What is LADA?
Type 1 diabetes is a disease characterized by a loss of insulin producing capacity as a result of an autoimmune response that targets and destroys beta-cells in the pancreas. Onset of Type 1 diabetes typically occurs in childhood or adolescence. LADA is a recognized subset of diabetes that possesses a similar pathology and set of symptoms as Type 1 diabetes, with the distinction that onset occurs in adulthood and is often marked by a slower and less dramatic loss of pancreatic function. Type 2 diabetes, in contrast, is characterized more by lack of sensitivity to the effects of insulin, rather than significant or total diminution of insulin producing capability.
Like all forms of diabetes, LADA results in an increase in mean blood glucose levels as a result of the reduced production of insulin, which acts as a mediator for glucose concentration in the blood. And although the pathological mechanism may be different, the course of treatment is similar for all types of diabetes. The first course of action for all diabetics is to lower dangerous high blood glucose concentration and to reduce variability in blood glucose concentration resulting from diet and lifestyle patterns, both of which also affect glucose levels in the blood.
How is LADA diagnosed?
If an adult begins having a fasting blood glucose concentration >125mg/dl or a random or post-prandial glucose concentration >200mg/dl and the onset of these occur during adulthood the presumption would be a diagnosis of Type 2 diabetes, rather than Type 1, which is characterized by juvenile onset.
The accepted course of action, depending on how dramatic the increase in serum glucose, is to place the patient on glucose management medication such as Metformin and in more severe cases, begin an exogenous insulin regime. In all cases of adults being diagnosed with these glucose concentrations, obtaining further blood tests to determine the existence of auto-immune antibodies, most notably GADA or ICA antibodies, is often employed to further assist with a diagnosis. An indication of at least two positive anti-body tests is a strong indication of auto-immune-related islet-cell deficiency characteristic of a Type 1 diabetic. If onset of the symptom occurs in adulthood this would be a basis for diagnosis of LADA.
How is LADA different from Type 1 diabetes?
Because LADA is a much rarer occurrence than the juvenile-onset Type 1 form of diabetes, LADA is only recently receiving attention in the medical scientific literature. But this growing body of research indicates that LADA is marked by several characteristics other than onset in adulthood that distinguish it from Type 1 diabetes.
- The loss of beta-cell function in those diagnosed with LADA often progresses more slowly than the rapid beta-cell dysfunction seen in Type 1 diabetics. [ Hernandez M 2015 – Spain ] [ Howson JM 2011 – England and Germany ]
- Because diminution of insulin producing capability in LADA patients is still present in varying capacity in a LADA diagnoses, treatment options to both slow the destruction of beta-cells, to possibly repair or revitalize dormant or damaged beta-cells and to more effectively control blood glucose concentration are more effective in LADA patients and in newly-diagnosed Type 1 diabetics than in most Type 1 diabetics. [ Brown RJ 2008 – USA ] [ Kandasamy 2012 – England ] [ Lima-Martinez 2014 – Venezuela, USA, Canada ]
- Because patients diagnosed with LADA often still have some insulin-producing capability, exogenous insulin will often not be mandated by symptoms or biomarkers and LADA patients will usually require lower doses and depending on diet, could eliminate the need for insulin boluses before or after meals. [ Rosário 2007 – Brazil ]
Can LADA be cured?
Although the official stance of mainstream medicine is that there is no cure for Type 1 diabetes that results in remission of pathological cause and symptoms, there is an increasing body of clinical evidence that patients diagnosed at Type 1 diabetics can with proper diet and medication reverse insulin dependence, and in some cases, effectively reach a state of remission.
The prognosis for remission is even more favorable in those diagnosed with LADA since many, if not most, still maintain some level of beta-cell function and capacity to produce insulin for many years after they are initially diagnosed. The importance of early diagnosis, initiation of an insulin regime, and a treatment plan that involves dietary and lifestyle changes that not only facilitate mediation of high serum glucose concentration but preserves the existing function of beta-cells by limiting the need for insulin production by the pancreas.
What treatment plan will best benefit LADA patients?
Again, the fact that LADA patients are characterized in the early stages after diagnosis with some degree of continuing capability to produce insulin, evidence supports the immediate recommendation of a treatment plan that reduces the stress on existing beta-cell function by lowering the need for endogenous insulin with the following components:
- An appropriate low-carb diet strategy that reduces the need for endogenous insulin by lowering blood glucose spikes at meals.
- Implementing a meal composition and timing strategy that reduces blood glucose spikes at meals
- Immediate initiation of an exogenous insulin regime, even where oral medications might be sufficient to mediate blood sugar fluctuations that do not necessarily reduce the burden of endogenous insulin production by the pancreas.
- Immediate initiation of PPT-4 inhibitor regime, a medication that, although expensive, has seen promising results in laboratory and clinical trials to reduce diminution of beta-cell function
- Test the efficacy of high-grade probiotics
[Click on the links in each bullet-list item to see the details for each of these promising treatment strategies with details on the science supporting this line of treatment.]
The Takeaway
Individuals diagnosed with LADA are unique in that this subgroup of diabetics often possesses continuing, although diminished ability to produce insulin. Accordingly, unique treatment strategies targeting preservation of and regeneration of beta-cell function in the pancreas hold more promise for this type of patient. The key to successful treatment is a comprehensive strategy that immediately reduces the need through a combination of medication and lifestyle and dietary changes.
