Late diagnosis of latent adult autoimmune diabetes (LADA) in an elderly patient with persistent episodes of hypoglycemia: case report

Authors

DOI:

https://doi.org/10.33448/rsd-v10i11.20041

Keywords:

LADA; Hypoglycemia; Type 1 Diabetes mellitus; Insulin; Glucagon.

Abstract

Introduction: The concept of latent autoimmune diabetes in adults, whose acronym in English is LADA, for "latent autoimmune diabetes in adults" was first introduced in 1993 by Tuomi and Zimmet to define adult diabetic patients who did not require insulin to control their hyperglycemia in the early stages of the pathology, but they presented autoantibodies against beta-cell proteins and faster progression to the need for insulin. Objective: to show a case report of an elderly patient with LADA who frequently presents hypoglycemic episodes. Methodology: this is a clinical case study with a qualitative and descriptive perspective, which consists of a research that, in general, takes place with direct data collection, in which the researcher is the indispensable instrument. Results and discussion: hypoglycemia triggers a series of counter-regulatory mechanisms: it suppresses insulin secretion by beta cells, stimulates glucagon release by alpha cells, adrenaline release by the adrenal medulla, in addition to cortisol and growth hormone . In addition, it is also observed the release of noradrenaline from postganglionic sympathetic neurons and acetylcholine from sympathetic and parasympathetic postganglionic neurons, in addition to other neuropeptides. Conclusion: patients with type 1 diabetes mellitus often have episodes of hypoglycemia during insulin therapy, which, in addition to discomfort and embarrassing situations in daily life, prevents the achievement of ideal glycemic control. Furthermore, hypoglycemia induces a deficient counter-regulation mechanism in a later episode, with decreased adrenaline release and alarm symptoms, establishing the hypoglycemia syndrome associated with autonomic failure.

References

Ahrén, B. (2000). Autonomic regulation of islet hormone secretion-implications for health and disease. Diabetologia, 43(4), 393-410.

Berlin, I., Sachon, C. I., & Grimaldi, A. (2005). Identification of factors associated with impaired hypoglycaemia awareness in patients with type 1 and type 2 diabetes mellitus. Diabetes Metab., 31 (3), 246-251

Bingham, E. M., Dunn, J. T., Smith, D., Sutcliffe-Goulden, J., Reed, L. J. & Marsden P. K. (2005). Differential changes in brain glucose metabolism during hypoglycaemia accompany loss of hypoglycaemia awareness in men with type 1 diabetes mellitus. Diabetologia, 48 (10), 2080-2089.

Calsolari, M. R., Rosário, P. W. S., Reis, J. S., Silva, S. C. & Purisch, S. (2008). Diabetes autoimune latente do adulto ou diabetes melito tipo 2 magro? Arq. Bras. Encodrinol. Metab., 52 (2), 1-6.

Couri, C. E., Oliveira, M. C. B., Stracieri, A. B. P. L., Moraes, D. A. & Voltarelli, J. C. (2009). C-peptide levels and insulin independence following autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus. JAMA, 301 (15), 1573-1579.

Gosmanov, N. R., Szoke, E., Israelian, Z., Smith, T., Cryer, P. E. & Gerich, J. (2005). Role of the decrement in intraislet insulin for the glucagon response to hypoglycemia in humans. Diabetes Care. 28 (3), 124-131.

Guisasola, F. A., Yin, D. D. & Nocea, G. (2010). Associação de sintomas hipoglicêmicos com a avaliação dos pacientes sobre seu estado de qualidade de vida relacionada à saúde: um estudo transversal. Resultados de Saúde Qual Life, 8 (86).

Jones, A. G., McDonald, T. J., Shields, B. M., Hagopian, W. & Hattersley, A. T. (2021). Latent Autoimmune Diabetes of Adults (LADA) is likely to representant a mixed population of autoimmune (type 1) and nonautoimmune (type 2) diabetes. Diabetes Care, 44 (1), 1-9.

Kishore, P., Gabriely, I., Cui, M. H., Di Vito, J., Gajavelli, S. & Hwang, J. H. (2006). Role of hepatic glycogen breakdown in defective counterregulation of hypoglycemia in intensively treated type 1 diabetes. Diabetes, 55(3), 659-666.

Schultes, B., Jauch-Chara, K. & Gais, S. (2007). Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus. PLoS Med., 4 (69), 1-5.

Silva, M. E. R. (2007). Precisamos diagnosticar o diabetes Latente Autoimune do Adulto (LADA)? Arq. Bras. Encodrinol. Metab., 51 (1).

Sociedade Brasileira de Diabetes (SBD) (2020). Diretrizes da Sociedade Brasileira de Diabetes: 2020-2021. Clannad.

Taborsky, G. J., Ahren, B., Mundinger, T. O., Mei, Q. & Havel, P. J. (2002). Autonomic mechanism and defects in the glucagon response to insulin-induced hypoglycaemia. Diabetes Nutr Metab., 15 (3), 318-322

Woerle, H. J., Meyer, C., Popa, E. M., Cryer, P. E. & Gerich, J. E. (2003). Renal compensation for impaired hepatic glucose release during hypoglycemia in type 2 diabetes: further evidence for hepatorenal reciprocity. Diabetes, 52(6):1386-1392.

Yale, J. F., Paty, B. & Senior, P. A. (2018). Hypoglycemia. Canadian Journal of Diabetes, 42 (1), 104-108.

Yeoh, E., Choudhary, P. & Nwokolo, M. (2015). Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: A systematic review and meta-analysis. Diabetes Care, 38 (8), 1592-1609

Published

07/09/2021

How to Cite

FIGUEIREDO, B. Q. de .; ALVES, G. A. B.; AMORIM, G. S.; BORGES, L. C.; MIRANDA, L. D.; NOGUEIRA, V. F. G. C. Late diagnosis of latent adult autoimmune diabetes (LADA) in an elderly patient with persistent episodes of hypoglycemia: case report. Research, Society and Development, [S. l.], v. 10, n. 11, p. e483101120041, 2021. DOI: 10.33448/rsd-v10i11.20041. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/20041. Acesso em: 25 nov. 2024.

Issue

Section

Health Sciences