An article on LADA from DiabeteCare.net. http://www.diabetescare.net/content_upclose_detail.asp?id=446639&utm_source=DC.net+-+Providers+Newsletter&utm_campaign=3e74ccd084-DC_net_Provider_Newsletter_
As a registered dietitian and certified diabetes educator with 32 years experience specializing in diabetes: Gestational, type 1 diabetes, type 2 diabetes and LADA. LADA? Well there is no “official name” for this type of diabetes, and I have been “calling it” type 1 ½ diabetes for years!
LADA (latent autoimmune diabetes of adults) is a name used to describe this different type of diabetes. Soon, I am sure, an official designation will be given. For purposes of this article, I will call it LADA.
LADA appears to be a cross between type 1 diabetes and type 2 diabetes. Type 1 diabetes has an autoimmune component and causes the beta cells of the pancreas to stop making insulin. It used to be called Juvenile diabetes because it is often diagnosed abruptly in childhood or teen years. Many people with type 1 diabetes are not overweight or overfat. People with type 1 diabetes require insulin injections or infusion to live. Oral medications do not work for those with type 1.
Type 2 diabetes usually occurs in adults…although children are increasingly being diagnosed with what used to be called Adult Onset diabetes. Type 2 diabetes does not happen abruptly, it has a progressive onset. Many people who develop type 2 diabetes are overweight or overfat, especially around the middle. They have had years of “OVER producing insulin. These years of over insulin production made them fat in the middle and in the blood (cholesterol/triglycerides) and, over time, left them resistant to their own insulin. Over years, their own insulin is less effective and the pancreas is pressed into making more and more insulin…even as blood sugar rises! As a result, the pancreas fatigues and ultimately, the person with type 2 diabetes does not make enough insulin and the insulin they do make does not work effectively. They can be treated with diet and exercise, diet, exercise, and oral medications or diet, exercise, oral medications, insulin.
LADA can occur in children or adults, but is usually diagnosed in the adult population. The patient is not necessarily overweight with midline fat. They present at normal weight with high blood sugar. Oral medications may initially work to bring blood sugar down. But…gradually (in shorter order than typical type 2’s, the oral medications become ineffective. Even high doses of orals and multiple types of orals become ineffective. Progressively, blood sugar worsens and insulin is prescribed. These patients may or may not be insulin resistant. They can develop what seems like type 2 (because of their age) as older adults. Gradually, less and less insulin is produced until they appear to have type 1 diabetes….with a twist. LADA progresses more gradually than the abrupt onset of type 1.
I have found that the typical diet for diabetes (50-55% carbohydrate, 20-25% protein, remainder fat) hastens the progression of LADA. A dietary intake the is top heavy with carbohydrate content makes the beta cells in the pancreas work harder and speeds up pancreas burn out.
I teach all of my patients with pre diabetes, LADA, or type 2 diabetes on a 3 step lifestyle program. I wrote about it in my two books: The Metabolism Miracle and The Diabetes Miracle.
When it comes to LADA , I agree that Lantus or Levimir is excellent for use at bedtime as it can be used to regulate fasting blood glucose readings without over-working a fatiguing pancreas.
With the exception of metformin (that works best for cases involving insulin resistance/ type 2 diabetes), most oral medications work by causing the pancreas to work harder pumping out more and more insulin. Over time, the pancreas will literally “poop out.”
In the case of LADA, we are not looking to hasten pancreas fatigue. Patients with LADA have an autoimmune slow destruction of the insulin- producing cells in the pancreas; the beta cells. Keep in mind that the pancreas is also involved in the release of glucagon to help blood sugar rise during the night and between meals. We need that pancreas working as long and as efficiently as possible…for both its insulin production as well as its glucagon production. If oral medications are going to speed up the demise of the beta cells…it’s best not to use oral medications for LADA!
So, I like Levimir or Lantus at bedtime, titrated until the patient has normal fasting blood sugar. (90-110). Then, they begin Step 1 of the 3 Step “Metabolism Miracle” or “Diabetes Miracle” diet.
Step 1 is 8 weeks of a low carbohydrate plan that allows the liberal intake of foods that don’t provoke spikes in blood sugar….like lean proteins, heart healthy fats, most veggies AND 5 grams Counter Carb at each meal and bedtime. During this time, the nighttime Lantus or Levimir is often the only insulin required as the meals are not causing a rise in blood sugar. Because we make sure that patients eat within 1 hour of wake up, 1 hour of bedtime, don’t have long gaps between meals…their liver does not over-release glycogen. Again, this rests the pancreas/liver even further. So Step 1 is a restful, rehabilitative state for the pancreas/liver and helps to settle down metabolic mayhem.
At the end of the 8 weeks of Step 1, blood sugar is normalized on as little Levimir/Lantus as possible. Then we move to Step 2.
In Step 2, a specific amount of low glycemic index carb is added to all meals and bedtime AND between meals that exceed 5 hours. In this way, we control the carb grams coming in AND keep the liver from over-releasing glycogen. The patient is in control of blood sugar! If insulin is needed to accommodate the carb grams, it’s VERY easy to determine the insulin/carb ratio with a small amount of quick acting insulin prior to the meal.
After 8 weeks of carb integration in Step 2, we move to Step 3…Maintenance. Guess what? Maintenance is a totally BALANCED diet! Not 50-55% carb that is so difficult for this patient’s pancreas to handle! The program is equal parts carb, lean protein, healthy fat, and lots of neutral veggies. The amount of carb is determined by gender, height, desired weight, and activity. Such an easy lifestyle. About 33% of each nutrient gives the patient with LADA a well balanced, nutritionally complete dietary intake with blunted blood sugar rise and less stress on the pancreas/liver for a lifetime.
So…the core program in The Metabolism Miracle or Diabetes Miracle with night time insulin and eventually, if needed, short acting insulin for meals or correction of high pre meal readings is the ticket to quickly and easily treating patients with type LADA.
You will be hearing more and more about LADA as it, as well as type 2 diabetes, appear to be linked to Alzheimer’s Disease. Check out my 2 part series on Alzheimer’s Disease from DiabetesDaily.com: