Latent Autoimmune Diabetes in a Young Female: A Case Report

Latent autoimmune diabetes (LAD) involves gradual autoimmune destruction of the pancreatic beta cells, leading to reduced insulin production. When it occurs in adults, the term "latent autoimmune diabetes in adults (LADA)" is used, and when it occurs in young people, the term "latent autoimmune diabetes in the young (LADY)" is used. Patients usually present with symptoms suggestive of type 2 diabetes, and test positive for islet cell antibodies, but do not require insulin therapy at diagnosis and for up to six months thereafter. We report an 18-year-old female who presented with symptoms of type 2 diabetes with non-ketotic hyperglycemia, had positive testing for multiple islet cell autoantibodies, but did not require insulin therapy at diagnosis. She was initially thought to have either type 2 diabetes or maturity-onset diabetes of the young, and so treated with a sulfonylurea with good results before the addition of metformin and subsequent conversion to basal-bolus insulin therapy because of raised postprandial blood glucose levels. This case highlights the importance of improved knowledge required to prevent the misdiagnosis of LAD as type 2 diabetes, the importance of regular follow-up for these patients, and the need for a low threshold for commencing insulin therapy to prevent diabetic ketoacidosis and long-term diabetes complications in patients with LAD.