Iam hearing every day from news articles and medical reports that LADA diabetics are a cross between Type 1 and Type 2. According to D-life we are between Type 1 with Type 2. We have gad auto-antibodies and yet we have some insulin resistance?, Do we? we are called double diabetics by d-life but as i understand it, if you have LADA - you are insulin deficient - not resistant. we have antibodies that are destroying our insulin. This makes no sense to me at all.so i would like you Type 1.5 out there to speak out - this is important!
i want your opinions please . Do you LADA diabetics have insulin resistance???
There is a growing disparity here - athough we have LADA awarness week, D-Life are still saying LADA is a mix of Type 1 and Type 2 combined, Are they right or wrong?
No! We are definitely not a combination of Type 1 and Type 2; that is a common misconception. (and the reason I hate the term 1.5). You are correct, LADA is a form of Type 1 which is characterized by insulin deficiency and is an autoimmune condition. There are some LADAs who have, or later develop insulin resistance of course. But this can also happen to regular type 1’s, especially if they eat very high carb, take more and more insulin and gain weight. That is what becomes known as a “double diabetic”. So, no, LADA is a subset of Type 1, the only difference being slower onset and later in life.
I actually watch the show dlife all the time and I have never heard them say that. I was always glad that they spoke intelligently about LADA.
Btw I think the reason some people believe LADA is a “combination of type 1 and type 2” is because of the slower onset. It is “in between” type 1 (very rapid/sudden onset) and type 2 (very gradual onset). But being an autoimmune disease is the key distinction of all type 1’s, so we are type 1’s.
Agree with Zoe here
Actually, there are as many as nine identified MODY forms (http://en.wikipedia.org/wiki/Maturity_onset_diabetes_of_the_young). The testing, while gene sequencing, is not particularly difficult. In the US, it is apparently a total ripoff, but there is a center in Exeter, UK which will perform the tests for apparently a reasonable expense (perhaps a tenth of the cost in the US).
Onset of Type 1 in babies is faster than onset of Type 1 in teens. Some Type 1 children also have IR. Many, many people with Type 1 diabetes also have the (very) common genes associated with Type 2 diabetes. No one says that these various groups are somewhere in between Type 1 and Type 2.
People become irrational and apoplectic about LADA because it is far more common than childhood-onset autoimmune diabetes. They want to cling to their myth that Type 1 diabetes is a childhood disease.
My point: LADA is not somewhere in between Type 1 and Type 2, it is Type 1 autoimmune diabetes according to the Expert Committee’s and WHO’s definition of Type 1 diabetes.
LADA and 1.5 are not officially, medically recognized terms. LADA is Type 1 autoimmune diabetes, according to the Expert Committee/WHO definition. MODY is associated with monogenetic defects in β-cell function, and the Expert Committee identifies MODY in a category separate from Type 1 and from Type 2 (“Genetic Defects of the Beta Cell”). Although the stats I have seen indicate that MODY is about 1-2% of all cases of diabetes, I suspect the percentage is actually higher, but as JohnG points out it takes some fancy testing to correctly diagnosis it, thus MODY is probably undercounted.
And Blammo. I am wrong again. There are now eleven types of MODY (http://www.ncbi.nlm.nih.gov/omim/606391). As Melitta points out, the categories LADA and 1.5 are wacko. Some of the forms of MODY are reflected in type 2 like symptoms and there is a lot of interaction between different genes (polygenic). While the “Expert Committee” may think that MODY is T2 with genetic defects of the beta cell, many researchers believe that T2 as a whole can probably be described as caused by genetic defects of the beta cell. The ones who truly don’t have the defect are the ones who are very overweight, yet not diabetic.
Looking back at D-day (yes only 2 months) sitting in my primary care office and hearing the nurse say your sound like your diabetic then testing my sugar 505 or 550 (kind of a hazy day). My LPN comes in looking over my records and asks “Your mother had gestational that developed into Type-1?” “Yes” I replied “she was in her late 20s early 30s” she hands me a cup and asks if I can fill it. Duh I could fill the cup every 15 minutes at this point.
A little later she comes back and says I am testing positive for antibodies not normally found in type-2s and points out the last time I was in 2 years ago my sugar was slightly elevated but on the follow up it was normal. Later that night in the ER I hear the term Adult onset Type-1 once I get in my room start searching the web and learn the term LADA/Adult onset and Slow onset diabetes. Now I just have to remember to ask my endo about Multiple Endocrine Neoplasm syndromes since my thyroid is also shot. But to the point I don’t think we are a mix of t-1 and t-2. Subset of t-1 yes. Just now wish I had gone to the Doctors more often
Ok, I’m going to be incendiary. I think most LADA’s, particularly before proper diagnosis are probably Insulin Resistant, but that does not make them T2.
What is insulin resistance?
Insulin resistance is a decrease in the effectiveness of the signaling for insulin production and response to insulin. It can take the form of reduced uptake of glucose from the bloodstream, but it can also take the form of increased liver production of glucose and problems in regulating fasting blood sugar levels (hypothalmus problems).
Can T1s (and LADAs) have insulin resistance?
Yes, T1s and LADAs can have insulin resistance. If your blood sugar goes high, you become insulin resistant (http://diabetes.diabetesjournals.org/content/41/5/571.short), that happens with T1s and it happens with LADA. Many long-term T1s have noted their insulin resistance. Further, I’d like to make the observation that a fair number of newly diagnosed T1s/LADA note that oral medications “worked,” also that they had high insulin use and weight gain in the first months as they gain control. Where do you think that comes from? Insulin resistance?
Are all T1s and LADAs insulin resistant?
No, but ongoing hyperglycemia is a recipe for insulin resistance.
Are LADAs often insulin resistant?
I suspect the answer is “yes.” The ongoing sporadic and declining insulin production causes hyperglycemia and that alone causes insulin resistance. So before proper diagnosis, whgen you have ongoing hyperglycemia, you become insulin resistance and you actually can respond to oral medications.
If they do, does that make them T2?
It really depends on your definition of T2. In my opinion, T2 is what is called a diagnosis of “exclusion.” If you are not T1, then you are T2. If you are diagnosed as autoimmune, then by definition you are T1 and are not T2, even though you may be insulin resistant.
Is it possible to be a T2, to be normally insulin sensitive and to just be insulin deficient?
Yes. T2 is a diagnosis of exclusion.
That was very informative, bsc… thanks for sharing. 
One of the problems is LADA is slower develeping T1 than that is seen in children . There is often a period of time that the LADA does not need to take insulin and people assume that makes it like T2 . Some are calling T1’s who develope insulin resistance as well Type3 diabetes.
She just had me fill a cup. They had taken blood when I first came in. Could of been referring to me being in dka. But they do have an in house lab. Like I said the day was a bit of a blur.
I think there is just plain LOTS to be learned. We are all trying to fit into so few catagories when in fact there are so many different genes that affect glucose.
While genes don’t affect glucose, they clearly affect the glucose regulation mechanisms (such as with MODY) and they related in some big way to autoimmunity (and autoimmune T1 in particular). Dan Hurley in his book “Diabetes Rising” discusses various correlations. There are some very specific genetic markers which are highly correlated with T1 diabetes and if you have them you are at higher risk of T1. Other sorts of genetic connections have been found for T2.
For the mix… idiopathic type 1 diabetes for me.
http://www.nejm.org/doi/full/10.1056/NEJM200002033420501#t=article
This is quite an interesting article. What I don’t understand about the study population is that it seems that a very high proportion the newly diagnosed type 1 patients do not have antibodies present. The article further cites two sources as supporting the notion that 10% of newly diagnosed T1s don’t have antibodies. What is not clear is whether this form of T1 is autoimmune (just without the known antibodies) or another form of T1 (not autoimmune).
Another article…
http://www.bentham.org/emi/samples/emi3-1/0006EMI.pdf
Slow-Onset, Insulin-Deficient and Idiopathic (Sb)
This form of diabetes corresponds to insulin-deficient
Type 2 diabetes. Individuals with extensive insulin secretory
defects, and therefore no residual insulin secretion, require
insulin for survival. It is classified into the “slow-onset,
insulin-deficient and idiopathic (Sb)” type of diabetes in this
classification. The Sb type of diabetes is thus a form of Type
2 diabetes, not Type 1 diabetes.
I find this article quite confusing. Why would you categorize Sb as type 2? I find this classification approach based partly on the presentation of symptoms just odd. In contrast, the approach taken in http://care.diabetesjournals.org/content/26/suppl_1/s5.full seems to attempt to focus more on the causes. The literature talks about type 1 as being characterized by beta-cell destruction and the insulin deficiency in the definition of Sb could also be from beta-cell destruction.