Nutritional Endocrinology Practitioner Training (NEPT)
Clinical Pearl
April 24th, 2016 

Latent Autoimmune Disease in Adults

I will be speaking for the Canadian Holistic Nutrition Society in May. The conference is focused on autoimmune diseases. I am talking on the little-talked-about connection between insulin resistance and autoimmune disease and discussing an autoimmune diabetes that comes on in adulthood called LADA – Latent Autoimmune Disease in Adults.

I discuss LADA in the blood sugar module, IRSPT: Insulin Resistance Solution Practitioner Training, and there I list the blood tests that help detect it.

LADA is often misdiagnosed as type 2 diabetes. A few things tip you off to look again, and I’ve developed my own protocol for assessment.

Here are some differentiating factors to help you recognize the difference between LADA and insulin resistance/metabolic syndrome/type 2 diabetes:

1. Fat distribution: LADA people are often thinner than the classic type 2 diabetic. Type 2 diabetics are usually overweight with fat distribution around the middle. LADA people are often lean.
2. Fasting insulin: Type 2 diabetics usually have high fasting insulin; LADA have low.
3. Postprandial insulin (after meals): Type 2 diabetics usually have a big spike in insulin levels after meals; LADA people often have very little.
4. Response to oral blood sugar lowering medications: Type 2 diabetics usually respond well. At least initially, LADA people often need multiple medications and, after a short while, tend to not do so well thus are often put on insulin.

 

These are some of the common differentiators. If you suspect LADA, there are a few blood tests you can do to confirm.

Often, I do the fasting and postprandial insulin measures to determine if their pancreas is making too much or too little insulin.

If the fasting and postprandial insulin are both low, I then need to differentiate between type 2 diabetes that’s resulted in pancreatic failure from excess insulin production, or LADA where the pancreas is under autoimmune attack.

 

The tests for LADA are:

• anti islet cell antibodies
• anti insulin antibodies
• GAD antibodies (glutamic acid decarboxylase, an enzyme that converts glutamic acid to GABA, and is produced by the pancreas)
• c-peptide which is an indicator of insulin production

 

The full panel runs over $500, so if budget is a consideration and the client doesn’t have insurance coverage, I often start with one of the antibodies and explain that they may need to go back and get tested again if the test is negative.

The bottom line: Keep your eyes and ears open, ask the right questions, and when someone comes in who’s relatively lean, says they are on multiple medications, their blood sugar is still not controlled, and the doctor is suggesting insulin — think “LADA”.