#455 Defining Diabetes: LADA Diabetes

March 19, 2021Scott Benner

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain LADA (Latent autoimmune diabetes in adults).

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Today friends, you are listening to Episode 455 of the Juicebox Podcast and today is another in the defining diabetes series. So you know what that means. Jenny's gonna be here.

I've been defining diabetes here on the Juicebox Podcast for ever, it feels like and I've done simple terms like Pre-Bolus a one c, Basal and Bolus. We also talked about honeymooning and things that people don't like to talk about. We've defined non compliant, brutal diabetes, and even talked about terms that are specific to the podcast like stopping the arrows trust will happen feeding insulin bumping and nudging. These episodes are chock full of good information. They're short and digestible. And if that wasn't enough, they're made even better with the presence of Jenny Smith, my friend and certified diabetes educator who helps me on these end the pro tip episodes. So today, Jenny and I are going to define a Lada la da diabetes. A lot of data here we go, we're gonna give you the definition tell you what it is chat about it for a little bit and let you be on your way. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you enjoy this episode, look for the other defining diabetes episodes right there in your podcast player, you can just search Juicebox Podcast defining diabetes, and you will get a super long list of them. You can also find them at Juicebox Podcast calm and diabetes protip.com. Speaking of websites, if you go to integrated diabetes comm you'll be at the place where Jennifer Smith works. There you'll learn things like Jennifer Smith has had Type One Diabetes since she was a child. Did you know that true over 30 years Jenny's had type one, she holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. And not only that she's a person you can point a microphone out and say to her, what's a lot of diabetes. And she'll just tell you, because Jenny is a font of good information. Not gonna have a bunch of ads, they just want to remind you to go to the T one D exchange, fill out their survey, help other people with type one diabetes, it is free for you, of course, because you're the one doing the thing. It is 100% HIPAA compliant. It is 1,000% anonymous. And if you want to remove your answers at any time, you can so easy thing to do. Why would you do this? Because the decisions that are made with your answers help people living with Type One Diabetes, all you need to be is a type one who's living in America, or the caregiver of a type one who lives in the United States. And you can go do this right now. T one d exchange.org. forward slash juice box. Everyone who completes the survey is benefiting people living with type one diabetes, and you're benefiting the show a little bit too. So thank you for that. I wanted to find Lada and Modi. So let's just start with Lada. Okay, because it comes in the alphabet before. So it just feels like so these are two terms that I have to I'm going to fully admit I don't particularly feel like I understand them. And I know they don't come up that frequently but they come up more often than people might assume. And people are always like my doctor told me I have Lada but they don't tell them what that means. And or and Moody's worse Modi Moody, whatever. modey modey modey. But we'll get to that one because that when people get that one, they're just like, I don't know. It's like something about a genetic and then that's like the best they can say and I don't even know if that's right. But we're gonna start first with you telling me what Lada is. And then we're actually going to use the internet a little bit here, which we don't normally do.

Jennifer Smith, CDE 4:24
Oh, sure. Yeah. I mean Lada is essentially a stands for latent autoimmune diabetes of the adult. That's the term where it kind of comes in right acronym right. And it does get confused. I would say an awful lot. Because typically, Lada is diagnosed in those over the age of about 30 to 35. And it's a very slow progressing form of autoimmune diabetes. So it is it's typical that many Ladas are just diagnosed as type one, okay? Because it's it's autoimmune in nature, but your pancreas over time stops producing inadequate insulin. Unlike the very abrupt and very acute diagnosis of type one typically, it's a pretty quick like very significant weight loss that's very significant symptoms of thirst and, and everything that come into the picture and you know, it's right so and for whatever reason, this sort of destruction of the beta cells happens more slowly in someone with Lada. So it could be years of developing. And many people with Lada they may be initially started on insulin, especially they come in with like high enough blood sugars to diagnose diabetes, but many can for a time period be left just on basal insulin. With a very small amount, still with lifestyle changes, obviously, I mean, you're not going to go out eating like, you know, big chocolate cakes three times a day are they stuck Nadav take insulin for that, but typical lifestyle changes of basal insulin may be utilized for a lengthy period of time honeymoon in Lada can last quite a long time. And in fact, from what the research that I've read about ladder, many who've been diagnosed years ago already with it still have a fair amount of natural insulin production, their c peptide levels essentially come back still in the diabetes range, but higher than somebody who would have like an all out destruction of the betas

Scott Benner 6:51
Well, in this now, so is this personal? Is this the thing? They also call type one and a half like 1.5. Do you hear that that way? Yes. So how do I, if this happens to me? How do I know the difference between this and type two? That's just like not that bad type two?

Jennifer Smith, CDE 7:10
Yeah, I mean, type two, again, is not an autoimmune disorder. So you're not going to have the antibodies, Gad, you're not going to have any of that present. If you have type two, type one and ladder are specific, that the body has attacked the beta cells, so you're going to have those antibodies to prove circulating in the system, to note the reason for the destruction, whereas type two again, and that kind of goes with like, Modi, which we'll talk about later, you know, but there there is no autoimmune component to type two.

Scott Benner 7:48
But people don't as a general rule, doctors don't. When you're, I guess what I'm saying is I've spoken to enough people at this point now who are in their, like 30s, or 40s. They when they get diagnosed, they don't immediately someone tells them they have type two,

Jennifer Smith, CDE 8:02
it's often misdiagnosed. Right,

Scott Benner 8:04
right. So without the antibody test, but the antibody test is a simple way to know that it's Lada and not just a slowly slow form of type two diabetes.

Jennifer Smith, CDE 8:15
Correct. Exactly. And that's it's unfortunate because you know, if you have, if you're somebody who's lean, pretty physically active, just you know, going to the gym a couple times a week, or you run several days a week, and you've never had a problem with like weight management, you have a pretty healthy lifestyle and whatnot and you're diagnosed with Type two, it would be very important for your doctor to go in and ask specifically, you know, I'd really like antibody testing, I really would like, you know, to discuss this further, because, I mean, I've seen it clinically myself. Before I was working for integrated I actually the clinic that I was working at, was working primarily as a dietitian and then a diabetes educator just for like the type two population and a gentleman was referred to me to come in to talk nutrition, right. And in looking at his record, he was just newly diagnosed, I looked at his age, I looked at his weight I look, this guy was like a marathon runner, and like a like an endurance athlete. And I'm looking at his data and looking at his levels he had come in and DK to the emergency room and I'm like, this guy is not type two. I call this doctor and I was like, one you need to get him referred. And two, I said my discussion with him needs to be different and three, you need to get him on insulin. He said I can guarantee he's feeling like crud right now. While you're like telling him he's type two.

Scott Benner 9:37
Because physically you look at them and you think this this isn't a person that even if they have type two diabetes, eating their way to decay can get into decay it with type two diabetes. Um,

Jennifer Smith, CDE 9:49
it, can you it's very rare. I guess that's the easiest. That's the easiest explanation is that it's very rare. There. Are some, I guess what our lack of a better word like some ketone or ketosis prone subtypes of type two, but we don't see decay in type two. We instead when they come in, in the emergency room with really high blood sugars, we usually see something or we usually call it something called honk. It's like a nonketotic, hyperosmolar. ketosis type of situation, it's, I know

Scott Benner 10:28
that honk just made me smile. She's trying to say something serious. And I'm like, wait, they call it honk. That's amazing.

Jennifer Smith, CDE 10:35
But again, it's very specific to type two because type two IDs will not usually be in DK.

Scott Benner 10:41
It just occurred to me while you were saying that I don't know that I've ever heard a person who has type two diabetes, say they were in DK. And I thought, so. Why would so the doctor in this scenario should have put those things together? Correct. Right. Okay.

Unknown Speaker 10:56
I should have what it could.

Scott Benner 10:58
Well, I guess we start waiting for all that to happen.

Unknown Speaker 11:00
We just that's another discussion.

Scott Benner 11:03
Listen, you doctors pull this all together, and you're gonna take my podcast away from me. So you just keep doing the job you're doing okay? I mean, really? Okay. So if I'm older, and it looks like I'm in that situation where like my a one sees like in the five and a half ish range, and doctors are starting to say like, Oh, you might be developing type two diabetes, I asked for the antibody test. It tells me for sure. Do I have type two, or a very slow onset of type one that is called Lada and latent? Say it again?

Jennifer Smith, CDE 11:38
latent autoimmune diabetes of the adult, okay.

Scott Benner 11:41
And I think just for perspective, because I find myself you know, when you go to the internet and you're just like trying to teach yourself something from scratch, sometimes you hit a word and you're like, Oh, yeah, it's latent autoimmune and then you never really think to yourself, what is latent mean? So just for this, it's existing, but not yet developed? Or manifested, it can be hidden or concealed is the definition of the word latent. so sneaky if you want to think of it that way can be sada.

Jennifer Smith, CDE 12:09
It's sneaky. Absolutely. Well, in your immune system is sneaky. Anyway, weird stuff that it does, you know, well, I

Scott Benner 12:15
just got done interview doing that interview with Francisco Leon about to plus a mob. I'm never gonna say that drug name, right.

Jennifer Smith, CDE 12:24
That drug man. Yeah, I know. It's like a bunch of letters that look like they were thrown against the wall together. It's just

Scott Benner 12:29
it's funny. I can't say it off the top of my head. But when I'm looking at it, it makes complete sense to me. But I'm, you know, I'm still stuck in his descriptions of autoimmune disease in general. And it's like clouding everything I'm thinking of today. So

Jennifer Smith, CDE 12:46
I can actually I got something similar. When I went to a conference, it was probably, it's probably about three years ago. Now, I attended two or three workshops on gut, micro biome. And the research in the conferences were specific to diabetes and what they're really looking at in terms of like, the term muscle use, loosely used, I hate to use it, but like leaky gut type of issue. And what that really does in the potential for somebody who is like got a sensitive immune system already like that turn on factor. It's almost like a light switch that just gets like flipped on once. There's something there to cue in that response.

Scott Benner 13:31
So in the thyroid episode, Dr. Benito starts to kind of talk about a little bit of there's like, there's this barrier, and and I was like, okay, but, you know, anyway, we've gotten off the beaten path. But anyway, I just, you know, what, once Dr. Leon started talking about, there's a place in Europe where they're now putting dirt in babies bonnets, to give them you know, like, like from farms, because he microbes, he said that we've industrialization, he thinks is the key to autoimmune, that we've cleaned the world up so much that our immune system is just like sitting around board tapping its fingers and like, hey, let's go after this now.

Jennifer Smith, CDE 14:13
Yep, I know is I mean, there's a sense of like, especially in this past year of everything, there's like this renewed sense of like, clean, hyper cleaned, and I like I still like the kids come in and they've got like grungy stuff from the rock pile out in the backyard and like, well, you clearly have to wash your hands, but I'm not too worried that you were playing in the dirt because they're probably really good things in there for you.

Scott Benner 14:38
Yeah, I don't have to dip you and alcohol just make you dirty anymore.

Jennifer Smith, CDE 14:42
Right? Yeah.

Scott Benner 14:50
Huge thanks to Jenny for lending her brilliance to the Juicebox Podcast. Don't forget to check her out at integrated diabetes comm you can actually hire Jenny and she'll help you with your diabetes. Thanks also to all the sponsors that I didn't mention today. And what else, check out the T one D exchange at T one d exchange.org. forward slash juice box. Take the survey, fill it out, help people with type one diabetes help the show feel good about yourself takes a few minutes to do something nice. If you hold on for a second after the music, I'll go over where the diabetes pro tip episodes are. The defining diabetes episodes how you can listen in a podcast player if you're listening online and all the other stuff that new listeners and interested parties should know. So here's how it goes. If you want to check out the Omni pod, the Dexcom g vo hypo Penn T one D exchange touched by type one with a Contour Next One blood glucose meter. I'd appreciate it if you use my links. They're right there in the podcast player show notes. You can also find them at Juicebox Podcast comm where you can type them into a browser. And at the very end of this, I'll leave them if you want to hear them. But I imagine you're gonna shut it off before I say that. But still, I'll put them there for you. Now the diabetes pro tip episodes, for those of you who listen to a podcast player, they're right there. You can just search diabetes pro tip and the word Juicebox Podcast and you're going to get them all. But you can also find them at diabetes pro tip.com. When you get there, you're going to see that they that the pro tip episodes begin at Episode 210 with an episode called diabetes pro tip newly diagnosed or starting over. And then they go on for their

pro tips began back in February of 2019. And there was a new one put up as recently as March fifth 2021. So it's a really great list of episodes that will help you manage your diabetes, the way you hear us talking about it here. And these defining diabetes episodes are also incredibly helpful. Right now the way diabetes pro tip comm is set up. If you scroll down a little bit, you can find those as well. There's also ask Scott and Jenny shows the latest episodes of the podcast. It's all right there. Actually. There's also links to places where you can listen through an app. So I know some people don't listen to a lot of podcasts. And this could be new for them. But you can listen in a free application. If you're on Apple, Spotify, amazon music, Google podcasts, Pandora, any apps that are available on Android, just keep in mind that podcast apps should not cost you money. So my links will take you to a number of apps that are free and work great. Otherwise, you can listen pretty much anywhere you get audio. If you're listening in an app now please like follow subscribe, whatever your app allows you to do. And you will get three new episodes of the Juicebox Podcast every week to choose from, even listen to them all. Listen to some of them. Whatever works best for you. If you're looking for people chatting about management, you should look no farther than the Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes, it's a private group. So you can talk freely. Go find that if you're looking for 10,000 users. Now, it's a really terrific place to talk about using insulin, and all the things that come up when you have type one. I'm also on Instagram. I don't do much on Twitter, but it's there at Juicebox Podcast. That's it really, I hope you're enjoying these. I hope they're helpful for you, there's going to be a number of them coming. In the next number of weeks we're gonna do Modi and some other stuff that build off of this initial conversation that Jenny and I had, but I like them to be in separate episodes where you can hear targeted information about one topic. So defining diabetes. I'm a big fan of them. Check them out. Thanks so much, Jenny. And thanks to the T one D exchange for supporting the Juicebox Podcast go to the T one D exchange with one of my links there right there in the show notes of your podcast player or at Juicebox Podcast comm T one d exchange.org. forward slash juicebox. Get there takes about 510 minutes to fill out very simple questions. And the answers help people living with Type One Diabetes, you need to be a US resident who has type one or a US resident who is the caregiver of someone who has type one. Again, it won't take you long, it's incredibly helpful. It's HIPAA compliant, completely anonymous. And you could even panic seven months from now and go I don't want my answers to be in there anymore. And they would take them out if you ask them it's there's no risk to you at all. It helps people with type one diabetes. That kind of help could help you as well as others and it also benefits the show. Other things that benefit the show dexcom.com forward slash juice box my Omni pod.com forward slash juice box Je Volk glucagon comm forward slash juice box touched by type one.org. Contour Next One comm forward slash juice box and I think that is that I think that's everybody. If you have any need for those things, please use my links. And if you don't, don't feel any pressure, maybe you will one day. Maybe you can just tell someone else about this podcast. You know, I'm not saying click on the link, click on the link. I'm saying if you need those things, use my link please. Alright, I hope you guys have a great day. Plenty more podcasts coming next week. Thank you so much for listening. I'll be back very soon.