LADA or type 1.5
There are two main types of diabetes most people know about:
– Type 1 diabetes which used to be known as juvenile diabetes due to it mainly being diagnosed in children and young adults, which is an autoimmune condition that most commonly appears in childhood and can only be controlled by insulin injections or pumps
– Type 2 diabetes which used to be called mature onset diabetes due to it mainly being diagnosed in adulthood and usually over 40, which is seen more often in overweight adults in their mid years. However, as the incidence of obesity increases in all age groups, type 2 is now increasingly seen in younger people. In the early stages type 2 can often be controlled by weight loss, diet and exercise, but over time, oral medication in increasing amounts is usually required. Insulin is now being used for many people with type 2 diabetes as the condition progresses.
Until recently it was thought that these were the only two main types of diabetes. However, it is now known that some people are incorrectly classified as type 2 diabetes at diagnosis when they actually have a type 1 diabetes – LADA.
These people have increased levels of glutamic acid decarboxylase antibodies (GAD Ab), an autoimmune marker of an attack on the cells that produce insulin. Eventually this leads to an absolute lack of insulin. It is this insulin deficiency that identifies type 1 diabetes. This late-onset type of type 1 diabetes is known as ‘latent autoimmune diabetes of adults’, ‘slow onset type 1’, or ‘type 1.5 diabetes’.
Unlike type 2 diabetes, LADA can not be adequately controlled with diet, exercise, oral medication and weight loss. In fact people with LADA often have a lower body mass index than people with type 2 diabetes.
Depending on the aggressiveness of the immune attack on the insulin-producing cells of the pancreas, people with LADA progress to need insulin injections at varying rates. Most will be on insulin within six years of the time of correct diagnosis. However, control in that intervening period is often not ideal. The early introduction of insulin treatment not only provides better control, but may preserve the remaining insulin-secreting cells for longer.
The national survey of over 850 people with Type 1 diabetes who were diagnosed as adults by the type 1 diabetes network, found that one in three adults were diagnosed with a condition other than Type 1 diabetes when they first visited their healthcare professional.
MODY (Mature Onset Diabetes in the Young)
This type of diabetes is more likely to be inherited than other types of diabetes, due to a stronger genetic risk factor.
MODY is sometimes compared to type 2 diabetes and shares some type 2 diabetes symptoms. However, MODY is not linked to obesity, and typically people are diagnosed younger and not necessarily overweight. It affects approximately one or two per cent of people who have diabetes, and may often go unrecognised in its early stages.
It is a form of diabetes that develops before the person reaches 25.It also runs in families, and can pass from one generation to the next. MODY does not always require insulin treatment.
MODY is directly caused by the change in a single gene, and all children of an affected parent have a 50 per cent chance of inheriting this gene, and consequently developing MODY themselves. Knowing and understanding MODY and even the different forms of MODY (six types have been identified), means that the affected person can be treated in the most appropriate way possible.
Advice can also be provided about how the disease will progress, and what complications can be expected. Furthermore, other family members can be advised about the risks of inheriting the disease.
The most common MODY type is HNF1 alpha. This is responsible for 70 per cent of MODY.
The amount of insulin produced by the pancreas becomes less as the person gets older, and MODY develops during adolescence or the early twenties.
Gestational diabetes (sometimes referred to as GDM) is diagnosed when higher than normal blood glucose levels first appear during pregnancy. From 3 to 8% of pregnant women will develop gestational diabetes around the 24th to 28th week of pregnancy, however, some may be earlier.
While maternal blood glucose levels usually return to normal after the birth of the baby, there is a known increased risk for type 2 diabetes in the mother in the future. Your child may also be at risk of developing type 2 diabetes later in life.
You are at risk of developing gestational diabetes if you:
- Are over 30 years of age
- Have a family history of type 2 diabetes
- Are overweight
- Are from an indigenous Australian or Torres strait islander background
- Are from a Vietnamese, Chinese, middle eastern, Polynesian or Melanesian background
- Have had gestational diabetes during previous pregnancies.
You can find more information on the Diabetes Australia website