Many doctors are not familiar with the Diabetes Lada , so many patients with this disease are initially diagnosed as type 1 diabetes or type 2 diabetes. Therefore, they could receive inappropriate treatment.


This confusion starts from the fact that lada diabetes has common features both with one and the other.Therefore, some researchers call it diabetes 1.5.


In this article we will give you the necessary guidelines to know when to suspect if you have it, and what to do with it.

What is Lada?


lada (adult autoimmune latent diabetes, for its acronym in English) is a type of antibody diabetes (called autoantibodies ) that, by mistake, attack and destroy the beta cells insulin producers of the pancreas.

Differentiation with type 1 diabetes


Type 1 diabetes is also an autoimmune disease, produced by similar pathophysiological mechanisms.Therefore, many researchers consider that Lada is a variety of type 1 diabetes.
However, half of the patients with type 1 diabetes are diagnosed at 20 years or less, while most of Lada are diagnosed between 30-50 years of age.


Type 1 diabetes develops in a short time, in a matter of days or weeks, and the patient deteriorates rapidly.In contrast, lada takes months or years before the patient presents symptoms, because the pancreas continues to produce some amount of insulin.


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Differentiation with type 2 diabetes


Compared to type 2 diabetes, patients with Lada tend to be younger, thinner and with worse glycemic control (LAUGESEN et al., 2015) .Half of patients with type 2 diabetes are diagnosed at 55 years of age or older.

If the patient has a strong family history of type 2 diabetes and obesity, it is most likely that it is type 2 diabetes, even if the patient is thin.In case of doubts, an antibody test Gada (Dr. Anne Peters, 2012) .

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Because Lada gradually develops, many patients are diagnosed as type 2 diabetes. In a review it was found that 9% of patients diagnosed with type 2 diabetes, really had Lada.The importance of establishing an early diagnosis is that patients with Lada will need insulin earlier than in type 2 diabetes.


Diagnosis of Lada


There is no international consensus for the diagnosis of Lada.However, there are certain guidelines that we can take into account:


Clinical presentation


The following characteristics can help us suspect Lada:



  • age .At the time of diagnosis, most LADA patients have between 30-50 years age.By contrast, half of patients with type 1 diabetes are 20 years old or less, and half of patients with type 2 diabetes have 55 years or more.


  • weight .Patients with Lada tend to be thinner than those who have type 2 diabetes. But eye!That does not mean that there may be patients with obesity.


  • glycemic level .There is a great variation of the glycemic level at the time of diagnosis: from ketoacidosis to mild hyperglycemia that does not require insulin.


  • Metabolic state .In Lada there is generally a better metabolic state than in type 2 diabetes, with triglyceridesLess high, HDL cholesterol (higher "good" cholesterol), lower abdominal circumference and lower prevalence of arterial hypertension.In Lada there is also less insulin resistance.



Generally, it is not possible

Laboratory


The following laboratory tests help establish the diagnosis of Lada:



  • autoantibodies .The autoantibodies that are present more frequently are anti -decarboxylase of glutamic acid (GADA).The anti-antibodies (ICA), antibodies against insulinoma-associated (IA-2) and antibodies against zinc transporter (ZNT8) (Wikipedia) .


  • peptide c .The C peptide measures the insulin secretory capacity of the pancreas.In Lada, at the beginning of the disease it tends to be normal, but decreases over time.


  • quantos ri .Measure insulin resistance.It is usually normal in Lada, and elevated in type 2 diabetes.



Complications


The most important acute complication is the ketoacidosis , which can occur at the beginning or during any time of the disease.

The microvascular complications chronic (retinopathy, nephropathy and neuropathy) are as frequent as in type 2 diabetes. However, the cardiac infarction is less frequent in Lada.


Lada treatment


There is no agreed guide for the treatment of Lada, and this depends on the doctor's preference.But here we will offer the most accepted treatment standards.


There is a wide range of possibilities depending on the stadium for the development of the disease.If the patient is diagnosed early, diet and exercise may be all he needs.But most patients also need oral

hypoglycemicism .

Eventually, all patients require insulin .Some doctors prefer to use it early in the disease to preserve the secretory capacity of the pancreas.

Non -insulin treatment


There are 2 types of popular non -insulin medications: metformin and therapies based on incretins .The sulfonylureas are not indicated.


Incredine -based therapies can be of 2 types:



  • DPP-4 inhibitors .They are oral medications that work neutralizing the DPP-4 enzyme, allowing the natural incredines of our body to work for a longer time.Its effect is to increase insulin secretion and decrease glucagon.Examples of these medications are: Sitagliptin, linagliptin and saxagliptin.


  • Analogues of the LPG-1 .They are injected medications, as are insulin, by subcutaneous route.LPG-1 analogues also decrease blood glucose by stimulating insulin production and inhibiting glucagon.


    • Insulin -based treatments


    There will come a time when patients treated with oral medications will need to complement each other with a slow insulin dose.The dose and the frequency of insulin will need to increase according to needs.

    When the insulin secretory capacity of the pancreas is exhausted, these patients will need a treatment scheme similar to type 1 diabetes, either with multiple insulin doses or with a insulin pump .