eventually be told to manage your LADA through insulin therapy, blood sugar monitoring, and diet.

This is where many of our coaching members have come to us - after that long road to their diagnosis, they have clarity on the condition but they are left with a lot of gaps in education (how to identify their specific bodies’ patterns), mindset (how to feel confident in their health mentally and physically), and community/relatability (how to feel less isolated with their diagnosis).