Latent autoimmune diabetes of adult (LADA) is an autoimmune endocrine disorder in which despite presence of autoantibody
to pancreatic islet cell progression to beta cell insufficiency is slow. Hence it is called slowly progressive type 1 diabetes
mellitus. It is often confused with other types of diabetes mellitus, therefore encounters both mistaken diagnosis and inappropiate
management. LADA is also known as �type 1.5 diabetes� as it shares symptoms of both type 1 and 2 diabetes. Autoantibody to
glutamic acid decarboxylase (anti GAD65 antibody) is the most sensitive and specific marker for this subgroup of diabetes.
In cases of positivity patients generally progress to insulin-dependency within 3 years, though some do not. Individuals with
LADA usually present before 50 years of age and they are mostly non-obese with BMI <25 kg/m2
. They usually present with
low magnitude hyperglycemia and normal or close to normal C-peptide values. Acute hyperglycemic crisis in the form of DKA
or HHS (hyperglycemic hyperosmolar state) is unusual. We report a clinical case of a 66-year-old female who presented for the
first time with diabetic ketoacidosis (DKA) and subsequently diagnosed as a case of LADA. Presumptive diagnosis of LADA was
confirmed with the presence of autoantibody to glutamic acid decarboxylase 65 (Anti-GAD65 antibody). This case highlights
that in the presence of clinical criteria for LADA, autoantibody measurements need to be considered in patient of adult onset
diabetes to diagnose it and once diagnosed patients should receive insulin therapy as early as possible. If not properly treated,
such insulinopenic patients may develop DKA like our patient.
Sayantan Ray has completed his MD degree in General Medicine at the age of 28 years from the West Bengal University of Health Sciences and presently working as a senior resident in the Department of Endocrinology, Medical College Hospital, Kolkata. He has a good number of publications in peer-reviewed journals.
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