THU358 A Case Of Latent Autoimmune Diabetes In Adults (LADA) Managed By Lifestyle And Dietary Intervention Alone

Abstract

Abstract Disclosure: M. Ahmad: None. U. Tarabichi: None. R. Patel: None. B. Arshad: None. A.P. Calimag: None. Introduction: LADA typically presents like Type 2 Diabetes at the time of diagnosis but it slowly progresses to insulin dependence for management. LADA is an autoimmune disease and it is distinguished from Type 2 diabetes by the presence of autoantibody. We present you an interesting case in which patient was diagnosed with LADA and was started on treatment with insulin regimen but over the time patient managed to stay off of insulin and managing his condition exclusively with a high protein ketogenic diet. Case Description: A 57 year old male with past medical history of Hyperlipidemia, gastroparesis, Hypertension and Diabetes. Patient initially diagnosed with diabetes in 2016 with A1C of 11% and was started on Metformin. In 2017, patient was admitted with diabetic ketoacidosis (DKA), had low c peptide on admission. At discharge, patient was started on basal bolus regimen. Patient had a follow up with Endocrinology and autoimmune labs. These were positive for GAD antibody, islet cell antibody and low c-peptide. With subsequent follow ups, lantus dose was decreased and Humalog with meals was discontinued. On further questioning patient reported that he started ketogenic diet along with intermittent fasting in March 2020. With his change of diet, he lost around 100 pounds over 1 year period and his insulin requirements continued to decrease throughout his journey. With time, patient desired to be off of insulin but Endocrinology didn’t recommend given his increased risk of DKA. Patient eventually stopped taking all of his insulin and it was recommended that he continues to use continuous glucose monitoring along with keto testing strips at home to monitor for DKA. Patient has sustained his diet change until this date and he continues to be on ketogenic diet with intermittent fasting 20 hours a day with 4-hour window of eating. He remains off insulin for 2 years, A1C continues to trend down, and with no evidence of DKA. Most recent labs; A1C is 5.5, positive for insulinoma associated antibody 2, negative for Zinc transporter antibody and insulin antibody. Conclusion: There is very little evidence available in the literature that supports treatment of LADA with dietary intervention alone. In our case, there are several fasting cpeptide levels that are less than 1.0, which typically would indicate initiation of insulin therapy. Our patient has managed to control hyperglycemia with dietary changes alone and has not been in diabetic ketoacidosis for greater than 2 years. It is rare for someone to maintain such a restrictive diet which includes 100g of protein, 100g fat and 5g of carbohydrates per day. This case highlights the ability of someone to maintain euglycemia with LADA without need for insulin therapy for greater than 2 years. Most diet studies are not followed that Longterm. Presentation: Thursday, June 15, 2023