Could It Be Type 1 Diabetes? Understanding the Signs, Diagnosis & Next Steps

By Ashlyn Smith, MMS, PA-C, DFAAPA, LSC

ELM Endocrinology & Lifestyle Medicine

Do you wonder if you may have type 1 diabetes (T1D)? If you were diagnosed with diabetes as an adult, are on insulin, and have other risk factors, you may have Latent Autoimmune Diabetes in Adults (LADA). A proper diagnosis is essential for early detection, life-saving treatment, and specialist support.

When most people think of T1D, they picture children or teens. But did you know that more than half of new T1D diagnoses are actually in adults? Whether it begins in childhood or later in life, T1D is a serious autoimmune condition that requires lifelong insulin therapy and expert care. Unlike type 2 diabetes, which is often linked to genetics plus weight or insulin resistance, T1D is not caused by lifestyle factors. It can affect anyone, at any age.

In 2024, over 50,000 people in the U.S. were newly diagnosed—most of them adults.

Diagnosed with diabetes as an adult? Learn the signs that might signal T1D.

What is LADA or Adult-Onset T1D?

During childhood, T1D often starts suddenly with critically high glucose levels requiring hospitalization and often a stay in the intensive care unit. However, in adulthood T1D (also known as LADA) has a slower onset of hyperglycemia and the disease responds to non-insulin therapies—at first. This is why LADA can initially look a lot like type 2 diabetes. But over time, the body stops making insulin altogether and insulin therapy becomes necessary.

While LADA is sometimes thought of as its own category or “Type 1.5 Diabetes,” it is usually managed like T1D because the end result is the same: your body no longer makes insulin and you require lifelong insulin therapy. LADA is not something that can be managed with lifestyle changes or oral medications alone. If your body stops producing insulin, you must take insulin treatment for life. Thankfully, we have strong support tools to help you thrive with LADA.

LADA is typically diagnosed when:

• You're over age 30 at the time of diagnosis

• You test positive for certain autoantibodies

• You don't need insulin for at least the first 6 months after your diagnosis

  
  

There’s a simple way to remember when to test for T1D or LADA:

               AABBCC    

• Age under 35 when diagnosed with diabetes

• Autoimmune conditions (like thyroid or celiac disease) in yourself or family

• BMI under 25

• Background of T1D in your family

• Control problems—your blood sugar stays high despite pills or other therapies

• Cancer treatment with immune checkpoint inhibitors, which can trigger autoimmune diabetes

Does this sound like you or your loved one? Let’s talk about the steps for blood tests to check for autoimmune diabetes.

How I can help support you with LADA

·       I ask about risk factors

One area where the medical community can struggle is challenging a diagnosis once it is made. That means that when someone is diagnosed with type 2 diabetes, that diagnosis tends to stick with them and is not questioned. However, I look at the clinical picture and proactively seek out and screen for the LADA risk factors to see if you are at risk.

·       I normalize feelings about a LADA diagnosis

Facing a LADA diagnosis can be overwhelming. Treatment does not only mean giving you the insulin that your body needs. It means treating YOU as a whole person: mental health, support system, sleep habits, stress level, nutrition support, physical activity, diabetes distress, food insecurity, and more. This means that in whichever area of your life you need support managing LADA, we will proactively partner together to address. Remember, LADA is an autoimmune condition—NOT caused by your activity level or nutrition quality.

·       We collaborate on your care plan together

We will discuss both clinical tasks and a whole-health approach to LADA, working toward a shared medical plan and realistic goals that align with your hopes for therapy. Additionally, I advocate strongly for patient access to diabetes technology, such as continuous glucose monitoring, insulin smart pens, insulin patches, or insulin pumps—whichever tools fit your needs and preferences best.

We will also discuss additional resources that may support you, including online resources, diabetes technology training, diabetes education, and mental health or other specialty providers.

Take home message:

In any diagnosis of diabetes in adulthood, the clinical picture, personal history, and family history should be reviewed to identify risk factors for LADA. Early diagnosis leads to more appropriate care with insulin initiation, which makes a big difference in diabetes control, diabetes distress, long-term health, and risk of complications. LADA management is a team sport—with you at the heart of it! You do not have to face LADA alone. The right medical team, support system, education, and tools can empower you to take control of your health.

Have more questions about LADA or T1D? I am here to help—let’s connect on a free educational consultation to discuss further!

Access the free Type 1 Diabetes toolkit I created with the American Association of Physician Associates for more resources and tips.

Disclaimer:

The content on this blog is for informational purposes only and is not intended to provide medical diagnosis, treatment, or replace professional medical advice, diagnosis, or care. Always consult a qualified healthcare provider with any questions regarding a medical condition or treatment.