(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . Kos Diabetes Group: LADA and MODY [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.'] Date: 2024-02-02 I would like to thank 1BQ for suggesting this diary. We’ve all heard of Type 1 and Type 2 diabetes and probably most people have also heard of gestational diabetes but there are a couple other types of diabetes that fall between Type 1 and Type 2 diabetes which are commonly referred to as LADA and MODY. What is LADA? Latent autoimmune diabetes of adults (LADA) is a type of diabetes which seems to straddle Types 1 and Type 2 diabetes. Bits of it are more like Type 1, and other bits are more like Type 2. It is often called Diabetes 1.5. It’s not actually classified as a separate type of diabetes at the moment, but there's some medical research going on to try and pinpoint exactly what makes it different from Type 1 and Type 2 diabetes. LADA progresses remarkably slowly over the course of decades instead of years which is why it's usually diagnosed in people aged 30 to 50 years old. LADA may account for 2% to 12% of all cases of diabetes in adult population. Diagnosing LADA can be difficult, and some people are diagnosed with having type 2 diabetes by mistake. Here are some clues that a doctor will use to help make the appropriate diagnosis. The patient is over 30 years old. The patient tests positive for at least one out of four types of diabetes-related autoantibodies. The patient does not need insulin for at least six months after their initial diagnosis (assuming you’re diagnosed properly within the first year of elevated blood sugar levels). The potential presence of other autoimmune diseases, including Grave’s disease, celiac, or Hashimoto’s. Other factors that can help determine a LADA diagnosis include: The patient is not overweight or obese. The patient does not have metabolic syndrome conditions including high blood pressure and high cholesterol. The patient does not have a family history of Type 2 diabetes. (Although, beware, your family members with Type 2 could potentially be LADA and were never diagnosed properly.) the two tests that offer the clearest and most immediate diagnosis of LADA are: Glutamic acid decarboxylase (GAD) Islet cell antibodies (ICAs) GAD and ICA testing is looking for autoantibodies which are the result of your immune system attacking the cells in your pancreas that produce insulin. A person with type 2 diabetes would not test positive for these autoantibodies. While autoantibody testing should be adequate for a LADA diagnosis, other testing can include: Hemoglobin A1c test (HbA1c) Fasting plasma glucose test (FPB) Oral glucose tolerance test (OGTT) Random plasma glucose test (RPG) Ketone test (performed through blood or urine) The symptoms of LADA are the same as Type 1 and Type 2 diabetes: passing a lot of urine feeling very thirsty feeling really tired getting thinner. But they generally come on much slower than they do with Type 1, over months rather than weeks. And the symptoms are more obvious and often come on more quickly than you’d expect with Type 2. Being overweight is a major risk factor for Type 2 diabetes, however, people with LADA tend to be a healthy weight. Medications and lifestyle changes used to treat Type 2 diabetes can be effective for a handful of years in managing LADA—whether or not it’s been diagnosed properly. But as your insulin production declines, these treatment options will not work, leaving you with stubborn high blood sugars. At this point, insulin becomes just as important to your daily health and management as it is for a person with traditional Type 1 diabetes. The most important thing is to take whatever medication helps you manage your blood sugar levels properly. That will help keep you well in the short term and help avoid complications of diabetes in the future. Research has found that most LADA patients will need daily insulin via injections or a pump within six years of being diagnosed (including the date of an incorrect Type 2 diagnosis). Within about 12 years, most LADA patients will produce as little insulin as a person with traditional Type 1 diabetes. At this point it means that the day-to-day management of LADA becomes identical to managing Type 1 diabetes as the body depends on the 24/7 presence of insulin to survive and maintain healthy blood sugar levels. However, with tight disease control, LADA patients can completely achieve a normal life expectancy. There are a couple of support groups on Facebook here and here What is MODY? MODY stands for “Maturity-onset diabetes of the young” and was given that name in the past because it acted more like the adult type of diabetes (Type 2 diabetes) but was found in young people. MODY limits the body's ability to produce insulin but is different than juvenile diabetes (Type 1 Diabetes). MODY is a rare form of diabetes which is different from both Type 1 and Type 2 diabetes and runs strongly in families. MODY is caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child they have has a 50% chance of inheriting it from them. Patients with this form of diabetes can sometimes be mistaken for having either Type 1 diabetes or Type 2 diabetes. It usually manifests before 25 years of age. Clues that a patient presumed to have Type 2 diabetes may actually have MODY include a lack of response to metformin, a larger drop in serum glucose level with sulfonylureas, greater sensitivity to insulin, and absence of pancreatic islet autoantibodies typically found in Type 1 diabetes. Since MODY is caused by a genetic mutation, a genetic test can also help diagnose it. The most common types of MODY are: HNF1-alpha. This gene causes about 70 per cent of cases of MODY. It causes diabetes by lowering the amount of insulin made by the pancreas. People with HNF1-alpha MODY generally don’t need to take insulin: they can be treated with small doses of a group of tablets called sulphonylureas (often used in Type 2 diabetes). HNF4-alpha. This isn’t as common as the other forms of MODY. People who have inherited a change in this gene are likely to have had a birth weight of 9lb or more. They may also have had a low blood sugar at, or soon after, birth which might have needed treatment. People with HNF4-alpha are generally treated with a sulphonylurea tablet but may progress on to needing insulin. HNF1-beta. People with this type of MODY can have a variety of problems including renal cysts (cysts of the kidneys), uterine abnormalities and gout, as well as diabetes. Often the renal cysts can be detected in the womb before a baby is born. This form of diabetes tends to develop later and insulin treatment is usually necessary, as well as following a healthy balanced diet and getting regular physical activity. Glucokinase. This gene helps the body to recognize how high the blood glucose level is in the body. When this gene isn’t working properly the body allows the level of blood glucose to be higher than it should be. Blood glucose levels in people with glucokinase MODY are typically only slightly higher than normal and they don’t generally have symptoms normally found with other types of diabetes so it’s often picked up through routine testing (like during pregnancy). Individuals with this type of MODY don’t need any treatment. Testing for MODY involves: Test blood samples for pancreatic antibodies and blood or urine tested for C-peptide (your doctor/hospital can do this). Having genetic testing. This will be done through a blood sample which will be sent for specialized testing. Why it’s important to know if you’ve got MODY: To make sure you get the right treatment and advice for your type of diabetes. So you can consider and discuss the risk to any children you have/plan to have because there is a 50% chance of a parent passing MODY on to their child. Genetic testing can be offered to other family members because it runs in families. There is a support group on Facebook. 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