The Slow Autoimmune Attack

Your immune system is built to attack things that do not belong — bacteria, viruses, damaged cells. In autoimmune diabetes it makes a mistake and attacks your own beta cells, the cells that make insulin.

Antibodies are proteins the immune system produces when it identifies a target. In LADA, antibodies against beta-cell proteins can usually be found in your blood, which is how the diagnosis is confirmed.

The distinctive thing about LADA is the pace. Beta-cell function declines roughly three times faster than in Type 2 diabetes, but far more slowly than in childhood Type 1.

Part of the reason is that the immune attack itself is milder. Antibody levels are generally lower than in Type 1, and examination of the pancreas shows a different mix of immune cells and more of the signals that calm inflammation rather than drive it.

The process also starts long before you notice anything. Antibodies can be present for several years before blood sugar rises enough to be diagnosed.

This slow decline is why LADA behaves the way it does. You have enough insulin at first, so you feel reasonably well and tablets work. Then the reserve shrinks, and treatment that was adequate last year is not adequate this year.

Understanding this makes the progression less alarming. Your treatment changing is not a sign you have managed things badly — it is the expected shape of the condition.