What is latent autoimmune (lada) diabetes, what are the symptoms, diagnosis and treatment? Special autoimmune diabetes: main characteristics and therapy Lada diabetes symptoms

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LADA diabetes got its name from the phrase L atent A utoimmune D iabetes in A dults, which translated into Russian means - latent (occurring secretly) autoimmune in adults. This type of disease is characterized by the clinical picture of both "classic" types of diabetes (1 and 2), so it is also called type 1.5 diabetes.

LADA diabetes mellitus, as a rule, develops in middle-aged patients, most often the diagnosis is made in patients aged 35-55 years.

Etiology of diabetes mellitus

In some adult patients with a normal physique, doctors observed a decrease in C-peptide (a protein that converts proinsulin to insulin) when exposed to glucagon, which indicates insufficient production of this hormone (laboratory studies confirmed low insulin levels).

At the same time, markers of diabetes of the autoimmune group were found in the majority: many antibodies to pancreatic glutamate decarboxylase. This indicated damage to the beta cells of the pancreas, which is fundamental

Features of the course of Lada diabetes

In the initial stages, the course of the disease resembles type 2 diabetes: patients do not need to inject injections. Over time (usually it takes 2-3 years from the onset of the disease), patients develop all the clinical signs of type 1 diabetes, with the need for insulin therapy.

In other words, the patient is diagnosed with type 2 diabetes, which then transforms into insulin-dependent, and the diagnosis is made: Lada diabetes.

Clinical picture of type 1.5 diabetes

As mentioned above, the clinical picture of the disease in the initial stages is very similar to type 2 diabetes.

In order to differentiate these two diseases, it is necessary to know the distinctive features of the development of DM 1.5.

Age. Most often diagnosed in the time interval from 35 to 50 years.
Anamnesis. Close relatives or the patient himself has various autoimmune pathologies.
The patient belongs to the group of normosthenic physique. Body mass index (less than 25 kg per 1 m2).
Acute onset of the disease (general weakness, urination above normal, sometimes 2 times, weight loss, thirst).

LADA diagnostics

To confirm the diagnosis of Lada diabetes, laboratory diagnostic methods are used:

The level of autoimmune antibodies to pancreatic glutamate decarboxylase. If the result is negative, the probability of having DM 1.5 is minimal.
The level of C-peptides of the gland. With Lada diabetes, the performance of this enzyme will be reduced.

To clarify the diagnosis, a test with prednisolone is performed - to determine the tolerance to glucose, or the Staub-Traugott test: blood sugar is determined, on an empty stomach, for several hours with correction by dextropur.

Treatment for this type of diabetes

When this type is suspected, diagnosis and treatment are carried out in specialized institutions under the clear guidance of doctors who are competent in the treatment of this type of disease.

Important!!! Diabetes Lada is relatively “young”, it was singled out as a separate type only in the mid-90s of the 20th century. Therefore, many doctors are unfamiliar with him and may prescribe an incorrect treatment regimen.

It is not advisable to prescribe treatment in the form of insulin therapy without making sure that the patient suffers from DM 1.5, and not DM 2 (in which the patient takes pills derived from sulfonylurea).

When clarifying the diagnosis, small doses of insulin therapy are prescribed to maintain the functions of the pancreas.

See below very interesting video about this type.

Concomitant therapy consists of following a low-carbohydrate diet, playing sports (there are special exercises) and constantly monitoring blood sugar levels. Be healthy.

Lada diabetes is a latent autoimmune diabetes that poses a rather serious danger.

It is difficult to diagnose but easily confused with type 2 diabetes.

As a result, the wrong treatment can be prescribed, which will lead to serious complications.

In the second half of the 20th century, nutritionists from Austria discovered a new type of diabetes - lada.

Patients who have antibodies and low levels of C-peptide secretion do not have type 2 diabetes. At the same time, the signs of both pathologies are similar. As a result of the fact that insulin must be administered early, this form is not recognized as type 1. Thus, an intermediate form of pathology was revealed - latent autoimmune diabetes in adults - lada.

This diagnosis means that the beta cells of the pancreas that produce the hormone insulin break down.

As a result, an autoimmune process occurs that is difficult to diagnose without undergoing additional research.

The peculiarity of the disease is that in diabetes mellitus, the cells of the pancreas produce the wrong insulin, so the concentration of sugar in the blood rises.

The second option is that peripheral tissues do not feel insulin produced in proper quantities.

In diabetes, the relevant organs do not produce insulin or produce very little insulin. As a result, beta cells are depleted.

There are several reasons for this phenomenon:

age: latent diabetes usually affects older people with a weak endocrine system,
excess weight contributes to the disruption of metabolic processes,
pancreatic diseases,
genetic predisposition to diabetes
pregnancy.

People who are predisposed to the appearance of autoimmune diabetes should be attentive to changes in the body. When the first symptoms of the disease appear, you should consult a doctor.

Lada diabetes has the following symptoms:

increased fatigue, impotence,
dizziness,
in some cases, the body temperature increases,
high blood sugar levels,
constant thirst, as a result of frequent urination,
plaque on the tongue,
the smell of acetone from the mouth.

Most often, the disease proceeds without pronounced symptoms.

It can occur during pregnancy or after the baby is born. Adult women develop autoimmune diabetes earlier than men (around age 25).

The mechanisms of occurrence of pathology are similar to other types of diabetes. At the same time, there are certain differences.

Differences between type 1 and type 1 diabetes.

in the first case, people fall ill after 35 years (women after 25), type 1 diabetes does not depend on age.
the symptoms of diabetes mellitus resemble the signs of some other diseases, which is why an incorrect diagnosis is made and incorrect treatment is prescribed.
the disease is mild, sometimes exacerbated, the need for insulin is low.

Difference between lada diabetes and type 2.

overweight is observed not in all cases.
six months later, you may need insulin injections.
blood contains antibodies - signs of autoimmune diabetes.
the use of drugs does not reduce high sugar.

The main difference is the death of all beta cells, insulin ceases to be produced by the pancreas.

After 1-3 years, complete dependence on additional insulin is formed. This does not depend on gender. The course of the disease resembles type 2 diabetes.

Latent autoimmune diabetes in adults has mild symptoms, patients do not feel the disease. In addition, basic analyzes cannot always detect it. A blood sugar test will show normal results.

Most endocrinologists do not conduct an in-depth examination when diagnosing the type of diabetes. If an incorrect diagnosis is made, medications that reduce sugar levels may be prescribed, which is contraindicated in diabetes mellitus.

Diagnosis of the mode of diabetes involves several procedures. First, they study the analysis of blood and urine.

If there is a suspicion of latent diabetes mellitus, narrowly focused studies are carried out, where they study:

response to glucose
glycated hemoglobin,
antibodies to IAA, IA-2A, ISA,
fructosamine,
genotyping,
microalbumin.

At the same time, the specialist pays attention to the age and weight of the patient, how insulin is produced, the possibility of compensating it with drugs and diet.

Modern medicine makes it possible to recognize autoimmune diabetes mellitus. If the diagnosis is confirmed, the patient is registered. The doctor selects the most effective methods of treatment in order to prolong the work of his own hormones for as long as possible.

With the wrong treatment, various complications can occur:

beta cells are completely destroyed,
insulin production and levels fall,
the patient's condition worsens.

In this case, large doses of insulin will be needed.

Lack of treatment leads to the development of disability, and in some cases death.

Unlike other types, Lada diabetes does not require the use of medications, additional insulin is sufficient.

The most effective treatment is one in which insulin is consumed in small doses. In some cases, prolonged insulin is prescribed, which is diluted (since a small dosage is needed). Injections are carried out regardless of sugar levels.

If therapy is started early, patients can restore their natural production of their own insulin. In this case, patients live to a ripe old age without complications.

In addition to insulin therapy, doctors prescribe:

diet - you need to eat foods low in carbohydrates,
physical activity - it is not necessary to engage in professional sports, a small charge daily is enough,
regular monitoring of blood sugar - readings should be monitored even at night,
refusal of drugs that are contraindicated for diabetics.

The main goal of treating autoimmune diabetes is to stop the death of beta cells due to immune changes. It is contraindicated to use drugs containing sulfourea, as they contribute to the death of beta cells. It is also necessary to reduce the load on the pancreas.

It happens that insufficient insulin is accompanied by insulin resistance. In this case, patients should take oral hypoglycemic drugs. These funds increase the threshold of sensitivity of peripheral tissues to insulin.

With the permission of the attending physician, you can use alternative methods of treatment: take decoctions and tinctures that help reduce blood sugar levels.

To raise awareness of patients, special schools of diabetes are being created. They tell basic information about how to measure sugar correctly, what to do in case of complications.

If you notice the symptoms of diabetes lada mellitus in time, you can avoid further development of the disease.

Preventive measures include the following:

If the patient finds that his weight is significantly higher than the norm, it is necessary to return his previous dimensions. To do this, use the following two points.
Physical exercise. walking, running in the morning or in the evening, swimming, cycling.
Compliance with dietary nutrition. As already mentioned, foods should be low-carbohydrate. It is necessary to eat fractionally (small portions) and often. Avoid sweet, fatty foods.
Monitor your emotional state: be less nervous, tune in a positive way.
Control of blood sugar levels by persons prone to diabetes.

It should be remembered that prevention should be regular. One diet breakfast and two runs are not enough to overcome the disease.

Thus, if you do not pay attention to the symptoms in time, diagnose and treat Lada diabetes, various complications may appear. When diagnosing diabetes mellitus, additional studies should be carried out in order to prescribe a correct and effective therapy.

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Preventive actions

Sugar level

In order to avoid the occurrence of a latent form of diabetes, it is recommended to minimize the influence of negative factors. So, experts insist on controlling body weight and the ratio of glucose in the blood.

It will be no less important to follow a diet, to exclude foods saturated with fats from the diet. It is recommended to play sports for preventive purposes, as well as to use vitamin and other names that will strengthen the immune system.

Another important criterion is the periodic implementation of diagnostics: control of blood sugar, glycated hemoglobin and cholesterol. All this will, if not exclude, then minimize the risks of developing latent autoimmune diabetes.

Importance and methods of diagnosis

Timely diagnosis will avoid negative consequences.

One and a half type diabetes mellitus needs timely diagnosis and differentiation from other types of this disease. In the opposite case, with improper therapy, the disease begins to progress very quickly, leading to irreversible and serious consequences. Diagnostic methods include:

collection of anamnesis;
prednisolone-glucose tolerance test;
detection of HLA antigens;
visual inspection;
detection of the level of C-peptide;
determination of glucose levels in blood and urine;
determining the response of autoantibodies to insulin therapy;
physical examination;
determination of the presence of autoantibodies to glutamate decarboxylase GAD;
general, biochemical laboratory tests of blood and urine;
determination of genetic markers;
Staub-Traugott test;
determination of glycated hemoglobin (HbA1c);
analysis and study of autoantibodies to ICA cells (islet);
detection of glutamate decarboxylase antibodies.

Methods of treatment

As noted, mandatory insulin therapy is provided for patients diagnosed with LADA-diabetes. Doctors recommend not to tighten with injections. If LADA-diabetes has been confirmed, then therapy will be based on this principle.

This category of patients needs the earliest possible detection of the disease and adequate prescription of drugs, and insulin in particular. First of all, this is due to the high probability of the lack of stimulated insulin production. Very often, insulin deficiency can be combined with the resistance of body cells to this hormone if Lada diabetes is diagnosed.

In such situations, patients may be assigned to take special means to reduce sugar in tablet format. Such drugs do not cause dryness of the pancreas, however, at the same time they increase the sensitivity threshold of peripheral tissues to the hormone insulin.

In addition, medicines that can be prescribed include biguanide derivatives (Metformin), as well as glitazones (Avandia), a complete list of drugs for diabetics can be found on our website.

Insulin therapy is extremely important for absolutely all patients suffering from LADA-diabetes. In this case, administering insulin as early as possible will aim to save natural basal insulin production for as long as possible.

Those patients who are carriers of LADA-diabetes should be limited in the use of secretogens. These drugs are able to stimulate the production of insulin and will lead to rapid depletion of the pancreas, and then to insulin deficiency in patients with type Lada diabetes.

An excellent addition to therapy will be:

fitness;
hirudotherapy;
physiotherapy.

In addition, with the permission of the doctor, courses of treatment can be carried out using traditional medicine. There are a fairly large number of medicinal plants that qualitatively reduce blood sugar in a patient with LADA-diabetes.

How latent diabetes manifests itself LADA

Diabetes LADA mellitus can begin to manifest, usually at the age of 25 years. The clinical signs of latent diabetes are more similar to type 2 diabetes, only in this case there is no obvious obesity. At the initial stage of the development of the disease, quite satisfactory control over the metabolic process is possible. Such positive results can be achieved with a normal diet and medications that lower blood sugar levels. The need for insulin doses may occur in the period from 6 months to 10 years. Also, the presence of markers of type 1 diabetes mellitus may indicate the presence of LADA-diabetes in a person.

In adults, the initial period of manifestation of latent diabetes mellitus has mild symptoms, and is often characterized more like type 2 diabetes. Due to the slower process of destruction of beta cells in the body of an adult suffering from Lada diabetes, the symptoms of the disease are blurred, there are no signs of polydipsia, a sharp decrease in body weight, no polyuria and ketoacidosis.

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Detection of LADA diabetes can occur under certain nutritional conditions. This method is called prednisone-glucose loading. Three days in a row before the test, you need to eat food that contains 250-300 grams of carbohydrates, but at the same time corresponds to the normal content of fats and proteins.

The essence of the prednisone-glucose test is that 2 hours before the introduction of a glucose load, prednisone or prednisone is administered in the amount of 12.5 mg. Fasting glycemia allows you to determine the level of functioning of beta cells. If the result exceeds 5.2 mmol / l, and after 2 hours the glycemia is outside 7 mmol / l, then such indicators indicate latent diabetes.

The Staub-Traugott test also helps to determine the presence of diabetes mellitus LADA. This test consists in the fact that before a blood test for glycemia, the patient must take 50 grams of glucose, and an hour later the same amount. In people who do not suffer from latent diabetes, a jump in blood glycemia will appear only after taking the first dose, while the second glucose load will practically not be pronounced in the blood test. If two obvious jumps in glycemia were recorded, then this is a clear indication of the presence of latent diabetes and poor functioning of beta cells.

I have been diabetic for 31 years. Now healthy. But, these capsules are not available to ordinary people, pharmacies do not want to sell them, it is not profitable for them ...

I have type 2 diabetes, non-insulin dependent. A friend advised me to lower my blood sugar with DiabeNot. I ordered via the Internet. Started taking. I follow a non-strict diet, I started to walk 2-3 kilometers every morning. Over the past two weeks, I have noticed a gradual decrease in sugar on a glucometer in the morning before breakfast from 9.3 to 7.1, and yesterday even to 6.1! I continue my preventive course. I will write about success.

Margarita Pavlovna, I am also now on Diabenot. DM 2. I really don’t have time for a diet and walks, but I don’t abuse sweets and carbohydrates, I think XE, but due to age, sugar is still elevated. The results are not as good as yours, but for 7.0 sugar does not come out for a week. What glucometer do you measure sugar with? Does it show on plasma or whole blood? I would like to compare the results of taking the drug.

Natalia — 03 Feb 2015, 22:04

Hello! Tell me, please, what tests should be taken to determine the markers of type 1 diabetes? I have been on metformin for a year and a half with a diagnosis of type 2 prediabetes. I am 34 years old, 160 cm, 65 kg (was 80), BMI 25 (was 28), waist 84 cm, HbA1c 5.33, HOMA index 2.18, insulin 8.33, c-peptide 1.48, GADA

Can this type of diabetes be cured?

Initially, it is required to accurately confirm the presence of this type of DM, and this can be done using 2 main studies:

analysis to determine the level of anti-GAD. Positive results confirm its presence, and negative results rule it out;
analysis to determine the level of C-peptide - if its reduced level is detected, then the disease is actively progressing;
in controversial situations, genetic markers can be used, which are also applicable in type 1 diabetes.

The basis of therapy, of course, is the constant administration of insulin, since the natural production of insulin practically stops in the body. It is also mandatory to take funds whose action is aimed at lowering blood sugar levels (tablet form). Their advantage is the absence of a negative effect on the pancreas, and the disadvantage is an increase in the threshold of sensitivity of peripheral type substances to insulin.

Equally important is the intake of biguanide derivatives, as well as glitazones, which are carefully selected by an endocrinologist. It is important to limit the use of secretogens, since, in addition to being capable of stimulating the process of insulin production, they can simultaneously cause pancreatic depletion, and this is a direct path to insulin deficiency.

Additional therapy that should not be ignored are moderate fitness classes, hirudotherapy procedures, a set of physical therapy exercises, a low-carb diet, swimming, walking in the fresh air. If there are no contraindications, then it is allowed to use traditional medicine in the form of all kinds of herbal infusions that can reduce sugar levels in an almost natural and harmless way.

Pay special attention to the constant monitoring of the level of sugar (glucose), which in our time is really done with the help of compact portable equipment (glucometers). Measurement not made in time can cause a coma, respectively, lead to irreversible consequences.

The type of SD Lada, as well as other varieties, by and large, cannot be completely cured, but this is not a reason to give up and do nothing. In the world, from 25 to 30% of people suffer from this disease, but constant monitoring and supportive therapy allows them to lead a relatively normal lifestyle and professional activities.

Therapy as a way to eliminate pathology

LADA-diabetes progresses slowly and may remain unnoticed for a long time. Therefore, treatment must be started as soon as it is discovered, in order to avoid a complete cessation of insulin production by the pancreas, as immune bodies attack and lead to the death of the cells of the gland. In order to prevent this, insulin injections are immediately prescribed. When the diagnosis is approved, it is prescribed in small doses, but to all patients. Insulin protects the pancreas from destruction of its cells by the autoimmune system. The main task in therapy is to preserve the natural production of insulin in the pancreas.

Treatment must be comprehensive.

It is important to control the intake of simple carbohydrates into the body and count the bread units, for which special tables are provided. A bread unit is a specific measure of carbohydrates.

Treatment involves the consumption of a low-carbohydrate diet, sugar in its pure form is permanently removed from the diet.

In addition, treatment is the slowing down of autoimmune inflammation due to the slow activity of autoantigens. And, of course, maintaining normal blood sugar. For this, patients are prescribed special sugar-containing drugs.

It is important to remember that with LADA diabetes, sulfonylurea derivatives and glinides should not be taken, Siofor and Glucophage are prescribed only for obese patients, which is observed in type 2 diabetes, but not in LADA diabetes. If long-acting insulin does not cope with the decrease in sugar, then you can “poke” fast-type insulin before meals

If long-acting insulin does not cope with the decrease in sugar, then fast-acting insulin can also be “pricked” before meals.

In addition to therapy, an active lifestyle, sports or fitness, hirudotherapy and physiotherapy exercises are recommended. Traditional medicine is also applicable in the treatment of autoimmune diabetes, but only in consultation with the attending physician.

Diabetes lada has a favorable outcome with its early diagnosis and timely treatment

And only then can you completely recover from this disease completely.

L o a d i n g . . .

Treatment of LADA-diabetes

Without such a diet, all other activities will not be effective.

The next step is to study the features of the use of insulin. It is necessary to learn everything about the extended types of the hormonal component (Lantus, Levemir and others), as well as the calculation of the dosages of the fast composition before eating. It is necessary to inject prolonged insulin at a minimum rate, even if, due to a low-carbohydrate diet, the sugar level does not reach 5.5-6 mmol on an empty stomach and after eating.

Speaking about how to treat autoimmune diabetes in adults, pay attention to the fact that:

dosages of the hormonal component should be low;
it is desirable to use Levemir, because it is allowed to be diluted, while Lantus is not;
an extended type of insulin is used even if sugar on an empty stomach and after eating does not increase more than 5.5–6 mmol;
it is important to monitor the blood glucose ratio for 24 hours. It is determined in the morning on an empty stomach, each time before a meal, and also two hours after a meal and at night before going to bed;
once a week, it is necessary to carry out such a diagnosis in the middle of the night. It is recommended to treat diabetes with LADA depending on the sugar indicators, namely, increase or decrease the amount of prolonged insulin

In the most difficult cases, it may be necessary to administer it two to four times a day. If, despite the use of prolonged insulin injections, glucose after a meal remains increased, experts insist on using fast insulin before meals as well.

It is recommended to treat LADA diabetes depending on the sugar indicators, namely, to increase or decrease the amount of prolonged insulin. In the most difficult cases, it may be necessary to administer it two to four times a day. If, despite the use of injections of prolonged insulin, glucose after a meal remains increased, experts insist on the use of fast insulin before meals.

In no case, with a latent form of diabetes, do not take pills such as sulfonylurea derivatives and glinides. They are usually prescribed for type 2 diabetes, and therefore, with form 1.5, they can affect the occurrence of side effects. Names such as Siofor and Glucophage are effective only for obese patients with diabetes. In the absence of excess weight, it is recommended to refuse such names.

Physical activity is another important pathology control for obese patients. In the presence of a normal body weight, it is necessary to engage in physical education in order to generally strengthen immunity and health. Preventive measures deserve special attention.

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There are two forms of diabetes: type 1 and type 2. In both types, there is an imbalance in blood sugar and problems with insulin in the body.

Insulin is a hormone that helps convert glucose into cellular energy that cells need to metabolize nutrients. Type I diabetes is commonly referred to as juvenile diabetes because it occurs early in life. The pancreas does not produce enough insulin, or does not produce it at all, and it must be supplied to the body through injections or tablets.

The pancreas works in type 2 diabetes, and happens at a later time. However, the body is insulin resistant, or does not use enough insulin. Often this type of diabetes can be controlled through exercise and diet to maintain blood sugar levels.
Chronically high blood sugar is an indicator of both types of diabetes. But sometimes blood sugar stays low, especially in type 2 diabetes.

Many of the symptoms of diabetes are associated with thyroid and adrenal problems, such as fibromyalgia. Therefore, it is necessary to check your sugar level to determine whether your health problems are related to diabetes or not.

What to eat with diabetes

Obviously, food for diabetics should not contain foods with a high glycemic index. These are refined starch, sugar, honey with high fructose corn syrup, sweets and biscuits.
Unsweetened fruit juices are a short term solution for hypoglycemia, but undiluted juices should be avoided if you have high blood sugar.

Did you know that many fast foods contain a lot of sugar, even if they are not sweet? Avoid them.

(1) Vegetables, especially green ones - you can eat them every day. Stewed vegetables and raw vegetable salads are nutritious for everyone. Store-bought salad dressings often contain sugar and sweeteners. Use only cold-pressed vegetable oils, other than soy, as well as vinegar and lemon/lime for dressings.

(2) Slice an avocado into your salad to add flavor and nutrition. Avocados have a low glycemic index and are also high in omega-3s, which can help treat chronic inflammation often associated with diabetes and other serious conditions. Avocados are also an excellent source of plant-based protein.

(3) Walnut also has a low glycemic index and is a source of omega-3s. You can add them to salads.

(4) Fresh sea fish, especially tuna and salmon, are rich in omega-3s and have a low glycemic index. If you like meat, then they have a low glycemic index. But try to stick to grass-fed meat to avoid the antibiotics and hormones that are injected into farm animals.

(5) The issue of cereals is much more complicated. Clearly processed grain must be avoided. But some whole grains are high on the glycemic index. A good substitute is quinoa and buckwheat. Organic brown rice may be suitable for some diabetics as it does not convert to glucose quickly. But many nutritionists do not recommend consuming it every day.

(6) Various legumes can be added to dishes. Legumes are rich in protein and fiber and have a low glycemic index compared to potatoes. They can also be mixed with vegetables or served as a side dish.

How the disease develops

Autoimmune diabetes manifests itself at a fairly rapid pace, while the manifestations of ketoacidosis can be observed after several weeks. The second type of diabetes mellitus, which is much more common, is mostly latent.

And the main symptomatology in the form of insulin deficiency of the disease is usually expressed after about 3 years, and this despite the fact that the disease has been identified and treated. Patients show signs such as significant weight loss, overt hyperglycemia, and signs of ketonuria.

In any autoimmune diabetes mellitus, insulin deficiency is observed. Insufficient intake of carbohydrate in the form of glucose into adipose and muscle tissues, as well as an energy deficit, lead to the disinhibition of products produced by contrainsular hormones, which just act as a stimulator of gluconeogenesis.

Insulin deficiency leads to the suppression of hepatic liposynthetic capacity, while the release of fatty acids is included in ketogenesis. In the event that dehydration and acidosis begin to increase, a coma may occur, which, without proper treatment, leads to death.

Autoimmune disorder type 1 accounts for approximately 2% of all cases of diabetes. Unlike type 2 diabetes, type 1 diabetes has time to manifest before the age of 40.

Symptoms

As for the clinical picture of the disease, it is quite clearly expressed, especially in children and in people at a young age. Symptoms for almost all types of diabetes are identical and are expressed in:

skin itching;
increased need for fluid intake;
intense weight loss;
muscle weakness;
general malaise and drowsiness.

At the very beginning of the disease, appetite may even increase slightly, which, as ketoacidosis develops, leads to anorexia. Intoxication at the same time causes nausea, accompanied by vomiting, acetone breath, pain in the abdomen and dehydration.

Diabetes autoimmune mellitus type 1 in the presence of severe concomitant diseases can cause impaired consciousness, which often leads to coma. In patients whose age category varies from 35 to 40 years, the disease usually manifests less pronouncedly: moderate manifestations of polydipsia and polyuria are noted, and body weight remains at the same level. Such a disease usually progresses over several years, and all signs and symptoms tend to appear gradually.

Risk factors

It should be noted that despite numerous studies, the true causes of such a disease as type 1 autoimmune diabetes mellitus have not yet been precisely determined.

However, there are risk factors that are predisposing conditions, the combination of which ultimately leads to the development of diabetes mellitus (autoimmune type).

As already noted, one of the causes of the disease can be attributed to the genetic factor. However, the percentage, as it turned out, is quite small. So, if the father was sick in the family, then the probability that the child will get sick is a maximum of 3%, and the mother - 2%.
In some cases, one of the mechanisms that can provoke type 1 diabetes is viral infectious diseases, these include rubella, Coxsackie B, mumps. Children who carry the disease in utero are most at risk in this case.
Frequent poisoning of the body can provoke diabetes mellitus, as a result of which toxic substances act on organs and systems, which contributes to the appearance of autoimmune pathology.
Nutrition plays a very important role. For example, it has been found that children are more likely to develop type 1 diabetes if cow's milk and formulas are introduced too early. The situation is similar with the introduction of cereals.

As for type 2 diabetes, people with the following predisposing factors are affected by this disease:

people over 45 years of age;
disturbed levels of glucose or triglycerides in the blood, a decrease in lipoproteins;
malnutrition, resulting in obesity;
insufficient physical activity;
polycystic ovaries;
heart disease.

All people with the above factors should monitor the state of their body, be regularly examined and tested for the presence of sugar in the blood. At the stage of the pre-diabetic state, diabetes can be prevented, preventing its further development. If at the initial stages the second type of diabetes develops without damage to the cells of the pancreas, then with the course of the disease, autoimmune processes begin in this variant of the pathology.

Gestational (during pregnancy) diabetes mellitus can develop against the background of obesity, predisposing heredity, a malfunction in the body's metabolic processes, and an excess of glucose in the blood and urine during pregnancy.

Individuals are at medium risk for the following reasons:

at the birth of a child whose weight exceeds 4 kg;
past case of stillbirth;
intensive weight gain during childbearing;
if the woman's age exceeds 30 years.

LADA-diabetes is a latent autoimmune diabetes mellitus, which is closer in etiopathogenesis to type 1 diabetes, but is accompanied by symptoms of an insulin-independent form of the disorder. In the article we will analyze latent autoimmune diabetes in adults.

Attention! In the international classification of diseases of the 10th revision (ICD-10), LADA is designated by the code E10.

The disease can develop at any time in adulthood. The 30-50 year olds have a higher incidence rate than the elderly.

There are no specific recommendations for the treatment of LADA. With regard to therapeutic goals, the general principles of the treatment of diabetes mellitus in case of secretory insufficiency of pancreatic β-cells, corresponding to the therapy of non-insulin-dependent diabetes, are applied.

In general, the prevalence of LADA diabetes is not known due to the lack of population-based screening programs. Asians are more likely to have antibodies than people of European descent.

In general, women are more prone to autoimmune diseases than men. According to the German Diabetes Society, there are 500,000 LADA diabetics in Russia.

Causes and pathogenesis

Diabetes in children is the result of an autoimmune disease, that is, dysfunction of immune cells. The immune system attacks the pancreas' own cells, resulting in a deficiency or complete absence of insulin.

However, typical adult diabetes (type 2) is a consequence of the fact that the cells of the body are able to respond to the insulin hormone (insulin resistance). In the long term, insulin resistance leads to chronic hyperglycemia.

It is known that even children can develop non-insulin dependent type of diabetes. Affected patients are usually diagnosed with type 2 diabetes for the first time before the doctor knows that specific antibodies are present. Patients with LADA usually do not need insulin for the first 6 months and beyond age 35. Unlike "typical" diabetics, patients with LADA are less likely to be obese, but they also have signs of a general metabolic disorder (arterial hypertension, lipid metabolism disorders) that the doctor considers to be due to a diabetic disorder.

The pathophysiology of LADA is not fully understood. The exact reasons for the development of LADA are not clear. As with type 1 diabetes, it is believed that a previously unknown cause (disease, viruses, toxins) is the initial signal for a gradual decrease in insulin-producing cells of the islets of Langerhans.

There are four types of antibodies that are found in this type of diabetes:

Cytoplasmic antibodies directly against beta cells;
Antibodies to glutamate decarboxylase;
Antibodies to the enzyme tyrosine phosphatase IA-2;
Antibodies against insulin itself.

Autoantibodies may occur alone or in combination. In the UKPDS study, 3,672 people were classified by physicians as "typical" patients with type 2 diabetes. Many of them were found to have autoantibodies.

Antibodies

Already in the 1980s, the onset of the insulin-dependent form of pathology was closely associated with the histocompatibility complexes HLA DR3 and HLA DR4. Most LADA patients have similar levels of risk for developing DM1T. Also, with respect to other parameters of cellular immunity and cytokine profile (eg, interleukin 4a, interferon-γ), there appears to be no difference between T1DM and LADA.

T2DM is more genetically related to T1DM. Even in identical twins, both twins have a 30 to 40% chance of developing DM1T. Patients with LADA have the same antibodies as type 1 diabetics.

Symptoms

Symptoms are similar to the insulin-dependent form of the disorder:

polydipsia;
polyuria;
Fatigue, weakness;
Headache;
Tremor;
Irritability;
affective disorders.

Diagnostic criteria

At the beginning, the doctor diagnoses only the presence of diabetes. Only in the course of the disease are further examinations carried out, which help to clarify the form of the disorder. Anamnestic and phenotypic diagnostic criteria:

Relatively young age<50 лет);
Thin or low BMI (<25 кг/м²);
Acute symptoms are polyuria, polydipsia, or ketonuria;
Signs of further autoimmune reactions in the patient;
Family history of autoimmune diseases;
Good response to insulin;
Ineffective oral antidiabetic agents;
Low levels of C-peptide and insulin in the blood

Evidence for LADA is the detection of antibodies in serum (GAD and ICA) or in capillary blood.

Insulin autoantibodies (IAA) should only be determined in patients who have not received insulin. The IA-2 antibody test is not as sensitive as the GADA test and should only be performed after other tests.

GAD antibodies are also found in other autoimmune endocrinopathies (eg, thyroid disease, Addison's disease) and neurological disorders.

Thyroid gland

Treatment

Therapy depends on the level of sugar in the blood and other associated diseases (high blood pressure, thyroiditis, lung diseases, and lipid metabolism disorders). Usually drug therapy is no different from the treatment of other forms of diabetes. Patients are advised to change their diet and physical activity. It is important to give preference to aerobic types of training, as they most effectively increase the sensitivity of various cells to the hormone.

Metformin or DDP-4 inhibitors are recommended as oral hypoglycemic agents. Metformin is especially indicated in overweight patients, as they may also suffer from insulin resistance.

Patients need to reduce weight (especially the child), as obesity has an adverse effect on the course of the disorder.

If LADA is detected, the patient should be informed that in the medium term, it may be necessary to switch oral therapy to insulin therapy. Although systematic studies have not been conducted, early use of insulin may delay damage to β-cells in the pancreas.

Forecast

Diabetes LADA has an intermediate status between type 1 and type 2 diabetes. On the one hand, autoimmune destruction can lead to a complete cessation of insulin production in the body. On the other hand, this process is significantly slowed down in most patients, which softens the course of the disease. Therefore, diabetes is usually diagnosed at a stage where impaired glucose metabolism can still be controlled by oral anti-diabetic medications and even diet. It is important to start insulin therapy as early as possible.

Medicines

Advice! Only a doctor can correctly diagnose and cure the disease. Regular medical check-ups are recommended because this form of diabetes is often asymptomatic (latent). Symptoms (clinical manifestations of the disease) appear only at a late stage of the disorder. Treatment methods and necessary tests are also determined by the doctor.

If any symptoms of the disease occur, patients are advised to seek medical advice immediately. Starting treatment early can help prevent serious diabetic complications. It is not recommended to delay the visit to the doctor, as this can lead to life-threatening consequences for the patient.

Latent Autoimmune Diabetes of Adults, in Russian - latent autoimmune diabetes in adults, is diagnosed in people aged 25+. The main reason for the development of the disease is a malfunction of the immune system, which, instead of performing a protective function, begins to destroy the cells and tissues of its own body. The autoimmune process that characterizes Lada diabetes is aimed at destroying pancreatic cells and stopping their insulin synthesis.

Features of Lada-diabetes

Insulin is a hormone of internal secretion (endogenous), the main purpose of which is to transport glucose into the tissues and cells of the body, as an energy source. A deficiency in the production of the hormone leads to the accumulation of dietary sugar in the blood. In juvenile type 1 diabetes, insulin synthesis is disrupted or stops in childhood and adolescence, due to the hereditary nature of the disease. Lada diabetes is, in fact, the same insulin-dependent type of disease as the first, only declaring itself at a later age.

A feature of the disease is that its symptoms are similar to type 2 diabetes, and the mechanism of development corresponds to the first type, but in a delayed latent form. The second type of pathology is characterized by insulin resistance - the inability of cells to perceive and consume insulin, which is produced by the pancreas. Because Lada diabetes develops in adults, the disease is often misdiagnosed.

The patient is assigned the status of a diabetic for insulin-independent type 2 disease. This leads to the wrong choice of treatment tactics, as a result, to its inefficiency.

When prescribing hypoglycemic drugs intended for type 2 therapy, the pancreas begins to force the production of insulin. Excessive activity of cells against the background of autoimmune processes leads to their death. There is a certain cyclical process.

Due to autoimmune effects, gland cells suffer - insulin production drops - medications are prescribed to reduce sugar - cells synthesize the hormone in an active mode - autoimmune reactions intensify. Ultimately, improper therapy leads to depletion (cachexia) of the pancreas and the need for high doses of medical insulin. In addition, if an autoimmune mechanism is running in the body, its effect may not be limited to only one organ. The internal environment is disturbed, which leads to the development of other autoimmune diseases.

Additionally

In Lada medicine, diabetes occupies an intermediate step between the first and second types of the disease, so you can find the name "diabetes 1.5". Dependence of the patient on regular injections of insulin is formed on average for two years.

Differences in autoimmune pathology

Factors affecting the occurrence

A high predisposition to Lada-diabetes is observed in the presence of a history of autoimmune diseases:

damage to the intervertebral joints (ankylosing spondylitis);
chronic pathology of the central nervous system (central nervous system) - multiple sclerosis;
granulomatous inflammation of the digestive tract (Crohn's disease);
thyroid dysfunction (Hashimoto's thyroiditis);
destructive-inflammatory damage to the joints (arthritis: juvenile, rheumatoid);
violation of pigmentation of the skin (vitiligo);
chronic inflammation of the lining of the colon (ulcerative colitis)
systemic connective tissue disease (Sjögren's syndrome).

Genetic risks should not be discounted either. In the presence of autoimmune pathologies in close relatives, the chances of developing the Lada-type increase. With special attention to control the level of sugar should be women with a history of gestational diabetes. It is generally accepted that the disease is temporary, but with low immunity, against the background of an experienced gestational complication, a latent form of autoimmune diabetes may develop. Probability risk is 1:4.

Triggers (triggers) for starting autoimmune processes in the body can be:

Infectious diseases. Untimely treatment of bacterial and viral diseases leads to a decrease in immunity.
HIV and AIDS. The immunodeficiency virus and the disease caused by this virus cause the immune system to fail.
Alcohol abuse. Alcohol destroys the pancreas.
Chronic allergies.
Psychopathology and permanent nervous stress.
Decreased hemoglobin levels (anemia) due to a poor diet. Deficiency of vitamins and minerals weakens the body's defenses.
Hormonal and endocrine disorders. The correlation of the two systems lies in the fact that some endocrine glands produce hormones that regulate the activity of the immune system, and some of the immune cells of the system have the properties of hormones. Dysfunctionality of one of the systems automatically leads to failure in the other.

The combination of these factors causes many autoimmune diseases, including Lada-diabetes.

Symptoms

Diabetes mellitus type Lada may not show symptoms from several months to several years. Signs of pathology appear gradually. Changes in the body that should alert are:

polydipsia (constant thirst);
pollakiuria (frequent urge to empty the bladder);
dysania (sleep disorder), decreased performance;
weight loss (without diets and sports activities) against the background of polyphagia (increased appetite);
long-term healing of mechanical damage to the skin;
psycho-emotional instability.

Such symptoms rarely cause potential diabetics to seek medical help. Deviations in plasma glucose are detected by chance during a medical examination or in connection with another disease. Detailed diagnostics is not carried out, and the patient is mistakenly diagnosed with non-insulin-dependent diabetes, while his body needs strictly dosed insulin.

Important! If there is no effect or worsening of the condition from erroneously prescribed pills to reduce sugar, it is necessary to undergo a special diagnosis.

Diagnostic measures

The age period of manifestation of Lada diabetes begins after 25 years. According to the norms of digital blood glucose values, the age group from 14 to 60 years corresponds to indicators from 4.1 to 5.7 mmol / l (on an empty stomach). The standard diagnosis of diabetes mellitus includes a study of blood and urine:

Blood sugar level.
Testing for glucose tolerance. Glucose tolerance test is a technique of double blood sampling: on an empty stomach, and two hours after the “load” (drinking sweet water). The evaluation of the results is made according to the table of standards.
Blood test for HbA1c - glycated hemoglobin. This study makes it possible to track the change in carbohydrate metabolism over a period of 120 days by comparing the percentage of glucose and protein (hemoglobin) in blood cells. The percentage norm of glycated hemoglobin by age is: age up to 30 years - up to 5.5%, up to 50 years - up to 6.5%.
General urine analysis. Glycosuria (sugar in the urine) in diabetes is allowed in the range of 0.06-0.083 mmol / l. If necessary, a Reberg test can be added to assess the concentration of creatinine (metabolic product) and albumin protein.
Blood chemistry. First of all, the liver enzymes AST (aspartate aminotransferase), ALT (alanine aminotransferase), Alpha-Amylase, alkaline phosphatase, bile pigment (bilirubin) and cholesterol levels are evaluated.

The main goal of diagnosis is to differentiate Lada diabetes from the first and second types of pathology. If Lada diabetes is suspected, extended diagnostic criteria have been adopted. The patient undergoes blood tests to determine the concentration of immunoglobulins (Ig) to specific antigens - enzyme immunoassay or ELISA. Laboratory diagnostics evaluates three main types of antibodies (immunoglobulins of the IgG class).

ICA (antibodies to pancreatic islet cells). Islets are accumulations in the tail of the gland of endocrine cells. Autoantibodies to islet cell antigens are detected in the presence of diabetes in 90% of cases. Anti-IA-2 (to the enzyme tyrosine phosphatase). Their presence indicates the destruction of pancreatic cells. Anti-GAD (to the enzyme glutamate decarboxylase). The presence of antibodies (positive) confirms autoimmune damage to the pancreas. A negative result rules out type 1 diabetes and type Lada.

Separately, the level of C-peptide is determined as a stable indicator of insulin production in the body. The analysis is carried out in two stages, similar to glucose tolerance testing. A reduced level of C-peptide indicates low insulin production, that is, the presence of diabetes. The results obtained during diagnosis can be as follows: negative Anti-GAD - the absence of Lada-diagnosis, positive Anti-GAD against the background of low C-peptide values - the presence of Lada-diabetes.

In the case when antibodies to glutamate decarboxylase are present, but the C-peptide does not go beyond the normative limits, the patient needs additional examination by determining genetic markers. When making a diagnosis, attention is paid to the age category of the patient. Additional diagnostics is necessary for young patients. Be sure to measure the body mass index (BMI). In the non-insulin-dependent second type of the disease, the main symptom is overweight, Lada diabetics have a normal BMI (from 18.1 to 24.0) or insufficient (from 16.1 to) 17.91.

Of the hardware diagnostic methods, abdominal ultrasound is used to study the state of the pancreas and ECG (electrocardiogram of the heart).

Treatment of pathology

Therapy of the disease is based on the use of medications, diet, moderate physical activity.

insulin therapy

The main drug treatment consists in the selection of adequate doses of insulin, corresponding to the stage of the disease, the presence of concomitant pathologies, the weight and age of the patient. Early use of insulin therapy helps to stabilize sugar levels, not overload the cells of the pancreas (they are quickly destroyed during intensive work), stop autoimmune processes, and maintain the residual performance of insulin.

When the gland retains reserves, it is easier for the patient to maintain a stable normal level of glucose in the blood. In addition, such a "reserve" allows you to delay the development of diabetic complications, and reduces the risk of a sharp drop in sugar (hypoglycemia). Early prescription of insulin preparations is the only correct tactic for managing the disease.

According to medical research, early insulin therapy for Lada diabetes gives a chance to restore the pancreas to produce its own insulin, albeit in a small amount. The treatment regimen, the choice of drugs and their dosage are determined only by the endocrinologist. Self-medication is unacceptable. Hormone doses, at the initial stage of treatment, are maximally reduced. Combination therapy with short and prolonged insulins is prescribed.

diet therapy

In addition to drug treatment, the patient must follow a diabetic diet. Nutrition is based on the therapeutic diet "Table No. 9" according to the classification of Professor V. Pevzner. The main emphasis in the daily menu is on vegetables, fruits, cereals and legumes with a low glycemic index (GI). GI is the rate of breakdown of food that enters the body, release of glucose, and its resorption (absorption) into the systemic circulation. Thus, the higher the GI, the faster glucose enters the bloodstream and the sugar levels “jump”.

Brief table of products indicating the glycemic index

Foods indexed from 0 to 30 are allowed, food with an average GI (from 30 to 70) can be consumed to a limited extent

It is strictly forbidden to use simple fast carbohydrates: confectionery desserts, milk chocolate and sweets, pastries from puff, butter, shortbread dough, ice cream, marshmallows, jams, jams, packaged juices and bottled tea. If you do not change your eating behavior, the treatment will not give positive results.

Physical training

Another important method of normalizing sugar indicators is rational physical activity on a regular basis. Sports activity increases glucose tolerance, as cells are enriched with oxygen during exercise. Recommended activities include gymnastics, moderate fitness, Finnish walking, swimming in the pool. Training should be appropriate to the patient's capabilities, without overloading the body.

As with other types of diabetes, patients should follow medical recommendations:

purchase a glucometer, and monitor glucose readings several times in laziness;
master the injection technique, and inject insulin in a timely manner;
follow the rules of diet therapy;
exercise regularly;
keep a "Diary of a diabetic", which records the time and dose of insulin, as well as the qualitative and quantitative composition of the food eaten.

It is impossible to cure diabetes mellitus, but a person can take control of the pathology in order to improve the quality of life and increase its duration.

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Additionally

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Symptoms

Diagnostic measures

Treatment of pathology

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diet therapy

Physical training