Diabetes is a common health condition that affects many people worldwide. There is a type of diabetes called "Diabetes 1.5" or "Latent Autoimmune Diabetes in Adults" (LADA) that many people may not know about. Based on certain studies, LADA might make up approximately 5% to 10% of the total number of diabetes cases.
Diabetes 1.5 is a type of diabetes that has features of both Type 1 and Type 2 diabetes. Like Type 1 diabetes, in case of LADA, the immune system attacks and damages the insulin-producing cells in the pancreas. This autoimmune process gradually leads to a decrease in insulin, which means that insulin therapy is needed. LADA progresses more slowly than Type 1 diabetes. LADA is similar to Type 2 diabetes.
People with LADA usually have a slim body and are more active than people with Type 2 diabetes. Type 1 diabetes usually starts in childhood or adolescence, while Type 2 diabetes is more common in older adults. However, LADA often appears in people between the ages of 30 and 50.
It is really important to accurately identify the type of diabetes so that we can manage and treat it effectively. Misclassifying LADA as Type 2 diabetes can cause delays in starting insulin treatment, which is important for preserving beta cell function.
LADA Diagnosis: Doctors need to do specific tests to tell the difference between LADA, Type 1, and Type 2 diabetes because they have similar symptoms.
1. Blood tests: A wide range of blood tests, including essential ones like fasting blood glucose levels, haemoglobin A1c (HbA1c) tests to determine the average blood sugar levels over the past few months, and autoantibody testing, will be required. LADA is identified by the presence of certain autoantibodies.
2. C-peptide assessment: This measurement shows how much insulin the pancreas produces. Low levels of C-peptide may mean less insulin production, which is a key sign of LADA.
3. The glucose tolerance test: It is sometimes used to assess the body's ability to process glucose after consuming a sugary beverage.
Strategies for prevention: Preventing Diabetes 1.5 (LADA) is challenging due to its autoimmune nature. In order to reduce the likelihood of complications, individuals can manage their blood sugar levels by implementing the following modifications to their daily routines.
• Consume a well-rounded diet that includes ample amounts of fruits, vegetables, lean sources of protein, and nutritious fats. Decrease the intake of unhealthy foods and sugary additives.
• Ensure that you engage in regular exercise, aiming for a minimum of 150 minutes per week at a moderate intensity level. This can enhance your body's insulin response.
• Minimise the likelihood of issues by attaining and sustaining a balanced weight.
• Remember to regularly check your sugar, blood pressure, and cholesterol levels when you visit your doctor.
• Manage stress by practising calming activities such as yoga or meditation to prevent sudden decreases in blood sugar.
• Smoking and drinking too much alcohol can make diabetic complications more likely. It is best for people with diabetes to avoid or limit these habits.
If you have any concerns or questions about diabetes and how to manage it, talk to a healthcare professional. By doing this, you can get personalised advice and expert guidance that is specifically tailored to your unique situation.
Having a late breakfast increases your risk of developing type 2 diabetes by nearly two thirds.
Those who breakfasted after 9 A.M. were 59 percent more likely to develop the condition than those who were done by 8 A.M.
A late dinner, after 10 P.M, also increased the risk, while eating five times a day reduced it.
Researchers looked at more than 100,000 people in France over a period of seven years.
The Spanish team said the results show that we can reduce the risk of diabetes not only by changing what we eat, but also when we eat it.
Dr. Anna Palomar-Cros, researcher at the Barcelona Institute for Global Health (ISGlobal) and first author of the study said: "Biologically, this makes sense, as skipping breakfast is known to affect glucose and lipid control, as well as insulin levels.
Brooke Lark
“This is consistent with two meta-analyses that conclude that skipping breakfast increases the risk of type 2 diabetes.
"We know that meal timing plays a key role in regulating circadian rhythms and glucose and lipid control, but few studies have investigated the relationship between meal timing or fasting and type 2 diabetes."
Type 2 diabetes is also associated with modifiable risk factors, such as an unhealthy diet, physical inactivity and smoking.
Participants filled in online dietary records of what they ate and drank over a 24-hour period on three non-consecutive days, as well as the timing of their meals.
Rachel Park
The research team averaged the dietary records for the first two years of follow-up and assessed the participants' health over an average of seven years.
There were 963 new cases of type 2 diabetes during the study.
The risk of developing the disease was significantly higher in the group of people who regularly ate breakfast after 9 A.M., compared to those who ate breakfast before 8 A.M.
However prolonged fasting is only beneficial if it is done by having breakfast before 8am and an early dinner.
Professor Manolis Kogevinas, ISGlobal researcher and co-author of the study added:
"Our results suggest that a first meal before 8 A.M. and a last meal before 7 P.M. may help reduce the incidence of type 2 diabetes."
Diabetes is a chronic metabolic disorder characterized by high blood sugar levels due to the body's inability to produce or effectively use insulin. It can lead to various symptoms affecting multiple organs, including the legs. From a health expert's perspective, it is crucial to recognize and understand the symptoms of diabetes-related leg complications to ensure timely diagnosis and appropriate management.
02/8Tingling sensation
Dr. Sanjay Singh, General Physician, Cygnus Laxmi Hospital says, “Diabetes can cause nerve damage, leading to peripheral neuropathy in the legs. Symptoms include tingling, numbness, burning sensations, and loss of sensation. Patients may experience difficulty in detecting injuries or sores on their feet, which can lead to infections and ulcers.
03/8Poor circulation
High blood sugar levels can damage blood vessels, leading to poor circulation in the legs. Symptoms include leg cramps, pain, weakness, and slow-healing wounds. If left untreated, PAD can cause severe complications like gangrene and may even necessitate amputation.
04/8Diabetic foot ulcers
According to Dr. Singh, “Neuropathy and poor circulation can result in foot ulcers, which are open sores that are slow to heal and prone to infections. These ulcers require meticulous wound care and management to prevent serious consequences.”
05/8Redness and swelling
Also known as diabetic foot deformity, this condition can cause fractures and dislocations in the feet due to weakened bones and joint damage. Symptoms include redness, swelling, and deformities in the foot or ankle.
06/8Skin changes
“Diabetes can lead to changes in the skin's appearance, such as dryness, cracking, and a higher risk of fungal or bacterial infections,” says Dr. Singh.
07/8Restless leg syndrome (RLS)
Although the exact connection between diabetes and RLS is not fully understood, some studies suggest a link. Patients with RLS experience uncomfortable sensations in their legs, often relieved by movement. It is essential for individuals with diabetes to monitor their blood sugar levels regularly, follow a healthy diet, engage in regular physical activity, and take prescribed medications or insulin as directed by their healthcare provider. Routine foot care and regular check-ups with a healthcare professional are vital to identify any potential complications early.READMORE
08/8The takeaway
“Health experts stress the significance of patient education in diabetes management. Understanding the symptoms associated with diabetes-related leg complications empowers patients to seek prompt medical attention when necessary, helping to prevent the progression of the condition and improve overall quality of life. As with any medical condition, early detection and comprehensive management are the keys to successful diabetes care,” says Dr. Singh.
People aged over 60 who reduce the time they spend being physically active run the risk of a lower quality of life, research has highlighted.
The study of nearly 1,500 people also found that quality of life is reduced in older people if they increase the amount of time they spend sitting down.
The findings have led researchers to stress the importance of older adults maintaining an active lifestyle.
Dr Dharani Yerrakalva, from the Department of Public Health and Primary Care at the University of Cambridge, said: “Keeping yourself active and limiting – and where you can, breaking up – the amount of time you spend sitting down is really important whatever stage of life you’re at.
“This seems to be particularly important in later life, when it can lead to potentially significant improvements to your quality of life and your physical and mental wellbeing.”
Ways to stay active in older age include a daily brisk walk for around 20 minutes, gardening, cycling, dancing or tennis.
Staying active, particularly if it raises your heart rate, helps to reduce the risk of conditions including stroke, diabetes, heart disease and cancer.
Adults should aim to do at least 150 minutes of moderate-intensity exercise a week or 75 minutes of vigorous-intensity exercise a week, according to the NHS.
Particular health benefits can be seen in older people if they break up long periods of sitting with some activity, even if it just standing.
This latest study involved 1,433 people aged 60 or over, with researchers examining their activity levels. They also measured their quality of life, giving them a score between 0 (worst quality of life) and 1 (best) based on their answers to a survey.
Lower quality of life scores are associated with a greater risk of being admitted to hospital, worse outcomes following hospitalisation, and early death.
Six years later, the researchers followed up on the initial findings to note changes in participants’ activity levels and quality of life.
Both men and women were, on average, doing 24 minutes less moderate-to-vigorous physical activity each day. In addition, sedentary time increased by an average of 33 minutes a day for men and 38 minutes for women.
Those people who did more moderate-to-vigorous physical activity at the start of the study, and spent less time sitting down, had a higher quality of life later on.
Quality of life scores show that someone who spent 15 minutes a day less engaged in moderate-to-vigorous physical activity would have seen their score drop by 0.45.
In terms of sedentary behaviour, those who spent 15 minutes a day more sitting down would have seen their quality of life score drop by 0.18.
For context, a 0.1 point improvement in quality of life scores has been linked in the past with a 6.9% reduction in early death and a 4.2% reduction in risk of being admitted to hospital.
Dr Yerrakalva said: “There are several ways in which improvements in our physical behaviours might help maintain a better quality of life.
“For example, more physical activity reduces pain in common conditions such as osteoarthritis, and we know that being more physically active improves muscle strength which allows older adults to continue to care for themselves.
“Similarly, depression and anxiety are linked to quality of life, and can be improved by being more active and less sedentary.”
The FDA has approved a new drug called Lantidra to manage low blood sugar in people with type 1 diabetes.
The drug helps control blood sugar levels through an infusion of donor pancreatic cells that create insulin in the body so that patients no longer need to take external insulin.
This drug is for people with severe and recurrent hypoglycaemia who are unable to achieve target blood sugar levels.
Illustration by Zoe Hansen for Verywell Health
In June, the FDA approved Lantidra—the first donor cell therapy for people with type 1 diabetes who struggle with severe and recurrent low blood sugar. The drug eliminates the need for external insulin, and avoids something as invasive as an islet cell transplant.
Lantidra (donislecel-jujn) is for people who have trouble managing their blood sugar and suffer from hypoglycaemia, or for people who have hypoglycaemia unawareness—a condition where patients are unable to detect their dropping blood sugar and might not be able to treat it before it drops to potentially dangerous levels. This can be a life-threatening condition that is not easily treatable with medication.
“Severe hypoglycaemia is a dangerous condition that can lead to injuries resulting from loss of consciousness or seizures,” said Peter Marks, MD, PhD, director of the FDA’s Centre for Biologics Evaluation and Research, in a FDA press release about Lantidra. “Today’s approval, the first-ever cell therapy to treat patients with type 1 diabetes, provides individuals living with type 1 diabetes and recurrent severe hypoglycaemia an additional treatment option to help achieve target blood glucose levels.”
Developed by CellTrans, Lantidra is an infusion of islet cells from a deceased donor into the liver portal vein of the diabetic patient. Because the infused cells restore functional pancreatic islet cells in people with type 1 diabetes, external insulin is no longer necessary.
Small—But Successful—Clinical Trials Led to Approval
Lantidra’s safety was studied in two non-randomized trials with 30 participants who live with type 1 diabetes and hypoglycaemic unawareness. The patients received at least one Lantidra infusion and a maximum of three infusions, the FDA said in its press release.
After their infusions, 21 patients did not need to take insulin for a year or more. Eleven patients did not need insulin for one to five years and 10 participants did not need insulin for more than five years. Five patients required external insulin after the infusions, and did not achieve any insulin independence.
During the trials there were two deaths—one from multiorgan failure with sepsis about one-and-a-half years after the first infusion, and one from progressive confusion, global atrophy and micro-ischemic disease almost 10 years after the first dose. Both subjects were on immunosuppression at the time.
What to Know About Lantidra
This drug was specifically approved to tackle ongoing and severe low blood sugar in patients with type 1 diabetes who are unable to reach target blood sugar levels despite intensive diabetes management and education.
Type 1 diabetes is a disease where the body's own immune system starts attacking the insulin producing cells of the pancreas, Omid Veiseh, PhD, an associate professor of bioengineering at Rice University, told Verywell. Once those cells are killed off, the patient can no longer regulate their blood glucose, meaning they need to rely on external insulin.
“This new drug gets those insulin producing cells from deceased donors…then they’re purified to be safe in terms of pathogens and whatnot—and then they’re infused into type 1 diabetic recipients,” Veiseh said. “But because the disease is autoimmune mediated, and the cells are from a donor, the patient will receive immunosuppression [medication]. The immune suppression basically protects the cells from the host’s immune response.”
Up until now, patients with recurrent and severe hypoglycaemia have had to work with their endocrinologist to manage blood sugar as best as they can through the dosing of their insulin as well as diet and exercise. In severe cases, the use of glucagon, which helps rescue patients from an episode of hypoglycaemia, is used, said Fernando Ovalle, MD, director of the Division of Endocrinology, Diabetes and Metabolism at the University of Alabama at Birmingham School of Medicine.
“You don’t want to have hypoglycaemia, especially severe or repeated,” Ovalle told Verywell, explaining that a severe low blood sugar can result in incidents like falling and hitting your head, cardiac arrest, or seizures.
For patients for whom ongoing hypoglycaemia poses a great threat to their health, including death, an islet cell transplant might be considered. During this procedure, islets are taken from the pancreas of a deceased organ donor, then transferred into a patient with type 1 diabetes. Once the cells are implanted in the liver, they are able to make insulin.
Lantidra introduces healthy islet cells without requiring a transplant procedure.
Veiseh said advancements like Lantidra are giving hope to the medical and type 1 diabetes community. In the future, advancements will likely include replaceable cell types that can be lab-grown—so you don’t have to rely on donors—as well as localized immunosuppression strategies. This means that only the site that cells are infused into will need to be immunosuppressed, not the entire body.
“I think, in the next five or 10 years, we’re going to see a lot more of these islet replacement therapies, on the market,” Veiseh said. “And it’s going to be great for patients, because the cure is to replace those missing cells that have been killed off.”
How Lantidra Is Administered
Lantidrais a prescription medication that is administered by a healthcare professional via infusion into the liver. The recommended minimum dose is 5,000 equivalent islet number (EIN) per kg for the first infusion, and 4,500 EIN/kg for subsequent infusions, the drug maker said.
The drug is currently only recommended for people who experience recurrent and severe hypoglycaemia or have hypoglycaemia unawareness. It is not for all people with type 1 diabetes, or for people with type 2 diabetes. It’s best for any patient considering the drug to first consult with their healthcare provider to see if they are the right candidate.
Lantidra is given in a single infusion dose. An additional dose or two may be necessary depending on whether the patient responds to the first infusion and achieves independence from external insulin within one year. In other words, if the first infusion is not successful, another dose might be needed. There is currently no data on the effectiveness or safety for patients who have more than three infusions.
How Does Lantidra Work?
Lantidra is an infusion of islet cells from a deceased donor into the liver portal vein of the diabetic patient. The infused cells restore functional pancreatic islet cells in people with type 1 diabetes, removing the need for external insulin.
Known Side Effects
In clinical trials, there were a series of adverse reactions associated with Lantidra. The drug maker said these varied with each participant and depended on the number of infusions they received.
Ninety percent of trial participants had at least one serious adverse reaction, and the major causes were attributed to the infusion procedure and immunosuppression drugs. Some of these side effects meant that the patient needed to stop taking the immunosuppressants, which stopped the drug from working.
Some of the most common reactions were nausea, fatigue, anaemia, diarrhoea, and abdominal pain.
Aside from the side effects of Lantidra itself, there are risks with taking immunosuppressants for a long period of time, including risk of infections, lymphomas and anaemia.
“These adverse events should be considered when assessing the benefits and risks of Lantidra for each patient,” the FDA said in its press release.
While the safety of taking Lantidra while pregnant has not been assessed, there are known risks for being on immunosuppressants while expecting. Fetal malformations are associated with some of the suppression drugs, therefore the drug maker warns patients should have a confirmed negative pregnancy test before starting Lantidra.
How to Get Lantidra
Veiseh said because Lantidra relies on donor cells, CellTrans has a limited supply of the drug.
“You’re sort of at the mercy of donors being available,” he said. “I think the best estimates put this at 2,000 to 4,000 patients per year that you could treat just because of the limitation of organ availability.”
However, Veiseh said Lantidra is a step in the right direction for patients with type 1 diabetes who suffer from severe, ongoing low blood sugar. It is giving them another option instead of an islet cell transplant—a procedure that is only available in certain healthcare settings.
“In other countries, this kind of therapy has been available and reimbursed by insurance for years, but in the U.S., it was sort of a patchwork system of various surgeons that did it but it wasn’t really available to everyone,” said Veiseh. The National Institute of Diabetes and Digestive and Kidney Diseases has said that islet transplantation is considered an experimental procedure, and until it’s approved as a treatment for type 1 diabetes, it can only be performed for research purposes through clinical trials and is generally not covered by insurance.
“I think this is really a big step forward towards making this a potential solution that is uniformly available to all the patients as opposed to just certain ones,” Veiseh said.
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