A surprising number of people who are joining the online diabetes community after recent diagnoses are people who have been diagnosed with a new form of diabetes which is called LADA, which stands for Latent Autoimmune Diabetes of Adults. It is neither Type 1 or Type 2, but is often called "Type 1.5."
Typically, a person with LADA goes to the doctor sometime after the age of 35 and is told they have type 2 diabetes. They are put on oral drugs like metformin or Avandia and almost nothing happens. If they read up online and cut their carbs their blood sugars do improve, but even so, over time they continue to rise.
Within an average of four years, they have no insulin production left at all. At this point they must go on insulin. But the Lantus-only regimens most doctors prescribe--the ones that work well for many people with Type 2 diabetes--do not stop the inexorable rise in their blood sugars, and eventually they end up needing the full basal/bolus treatment that Type 1s use.
That's because LADA is really a slow-developing form of Type 1. The body mounts an immune attack on the pancreas and wipes out the insulin producing cells. The difference between LADA and classic Type 1 is the speed with which this happens. In young Type 1s a person can go from normal to completely whacked in a week. People with LADA may take up to a decade to lose all their insulin-secreting capacity.
People with LADA are often thin, so if you are thin and are told you have Type 2 diabetes, you should demand the antibody tests that are used to diagnose LADA. The antibodies tested for are: GAD antibodies, Islet cell antibodies, and more rarely, tyrosine phosphatase antibodies.
But not all people with LADA are slim. People with defective autoimmune genes are also prone to get thyroid disease and rheumatoid arthritis both of which can promote obesity, the first because incorrectly treated thyroid disease will make you fat and the latter because it limits mobility and hence the ability to exercise and because it is often treated with steroids that promote weight gain.
People with LADA benefit from being put onto full basal/bolus insulin regimens as soon as possible. There's some evidence that injecting insulin may turn off the immune attack on the beta cells and preserve them.
But because overweight people with LADA are universally diagnosed as having Type 2 they are almost always denied insulin treatment until they have spent years with extremely high blood sugars. This isn't because they are overweight, it's because that's the treatment given to ALL people diagnosed with Type 2 whose doctors allow them to maintain criminally high blood sugars for years out of a misguided belief that insulin will worsen, not better, their insulin resistance.
Genetic testing recently revealed that people with LADA have similar immunity-related genetic errors to people with juvenile onset Type 1 diabetes but that they also have defects in a gene, TCF7L2, that are frequently found in people with Type 2. Since just about every LADA I've ever met is thin, this suggests to me that there are probably a lot more people out there who are carrying Type 2 diagnoses who have LADA than we realize who are not getting diagnosed correctly because of their weight and because that TCF7L2 gene may cause enough insulin resistance to make them look like a classic Type 2.
I have to wonder though, WHY we are seeing so many people developing what was an extremely rare syndrome just a few decades ago. Is it better diagnosis, or is it the same thing that is driving the huge increase in the number of kids getting autoimmune diabetes? My guess is the latter, and though there is officially no explanation for this, my guess is that it has a lot to do with the environmental pollutants that saturate our bodies. Plastics, industrial chemical residues, pesticides, PCBs, etc.
Many genetic flaw--for instance those that lead to cancer--do not manifest in overt disease until the borderline-defective gene takes a hit from some environmental exposure. Chemicals, radiation, and viruses can all cause cancer in people with defective genes, and probably they cause autoimmune diabetes in people with defects in their autoimmune genes.
This is likely because even among identical twins who share genes, it is possible for one twin to develop autoimmune diabetes while the other remains normal. So my guess is that many of us have carried slight abnormalities in our autoimmune genes that did not get those extra hits until we started filling our world with plastics and the other toxic chemicals that are now found in our blood, tissues and even, as I blogged earlier, in mothers' milk.
The Warning Signs YOU May Have LADA
1. You are diagnosed with Type 2 diabetes while at a normal weight.
2. Whatever your weight, either you or a member of your family has some other autoimmune disease such as thyroid disease, rheumatoid arthritis, lupus, or multiple sclerosis.
3. You lower your carbohydrate intake shortly after diagnosis to no more than 15 grams a meal and still have a fasting blood sugar over 110 mg/dl and blood sugars that rise 40 mg/dl or more after each meal.
4. No matter what your weight, you do not see a dramatic drop in your blood sugar when you take metformin, Avandia, Actos, Januvia or Byetta in combination with a lowered carbohydrate intake.
5. Your blood sugar deteriorates significantly over the period of a year despite treatment with oral drugs and carbohydrate restriction.
What To Do To Get A LADA Diagnosis
If you think you have LADA ask your doctor for:
1. A fasting C-peptide test. If the value is low, it is suggestive of LADA.
2. GAD and Islets antibody tests. High levels of these antibodies are diagnostic of LADA especially in combination with lowered C-peptide.
The Next Step
Many doctors assume patients will do anything to avoid shots and delay giving people insulin. If you have LADA you want to go on a full-fledged Type 1 insulin regimen as fast as possible.
The sooner you start insulin the easier it will be to control your blood sugar with insulin for many years to come. And by injecting insulin you may be able to stop the attack on your beta cells completely. This is essential because technologies are emerging that might be able to stop the immune attack permanently and even regrow your beta cells. But for these treatments to work you need to have living beta cells. The longer you delay insulin, the fewer beta cells you will have left.
Insulin shots are painless and if you have been running high blood sugars for a while, you will feel much, much better once you start using insulin to get normal blood sugars.
Get Support From Others with LADA
There are lots of people with LADA active on all the online discussion boards that provide diabetes support. If you have LADA be sure to seek out others because their personal experiences will be extremely helpful to you once you start working on adjusting your insulin doses and diet.
You can find people with LADA at Tudiabetes.com, Diabetes Daily Forums, and Diabetesforums.com. LADA is usually discussed in the "Type 1.5" area.
No comments:
Post a Comment