LADA: Should I Be Tested for Diabetes Antibodies?

Latent autoimmune diabetes in adults (LADA) is often misdiagnosed as type 2 diabetes. Here’s how it’s tested and the key differences.

I was diagnosed with type 2 diabetes in 2019, but my case seemed abnormal. My A1C was 10.8% when I was diagnosed, but I was never diagnosed with prediabetes.

My initial diagnosis didn’t match my symptoms, and I wasn’t sure how to tell my primary care doctor or where to start my search for answers.

Hearing about others’ experiences made me realize my doubts were common. Similar symptoms and risk factors have been reported by many people with type 2 diabetes. Later, they were diagnosed with latent autoimmune diabetes in adults (LADA).

Their experiences inspired me to ask my endocrinologist to test for the condition.

The endocrinologist ordered a glutamic acid decarboxylase autoantibodies (GAD) autoantibody blood test. It took a few minutes to get my blood drawn, and then I had to wait 3 days for the results.

My results showed extremely high GAD antibody levels, confirming my suspicions. It was 3 years after I was misdiagnosed with type 2 diabetes that I was diagnosed with LADA.

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What is LADA?

LADA is a slow-progressing form of autoimmune diabetes that occurs in people over age 30.

A 2021 study describes LADA as the body’s immune system attacking and killing pancreatic beta cells more slowly than type 1 diabetes. Since insulin is produced by the pancreas’ beta cells, your body cannot regulate your blood sugar without it.

LADA is sometimes misdiagnosed as type 2 diabetes. In a 2018 research review, they estimated that about 15% of people with type 2 diabetes have LADA.

When LADA is misdiagnosed as type 2 diabetes, it can cause insufficient glycemic control and harm, resulting in diabetic ketoacidosis (DKA).

LADA symptoms are the same as type 1 and type 2 diabetes. However, 2020 research tells us there are certain typical characteristics when you have LADA:

• symptoms start in adulthood (after age 30)
• a family or personal history of autoimmunity
• compared with type 2 diabetes, you have:
  • a lower BMI
  • lower blood pressure
  • normal HDL levels (“good” cholesterol)

In my case, all of these characteristics were true. I was 41 years old at the time of my LADA diagnosis.

Besides gestational diabetes, I had no symptoms of diabetes, nor had I been diagnosed with prediabetes. I was severely underweight at 104 pounds and had normal cholesterol levels. My family also has a history of autoimmune diseases.

What causes LADA?

There are a few causes of LADA. Insulin resistance and unhealthy lifestyle factors may be key to LADA.

Research published in 2019 found that there’s an increased risk of LADA in people with a family history of diabetes, especially autoimmune diabetes.

It‘s unclear what caused my LADA condition, but I have a family history of diabetes. I’ve also experienced psychosocial stress in the last few years, including starting my own business, losing close family members, and having family health problems.

Tests for LADA

Autoantibodies are rarely found in people with type 2 diabetes. People living with LADA have at least one autoantibody.

Four tests are available for diagnosing LADA, the two most common of which are GAD and islet cell autoantibodies (ICA). These tests are used to detect GADs and ICAs in the body. These same tests may detect type 1 diabetes.

My GAD autoantibody test confirmed my levels were over 25,000 units per milliliter (U/mL), higher than the typical range of 0.0–5.0 U/mL.

How is LADA treated?

Lifestyle changes

Since LADA is a slow-progressing disease, many people diagnosed with it do not need insulin at first. The same recommendations for managing type 2 diabetes apply to LADA as well, including eating a balanced diet, doing physical activity, managing stress and weight, and quitting smoking if you smoke.

During my treatment for type 2 diabetes, I followed a strict, low-carb diet and took metformin. Although my A1C level decreased, I felt very lethargic, making it difficult for me to perform daily tasks.

It wasn’t until I was correctly diagnosed that I realized my body wasn’t capable of sustaining this type of diet. I became anemic, malnourished, and was diagnosed with orthorexia after following the wrong diet.

Medications

Oral medications can also be used to lower blood sugar levels in people living with LADA. In contrast to type 2 diabetes, people living with LADA lose their ability to produce insulin.

I was diagnosed with LADA at a very early stage. My A1C level is currently within my target range. I take oral medications, follow a healthier eating plan, manage stress, exercise regularly, and use a continuous glucose monitor to maintain in-range blood sugar levels.

I will be prescribed insulin when my levels consistently fall outside the target range. I also work with a diabetes educator and nutritionist to help me recover from orthorexia.

Takeaway

I regret not addressing my concerns with my doctor after my original diagnosis and seeking a second opinion sooner. I sought a second opinion 3 years after my original diagnosis.

Receiving the correct diagnosis saved me from putting my body at greater risk from my strict, low carb diet.

Don’t hesitate to ask your doctor if you have questions about your diagnosis. Always get a second opinion if you’re unsure.

It’s been important for me to stay informed about LADA through reliable sources, attend educational sessions, or seek reputable support groups.

Contact your care team immediately if you do not see results, your blood sugar numbers are increasing, or you’re experiencing symptoms consistent with LADA. When health concerns are detected and addressed early, complications from a possible misdiagnosis can be prevented.