Adam’s Journal
Here’s a question from a reader:
I read an interview with someone who said they were diagnosed with type 1.5 diabetes. What is this disease exactly?
Susan Kovats
Dr. Scofield Prescribes
As its name suggests, type 1.5 diabetes – now known as latent autoimmune diabetes (LADA) – is a form of the disease that shares characteristics with both type 1 and type 2 diabetes.
Let’s start with a quick overview of the two types of diabetes people know best. Type 1 is an autoimmune disease that most often takes hold in childhood. Type 2 more typically develops later in life, usually due to a combination of factors like genetics, excess weight, physical inactivity and age.
Both of these forms of diabetes are marked by problems with insulin, a hormone that turns food into energy. In both, your body can’t make enough insulin or can’t use it properly. This leads to high blood sugar, which can require lifelong insulin treatments.
LADA is a slowly progressing form of autoimmune diabetes. It develops when the body’s immune system mistakenly begins attacking the cells that produce insulin. So, in this way, it is like type 1 diabetes.
However, the disease usually develops in adulthood, most commonly over the age of 30. This later onset is a characteristic LADA shares with type 2 diabetes. And like type 2, LADA progresses slowly.
As a result, physicians often mistake LADA for type 2 diabetes. An estimated 4-14% of patients diagnosed with type 2 diabetes may actually have LADA.
So, what does this mean?
If LADA is misdiagnosed as type 2 diabetes, doctors frequently start patients on non-insulin treatments. And while these approaches – which include the drug metformin, various inhibitors, and GLP-1 drugs like Ozempic and Mounjaro – can be effective for type 2 diabetes, they don’t help people with LADA.
For LADA, the course of treatment mirrors that for type 1 diabetes: beginning low-dose insulin injections and controlling blood sugar through diet and exercise. And like type 1 diabetes, LADA requires this therapeutic regimen to continue throughout a patient’s life.
If a person starts showing symptoms of diabetes later in life – excessive thirst, frequent urination, unexplained weight loss – chances are it’s type 2. However, it could be LADA. Some of the telltale clues are what’s not there: high blood pressure, excess weight, a family history of type 2 diabetes, a response to non-insulin drugs. If some or all of these factors are missing, LADA may be the answer.
Dr. Hal Scofield is a physician-scientist at the Oklahoma Medical Research Foundation, and he also serves as Associate Chief of Staff for Research at the Oklahoma City VA Medical Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
