Carlos’ Story – Type 1.5 Diabetes (LADA) (Honduras)

Patient: Carlos, 45 years old 

Location: Tegucigalpa, Honduras 

Diabetes Type: Type 1.5 (Latent Autoimmune Diabetes in Adults, or LADA)

Background:

Carlos, a 45-year-old high school teacher from Tegucigalpa, Honduras, was diagnosed with diabetes a few years ago. Initially, his doctor assumed he had type 2 diabetes because of his age and the slow progression of his symptoms. Carlos had been feeling unusually tired, was urinating more frequently, and had lost some weight without trying. His blood sugar levels were moderately high, but manageable with oral medications at first.

Carlos made lifestyle changes, like cutting back on sugary drinks and incorporating more exercise into his routine. But over time, his blood sugar levels became harder to control, even though he was taking the prescribed medications and following his diet plan. He began to notice more significant weight loss, which didn’t fit the usual type 2 diabetes profile, and his energy levels kept dropping.

Presentation of Symptoms:

Despite being on treatment, Carlos’ blood sugar continued to fluctuate. He was often fatigued and had difficulty concentrating at work. His medications, which were effective for type 2 diabetes, weren’t controlling his blood sugar as expected. After several frustrating months, his doctor ordered additional tests, including tests for autoantibodies that indicated an autoimmune attack on his insulin-producing cells.

The results showed that Carlos didn’t have typical type 2 diabetes—instead, he had Latent Autoimmune Diabetes in Adults (LADA), also known as type 1.5 diabetes. This type shares features of both type 1 and type 2 diabetes. It is autoimmune in nature, like type 1, but it progresses more slowly and is often initially misdiagnosed as type 2.

Key Symptoms:

  – Gradual weight loss despite no changes in diet

  – Fatigue and difficulty concentrating

  – Increased thirst and frequent urination

  – Poor response to oral medications typically used for type 2 diabetes

Diagnosis & Treatment:

Carlos’ diagnosis of LADA meant that his body was still producing some insulin, but it was decreasing at a slower rate compared to type 1 diabetes. Over time, however, he would require insulin injections because the autoimmune attack would eventually destroy the remaining insulin-producing cells.

His new treatment plan involved starting insulin therapy to help control his blood sugar, along with continued monitoring of his diet and exercise habits. Carlos had to adjust to the idea of using insulin, which felt like a major shift from the oral medications he had been taking.

Treatment Plan:

  – Transition to insulin therapy (basal and bolus insulin)

  – Continued blood sugar monitoring multiple times a day

  – Diet adjustments to focus on low glycemic index foods

  – Regular visits to an endocrinologist to track the progression of his condition

Complications:

Because of the delay in his correct diagnosis, Carlos developed neuropathy in his feet, a common complication of diabetes that causes numbness, tingling, and sometimes pain. This made standing for long periods at work difficult. The neuropathy was a constant reminder of how important it was to manage his blood sugar carefully going forward.

Carlos also had to be mindful of potential long-term complications like kidney disease and cardiovascular issues. His healthcare team encouraged him to stay active and focus on maintaining a healthy weight, which would help mitigate some of these risks.

Complications Faced:

  – Peripheral neuropathy (numbness and pain in feet)

  – Ongoing risk of other complications like retinopathy and nephropathy

  – Increased difficulty managing work-life balance due to fatigue

Cultural and Family Support:

Carlos comes from a close-knit family, and they have been supportive of his health journey. Like many people in Honduras, Carlos grew up enjoying rich, traditional meals with ingredients like corn, beans, plantains, and tortillas. However, he found it challenging to adapt his diet to one better suited for his condition.

His wife took the lead in adjusting family meals to be healthier for Carlos. She reduced the amount of rice, tortillas, and fried foods and increased the use of vegetables, lean proteins, and whole grains. They also began incorporating more fish into their diet, which is common in some Honduran coastal regions. A favorite dish, baleadas (flour tortillas filled with beans, cheese, and cream), was modified by using whole wheat tortillas and leaner fillings.

Though the changes were difficult at first, Carlos and his family adjusted to a new normal, and they all became more health-conscious in the process.

Life Today:

Now fully adjusted to insulin therapy, Carlos has regained his energy and manages his diabetes with discipline. He checks his blood sugar several times a day and continues to work closely with his healthcare team. While the neuropathy in his feet remains a challenge, it hasn’t stopped him from teaching or staying active with his students.

Carlos is an advocate for better diabetes awareness in Honduras, especially concerning less common forms like LADA. He speaks at local health centers, sharing his experience and urging others to pay attention to the signs and symptoms that may go unnoticed in the early stages of diabetes. He hopes to empower others to seek early diagnosis and proper treatment, especially in communities where healthcare access is limited.