LADA: The Epidemic Your Doctor Doesn't Know About

The past few weeks my inbox has been filled with letters from desperate people with diabetes whose doctors have completely failed them.

They have blood sugars that continue to climb no matter what they eat. They ask me why when they eat no carbs at all their blood sugars are still over 140 mg/dl hours after a meal.

They are on all the oral drugs and sometimes even Byetta, but their blood sugars still go into the 300s.

Some have histories of Gestational Diabetes that came on when they were thin. Some gained a lot of weight very recently but were normal weight before that.

All have relatives with diabetes. Some have relatives with Type 1 diabetes. Most have relatives with other autoimmune disease.

And all of them, it turns out, though diagnosed with Type 2 diabetes and given the miserably ineffectual medical treatment doctors give people with Type 2, turn out to have LADA.

This isn't a guess on my part. Quite a few are writing to me after finally convincing their doctors to give them C-peptide tests or antibody tests. Others are responding to tiny doses of basal insulin which would not do anything for a person with Type 2.

I know that the reason I hear from so many people with LADA is because I discuss LADA on my web site, HERE. There is almost no other information on the web about slow adult onset autoimmune diabetes, so it makes sense that when people are finally diagnosed with it, they let me know.

But my impression that there is a hidden epidemic going on is not just because of all the mail I get. There are plenty of people with LADA posting on TuDiabetes.com and the other diabetes boards.

Most of the people who have a relatively easy time getting diagnosed with LADAs are young and thin. That is because their weight sometimes (but not always) raises the suspicion in the minds of their doctors that they don't have Type 2.

But the people I hear from who are having a really tough time getting a proper diagnosis are those who are struck with autoimmune diabetes in middle age, after they have experienced the usual middle aged weight gain that 95% of the normal population experiences. Because they are overweight, doctors refuse to consider the possibility that they don't have the kind of diabetes they mistakenly believe is "caused by obesity." (To read why they are mistaken, read THIS.)

If you are 20 lbs overweight when you develop autoimmune diabetes, the chances are very good you will not get your diagnosis of LADA until you end up in the ER with Diabetic Ketoacidosis (DKA), a condition so serious that if you do not get to the ER when you have it, you are likely to die.

I'm hearing from people misdiagnosed with Type 2 who have ended up in the ER with DKA. People with real Type 2 do not get DKA though if their blood sugar rises high enough they can develop another dangerous condition called hyperosmolar hyperglycemia which also requires hospitalization.

There has been a huge increase in the incidence of all autoimmune conditions over the past decade. The number of children with Type 1 diabetes is predicted to double over the next decade. (Details HERE.) It has already much more than doubled compared to its incidence even 30 years ago.

Researchers have also documented sharp rises in the incidence of many other autoimmune diseases including autoimmune thyroid disease, rheumatoid arthritis and multiple sclerosis.

Why? No one knows, and very little effort is being invested in finding out, because there isn't money in it for investors. Not only that, but the chances are very good that the toxic contamination of our air, water, and food supply by industrial chemicals, pesticides, pharmaceuticals,and plastics may have something to do with it. Which is not something industry is going to pay money to learn.

Whatever the explanation for the huge rise in the incidence of authoimmune conditions, it is time someone educated physicians about slow onset autoimmune diabetes a.k.a. LADA. Misdiagnosing people with LADA exposes them to years of debilitating poor health. In fact the one thing that everyone with LADA who writes me says is how exhausted, wretched and sick they felt through the years when they were misdiagnosed.

Patients with LADA are not producing insulin and their cells, including brain cells, are starving. They need basal/bolus insulin regimens, and they need them as soon as possible. They also need high quality diabetes education that will teach them how to use insulin properly to maintain good control and avoid hypos.

Studies have shown that on average it takes 4 years for a person with LADA to get to where they are completely insulin dependent--and likely to develop DKA without insulin. For too many of these people, those 4 years are being spent receiving the mediocre treatment (or lack of treatment) doled out to Type 2s. They are told to lose weight. They are told to exercise and eat low fat diets. They are given oral drugs and told to keep taking them even when they are having no effect on blood sugars.

If you have a family history of autoimmune disease or a form of diabetes that is not responding well to carb restriction and oral drugs, read THIS PAGE. Write down the names of the three kinds of antibody tests. Demand that your doctor order the antibody tests and a C-peptide or fasting insulin test.

Don't believe it when a doctor tells you that you are a Type 2 unless you show near normal amounts of C-peptide and despite having diabetes for a year do not have any diabetic antibodies. (The antibody tests may be negative until you have had autoimmune diabetes for a while.) If you are given Lantus and your fasting blood sugars responds to a dose that is less than 30 units, consider asking for C-peptide tests too. Typical doses of Lantus that will have an impact on someone with classic Type 2 diabetes range from about 30 to 100 units a day with the very low dose only found in people who are small and eating low carb diets.

If your doctor won't order these tests, find a new doctor.

My guess is that there is a hefty chunk of overweight people diagnosed with "garden variety" Type 2 who actually have autoimmune forms and who would benefit from insulin supplementation. The most recent statistic I saw was that something like 8% of people diagnosed with Type 2 turn out to have diabetes-related antibodies. It is not impossible to be insulin resistant and to have an autoimmune form of diabetes. But all people with autoimmune diabetes will, after four or five years show lower than normal levels of fasting C-peptide.