LADA (Type 1.5 diabetes) Misdiagnosis – Anna’s Story

Article written and reviewed by Cyrus Khambatta, PhD
Published July 19, 2018

Misdiagnosing Diabetes: The Importance of Diagnostic Tests

Imagine trying to manage your blood glucose by restricting calories and carbohydrate-rich foods, exercising every day for hours, and performing regular juice cleanses.

Imagine thinking that you have type 2 diabetes that can be controlled with oral medication, developing a laundry list of side effects that make you feel terrible.

Imagine that your blood glucose control got worse over time, despite your heroic efforts at controlling your blood glucose using diet, exercise, and oral medication.

Meet Anna. This was her experience.

Anna’s Misdiagnosis with Type 2 Diabetes

Anna spent 11 years trying to manage her blood glucose using multiple medications. She had been diagnosed and living with type 2 diabetes since 2007 when she was diagnosed during her first pregnancy. 

During her second pregnancy a few years later, she was prescribed insulin to manage her blood glucose.

Over the years, Anna felt ashamed because no matter how hard she tried, every time she went to the doctor’s office her blood glucose control wasn’t improving.

Anna was given either higher doses of oral medications or another diabetes medication. She grew increasingly frustrated that every time she ate anything (including non-starchy vegetables), her blood glucose would increase significantly.

The result? Anna grew scared of eating.

Anna felt terrible from the side effects of a growing list of unnecessary oral medications. She tried fad diets and juice cleanses, and became increasingly confused about how to control her blood glucose.

A Simple C-Peptide Test Changed Everything

Anna’s physician diagnosed her with type 2 diabetes, and told her that she had a “normal” c-peptide value – a blood-borne marker used to determine how much insulin her pancreatic beta cells were capable of producing.

Put simply, a c-peptide test measures whether the beta cells in your pancreas are able to produce a sufficient amount of insulin, or whether their ability to produce insulin has been permanently impaired due to progressive damage over time or autoimmune diabetes (type 1 diabetes or type 1.5 diabetes – LADA).

Operating with the understanding that her pancreas was capable of producing a sufficient amount of insulin, Anna and her doctor believed that an increasing list of oral medication was the only answer.

Frustrated, Anna decided to begin eating a low-fat, plant-based, whole-food diet after watching “What the Health” in November of 2017. She thought this would be the answer to finally reversing type 2 diabetes.

Unfortunately, Anna quickly discovered that even though she stopped eating meat, cheese, dairy, and eggs, her blood glucose was still uncontrollable.

Next, she found the Mastering Diabetes Program and immediately signed up, thinking… “This has to be the answer.” Unfortunately for Anna, even following the guidelines for food in the Mastering Diabetes Program, her blood glucose remained elevated.

Anna joined small group coaching in which Cyrus asked some clarifying information to understand why her blood glucose was constantly elevated, despite her efforts to eat a truly low-fat, plant-based, whole-food diet.

When Cyrus asked her a simple question: “What is your c-peptide level?” Anna responded “It is normal.” Cyrus asked “No, what was the actual number?” and Anna replied, “my c-peptide is 0.8.”

Cyrus then explained to her that with a c-peptide value of 0.8, her pancreas was not producing sufficient insulin to meet her metabolic needs.

The reference range for c-peptide is 0.8 – 3.8, and even though a value of 0.8 is technically within the normal range, it indicates that your insulin production is extremely low and insufficient to meet your basic metabolic needs.

When Anna heard this, a light bulb went off. This was the turning point in her 11-year history battling high blood glucose.

What Exactly is Latent Autoimmune Diabetes of Adults (LADA)?

Anna found a physician who prescribed the use of insulin, supported her desire to eat a low-fat, plant-based, whole-food diet, and ordered a c-peptide test and antibody test to determine what version of diabetes Anna was actually living with.

Anna’s physician ordered a diabetes antibody panel to determine if her low c-peptide value was due to an autoimmune reaction or not. She tested positive for one autoantibody, which classified her as having type 1.5 diabetes (LADA), the adult-onset version of type 1 diabetes that now affects a growing number of adults around the world.

Think of LADA as a slow progressing, adult-onset version of type 1 diabetes that affects adults over the age of 30. 

Those diagnosed with LADA have a pancreas that is still capable of producing insulin, however a weak autoimmune reaction targets beta cells for destruction over the course of time.

People with LADA often exhibit characteristics of both type 1 diabetes and type 2 diabetes, which is why it can be challenging to diagnose. In most cases, people living with LADA exhibit the following characteristics:

  • They are older than age 30 when diagnosed

  • They have only 1 antibody against beta cells or insulin (a weak autoimmune reaction)
  • They have a low c-peptide level which eventually progresses to zero insulin production over the course of many years (slower than those with type 1 diabetes)
  • They have a lower BMI compared with most people living with type 2 diabetes

Insulin and Plant-Based Nutrition to the Rescue!

Anna’s physician prescribed the use of both basal and bolus insulin, which improved her blood glucose control immediately.

As she adjusted to using insulin on a daily basis, her doctor removed all oral medications that caused unnecessary side effects (including low energy and impaired digestion) but did nothing to control her blood glucose.

Anna also fully embraced a low-fat, plant-based, whole-food lifestyle, which has significantly increased her insulin sensitivity, which has kept her overall insulin requirements quite low. 

Most importantly, she feels empowered and in full control over her diabetes health, for the first time in her 11-year history living with LADA.

Prior to joining Mastering Diabetes, Anna was in a near-constant state of hunger. She thought that she had to limit her carbohydrate intake and was therefore eating primarily nuts and green vegetables – and even then, her blood glucose values were still high.

Today, she feels liberated to be able to eat delicious, satiating foods once again. Since learning how important c-peptide and antibody testing truly is, she is able to eat carbohydrate-rich foods including fruits and starchy vegetables, and can control her blood glucose with precision.

She starts her day with a big fruit breakfast and eats more fruit, vegetables, beans, whole grains, and hearty “buddha bowl” salads throughout the day.

Anna no longer has questions about what to eat, nor does she feel frustrated about her blood glucose control. She understands the physiology of LADA and knows how to measure her carbohydrate:insulin ratio.

Anna is grateful to finally be able to fuel her body with nutrient dense foods, without having to restrict calories or carbohydrates.

Today, Anna lives in full control of her blood glucose, using small amounts of basal and bolus insulin. She truly enjoys eating a low-fat, plant-based, whole-food diet, and has more energy today than she has had in many years.

Take Home Message

Both the c-peptide test and diabetes antibody tests were critical missing pieces of information that dramatically changed the course of Anna’s diabetes management, and without those diagnostic tests she would likely still be suffering from uncontrollable blood glucose.

If you’re living diabetes and are unsure of your diagnosis, we recommend asking your doctor for a c-peptide test to determine whether your pancreas is capable of producing sufficient insulin.

You can also order a c-peptide test directly using an online resource called Request A Test. You will not need a prescription to order the test, and the price range is between $59 (LabCorp) and $69 (Quest). 

Order the C-Peptide Blood Test today, and follow the directions to get your c-peptide tested.

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About the author 

Cyrus Khambatta, PhD

Cyrus Khambatta, PhD is a New York Times bestselling co-author of Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes.

He is the co-founder of Mastering Diabetes and Amla Green, and is an internationally recognized nutrition and fitness coach who has been living with type 1 diabetes since 2002. He co-created the Mastering Diabetes Method to reverse insulin resistance in all forms of diabetes, and has helped more than 10,000 people improve their metabolic health using low-fat, plant-based, whole-food nutrition, intermittent fasting, and exercise.

Cyrus earned a Bachelor of Science in Mechanical Engineering from Stanford University in 2003, then earned a PhD in Nutritional Biochemistry from the University of California at Berkeley in 2012. He is the co-author of many peer-reviewed scientific publications.

He is the co-host of the annual Mastering Diabetes Online Summit, a featured speaker at the Plant-Based Nutrition and Healthcare Conference (PBNHC), the American College of Lifestyle Medicine Conference (ACLM), Plant Stock, the Torrance Memorial Medical Center, and has been featured on The Doctors, NPR, KQED, Forks Over Knives, Healthline, Fast Company, Diet Fiction, and the wildly popular podcasts the Rich Roll Podcast, Plant Proof, MindBodyGreen, and Nutrition Rounds.

Scientific Publications:

Sarver, Jordan, Cyrus Khambatta, Robby Barbaro, Bhakti Chavan, and David Drozek. “Retrospective Evaluation of an Online Diabetes Health Coaching Program: A Pilot Study.” American Journal of Lifestyle Medicine, October 15, 2019, 1559827619879106. https://doi.org/10.1177/1559827619879106.

Shrivastav, Maneesh, William Gibson, Rajendra Shrivastav, Katie Elzea, Cyrus Khambatta, Rohan Sonawane, Joseph A. Sierra, and Robert Vigersky. “Type 2 Diabetes Management in Primary Care: The Role of Retrospective, Professional Continuous Glucose Monitoring.” Diabetes Spectrum: A Publication of the American Diabetes Association 31, no. 3 (August 2018): 279–87. https://doi.org/10.2337/ds17-0024.

Thompson, Airlia C. S., Matthew D. Bruss, John C. Price, Cyrus F. Khambatta, William E. Holmes, Marc Colangelo, Marcy Dalidd, et al. “Reduced in Vivo Hepatic Proteome Replacement Rates but Not Cell Proliferation Rates Predict Maximum Lifespan Extension in Mice.” Aging Cell 15, no. 1 (February 2016): 118–27. https://doi.org/10.1111/acel.12414.

Roohk, Donald J., Smita Mascharak, Cyrus Khambatta, Ho Leung, Marc Hellerstein, and Charles Harris. “Dexamethasone-Mediated Changes in Adipose Triacylglycerol Metabolism Are Exaggerated, Not Diminished, in the Absence of a Functional GR Dimerization Domain.” Endocrinology 154, no. 4 (April 2013): 1528–39. https://doi.org/10.1210/en.2011-1047.

Price, John C., Cyrus F. Khambatta, Kelvin W. Li, Matthew D. Bruss, Mahalakshmi Shankaran, Marcy Dalidd, Nicholas A. Floreani, et al. “The Effect of Long Term Calorie Restriction on in Vivo Hepatic Proteostatis: A Novel Combination of Dynamic and Quantitative Proteomics.” Molecular & Cellular Proteomics: MCP 11, no. 12 (December 2012): 1801–14. https://doi.org/10.1074/mcp.M112.021204.

Bruss, Matthew D., Airlia C. S. Thompson, Ishita Aggarwal, Cyrus F. Khambatta, and Marc K. Hellerstein. “The Effects of Physiological Adaptations to Calorie Restriction on Global Cell Proliferation Rates.” American Journal of Physiology. Endocrinology and Metabolism 300, no. 4 (April 2011): E735-745. https://doi.org/10.1152/ajpendo.00661.2010.

Bruss, Matthew D., Cyrus F. Khambatta, Maxwell A. Ruby, Ishita Aggarwal, and Marc K. Hellerstein. “Calorie Restriction Increases Fatty Acid Synthesis and Whole Body Fat Oxidation Rates.” American Journal of Physiology. Endocrinology and Metabolism 298, no. 1 (January 2010): E108-116. https://doi.org/10.1152/ajpendo.00524.2009.