Thin Type 2 Diabetics

[Guzzler]

Hi this is my first post so please excuse me if this is not the correct forum.

I am happy to see posts from other T2D "skinny" people as most of the posts and advice I have seen so far do not fit this model.

I have been diagnosed for about 2 years now and have not found much advice I could use. I am just over 5ft.4" and weigh 62kg, have no flat belly and wear UK size 8-10 trousers (& just turned 50) . I prefer vegetables and fruit and do not eat much in the line of sweets (never been a big fan), preferring savouries and cheeses. I am generally active and do a lot of walking, especially for work. The only advice I got from a doctor was cut out sugars and try not to lose weight.
I have seen the nurse 3 times since being diagnosed. At my last blood test I was told my sugar level was 80 and the nurse doubled my medication. I haven't been back for any other tests since and when I did phone the surgery recently to ask when I will be sent for another one (being my annual check-up), they told me I should receive an invitation shortly. This was over two months ago.

So, in summary I am not very sure about my condition and what I should be doing, am getting no help from the nurse that I was allocated to, never had a regular doctor and am very confused.

Any advice would be greatly appreciated.

May I ask which medications and at what dosage you were prescribed? Also, when were you diagnosed? All this is useful information and will help us to help you.

 

[Daibell]

Am I right that what would usually happen in that case is that months (maybe a year or two?) later, the patient will develop more obvious T1/LADA symptoms? (This is the impression I get from the relatively frequent threads started by anxious people whose diabetes type is in doubt.)

I wonder why, at diagnosis, the doctors do not systematically run those extra tests that help distinguish between insulin resistance, and a failing pancreas? Presumably because the majority of the late-adult/middle-age cases are T2? Or do they just figure, "if this diagnosis is wrong, symptoms will appear in due course and we can just change the diagnosis at that time"? Or is the diagnostic challenge really hard?

It is rather strange!

Hi. There is a high level of ignorance amongst GPs about diabetes and many just have very simple view of the types and underlying causes. This is not helped by the national diabetes bodies who share some of that ignorance. It's only recently that Diabetes UK (not this site) has started to spot that late onset T1 actually exists. Diabetes training for GPs in the UK is also poor in this area as my newly trained diabetes GP demonstrated. The UK NHS doesn't routinely do the tests on slim 'T2' due to cost and ignorance which is why I had my GAD and c-peptide done privately. I believe there is too much reliance on GAD when tests are done as it's not a very reliable indicator of a failing pancreas whereas the c-peptide does highlight where there is high (T2) or low insulin (T1). It's better to know what the treatment should be rather than what caused the pancreas to fail. My honeymoon period was several years and this aids confusion in GPs. This ongoing mis-diagnosis of slim 'T2s' messes up the statistics and skews research into diabetes causes and types etc.

 

[caroline_92]

I am just over 5ft.4" and weigh 62kg, have no flat belly and wear UK size 8-10 trousers (& just turned 50) . I prefer vegetables and fruit and do not eat much in the line of sweets (never been a big fan), preferring savouries and cheeses. I am generally active and do a lot of walking,

This sounds like it could be me (more or less on some aspects!) - so hello!

What kind of things are you eating? Are you keeping away from the savouries, which I know raises my blood sugar something shocking? And I do love them...

And sorry, I wasn't clear if your belly was flat or not?!?! I don't believe there is any magic weight to aim for, it is whatever is right for you. I am the same height as you, but a little lighter, but still have a little flab around my middle which fluctuates according to how much carbohydrate I eat...

 

[Alexandra100]

Hi this is my first post so please excuse me if this is not the correct forum.

I am happy to see posts from other T2D "skinny" people as most of the posts and advice I have seen so far do not fit this model.

I have been diagnosed for about 2 years now and have not found much advice I could use. I am just over 5ft.4" and weigh 62kg, have no flat belly and wear UK size 8-10 trousers (& just turned 50) . I prefer vegetables and fruit and do not eat much in the line of sweets (never been a big fan), preferring savouries and cheeses. I am generally active and do a lot of walking, especially for work. The only advice I got from a doctor was cut out sugars and try not to lose weight.
I have seen the nurse 3 times since being diagnosed. At my last blood test I was told my sugar level was 80 and the nurse doubled my medication. I haven't been back for any other tests since and when I did phone the surgery recently to ask when I will be sent for another one (being my annual check-up), they told me I should receive an invitation shortly. This was over two months ago.

So, in summary I am not very sure about my condition and what I should be doing, am getting no help from the nurse that I was allocated to, never had a regular doctor and am very confused.

Any advice would be greatly appreciated.

Hello Hazel and welcome. I am skinny too (very!) and am pre-pre-diabetic. Yes, it is very confusing for us thin people as most advice and research centres around the over-weight and obese. I find this very frustrating. However, you have found the right place for lots of help and support. In addition, I strongly advise that you read Jenny Ruhl's book "Your Diabetes Questions Answered".
https://www.amazon.co.uk/Your-Diabe...=sr_1_2?s=books&ie=UTF8&qid=1510945870&sr=1-2
She is herself a T2 and has survived relatively unscathed to be now over 70. She has done a wealth of research and is very sane and down to earth. You could also visit her site, where she gives detailed free information on all aspects of T2 diabetes. http://www.phlaunt.com/diabetes/
Like you, I love fruit, but now I am avoiding most fruits as I have realised how high they are in sugar. In addition starchy vegetables turn into sugar inside us, as do all carbohydrates. Luckily we have excellent food labelling in the UK, so we can easily see how many grammes of carb are in all packaged food we eat. For fruit and vegetables you can just Google. You might want to experiment by setting an initial daily limit of eg 130 grammes of carbs. To give you an idea, a small apple contains about 15 grammes of carbs, as does half a banana. To get feedback on your experiment you would need to obtain a meter to test your blood for carbs after meals. I won't go on about that, as I am sure other people will be telling you about testing even as I type!

Good luck, I'm sure you will soon be feeling much more confident in managing this problem and be giving advice to other new arrivals on the forum.

 

[jrw2007]

Completely agree that diet is the foundation to good diabetes control and great expression - will remember that!

Exercise is also terribly beneficial, if you able to do it, for a range of reasons. Finding any activity you can do is worth persevering with.

One thing exercise does is help with reducing insulin resistance by facilitating your cells use the excess blood sugar. Not clear on the mechanism for this without looking it up.

Completely agree that diet is the foundation to good diabetes control and great expression - will remember that!

Exercise is also terribly beneficial, if you able to do it, for a range of reasons. Finding any activity you can do is worth persevering with.

One thing exercise does is help with reducing insulin resistance by facilitating your cells use the excess blood sugar. Not clear on the mechanism for this without looking it up. When I was first diagnosed and measuring my blood sugars quite obsessively, I had a post meal reading of 11.5. I went out for a 30 min cycle, not a very strenuous one, but it got me moving. When I came back my blood sugar had dropped to 5.7! That did it for me and I now try my hardest to do some activity every single day...

Intensity of exercise is a factor. At low intensity the fuel used by the skeletal muscle is primarily fat - at high intensity the fuel is primarily glucose and mainly glucose already stored in the muscle. If you deplete the stored glucose the skeletal muscle removes glucose from the blood stream by moving GLUT4 transporters from inside the muscle cell to the cell membrane where insulin locks onto the transporter and facilitates the transfer of glucose into the cell. There is some understanding that the GLUT4 transporters will decline in number if there is insufficient activation in response to depletion of the cell glucose.

Strength training exercise is high intensity which might be one factor as to its usefulness.

 

[tina1966]

This is the first time i have wrote on here, i was diagnosed as a type two diabetic nine years ago, i have always been slim and active, i was on metformin and gliclazide which worked fine until last november when my blood sugars went haywire into the 30+ range, saw the diabetic doctor at the surgery who told me off for testing as i was a type 2 who should not test.was feeling so ill i saw the diabetic nurse who doubled my dose of tablets but that did not work either, in the end i was put on insulin, abasaglar and novorapid and i have felt so well ever since. I have recently seen the specialist and he says i am very unusual, and if it goes haywire again they will do further tests on me, but says i will be treated as a type one. I am under 8 stone, and at least now i am being monitored

 

[Guzzler]

This is the first time i have wrote on here, i was diagnosed as a type two diabetic nine years ago, i have always been slim and active, i was on metformin and gliclazide which worked fine until last november when my blood sugars went haywire into the 30+ range, saw the diabetic doctor at the surgery who told me off for testing as i was a type 2 who should not test.was feeling so ill i saw the diabetic nurse who doubled my dose of tablets but that did not work either, in the end i was put on insulin, abasaglar and novorapid and i have felt so well ever since. I have recently seen the specialist and he says i am very unusual, and if it goes haywire again they will do further tests on me, but says i will be treated as a type one. I am under 8 stone, and at least now i am being monitored

Hi there and welcome. You might like to make an introductory stand alone Thread and you will then get loads more information on your circumstances per your possible change in diagnosis. Your comment here in this thread is valuable but it may be lost for a while by those who may be able to guide you through this time. Best wishes.

 

[Grateful]

I am posting this here at the suggestion of @Guzzler. It is particularly enlightening about the whole subject of insulin resistance (IR), adipocytes (fat cells) and how one can be "thin outside, fat inside" (TOFI). It is a bit much to take in, all in one go, but good stuff.

 

[Guzzler]

I am posting this here at the suggestion of @Guzzler. It is particularly enlightening about the whole subject of insulin resistance (IR), adipocytes (fat cells) and how one can be "thin outside, fat inside" (TOFI). It is a bit much to take in, all in one go, but good stuff.

For a half hour video you really get a lot for your dollars!

 

[seadragon]

I'm a thin pre-diabetic but only learned this fact due to my mother being a thin type 2 and using her BG monitor on me one day which put me at the very top of "normal' range and she suggested getting a GTT done. Her sister sadly had died of diabetes related complications and I knew I might be at risk having had gestational diabetes despite putting on very little weight in pregnancy and being lighter immediately after delivery than before getting pregnant. BMI was about 25 though i put no store in BMI as an indicator of anything. I was told to come back a year later and that one put me definitely on the pre diabetic scale - possibly due to the very stressful year I'd had which may have put me over the edge with my probably hereditary disposition anyway.

Strangely all my life I had suffered from a cough after eating (apparently no matter what it was) and I now think this may have been a sign of my body's intolerance to carbs. I'd also often suffered from low blood sugar in my teens and early twenties and had several fainting episodes so I guess my BG control has always been a bit out of whack.

After going low carb/ketogenic I was amazed at the difference it made in my life. Almost every minor ailment from skin rashes to the cough disappeared. Suddenly had energy to spare instead of being tired all the time and lost weight effortlessly (My doctor had said diet and exercise would not work for me as I had no weight to lose so wanted me on metformin and a statin straight away - I refused). I did exercise regularly but always felt tired after it til I reduced the carbs.

I find like Caroline that exercise helps BG but for me it very specifically has to be right after eating. I can reduce BG several mmol by going for a 30 minute walk or doing 5 mins of HIITs. I have also taken up weight truing to add muscle and I am sure that also helps glucose absorption.

My problem now is dawn phenomenon which means my fasting BG is definitely not my lowest of the day. I can be anywhere from about 4.8 to 5.5 in the afternoons but mornings now are invariably in the high 6's and other than drinking a lot of red wine the night before (not advisable for other reasons) I haven't found anything that reliably reduces it.

I also realise that had I not learned about the pre diabetes and low carb high fat diets then I'd probably have got fatter and fatter until one day I'd have been diagnosed with T2 and they'd have said - it's because you're fat when in fact I was getting fat because I had a genetic carb intolerance. In many cases I think they have cause and effect the wrong way round.

What upsets me now is that if i'd only known before about low carb and exercise etc i might have been able to help my aunt.

 

[Grateful]

This is pretty interesting: https://www.dietdoctor.com/thin-diabetic-reversed-type-2-diabetes.

It is a case study of a lady of Chinese origin, related by Dr. Jason Fung. She is a "thin diabetic" who really went through the wringer, trying all sorts of alternatives before settling on LCHF and successfully reversing her diabetes. She kept good records (see the screenshot of her data about halfway through the article) which is one reason why it is so interesting.

Although she was thin, her total body fat was 32.3%.

In China, the average BMI at diagnosis is 23.7 for a Type 2 diabetic.

 

[Alexandra100]

I'm a thin pre-diabetic but only learned this fact due to my mother being a thin type 2 and using her BG monitor on me one day which put me at the very top of "normal' range and she suggested getting a GTT done. Her sister sadly had died of diabetes related complications and I knew I might be at risk having had gestational diabetes despite putting on very little weight in pregnancy and being lighter immediately after delivery than before getting pregnant. BMI was about 25 though i put no store in BMI as an indicator of anything. I was told to come back a year later and that one put me definitely on the pre diabetic scale - possibly due to the very stressful year I'd had which may have put me over the edge with my probably hereditary disposition anyway.

Strangely all my life I had suffered from a cough after eating (apparently no matter what it was) and I now think this may have been a sign of my body's intolerance to carbs. I'd also often suffered from low blood sugar in my teens and early twenties and had several fainting episodes so I guess my BG control has always been a bit out of whack.

After going low carb/ketogenic I was amazed at the difference it made in my life. Almost every minor ailment from skin rashes to the cough disappeared. Suddenly had energy to spare instead of being tired all the time and lost weight effortlessly (My doctor had said diet and exercise would not work for me as I had no weight to lose so wanted me on metformin and a statin straight away - I refused). I did exercise regularly but always felt tired after it til I reduced the carbs.

I find like Caroline that exercise helps BG but for me it very specifically has to be right after eating. I can reduce BG several mmol by going for a 30 minute walk or doing 5 mins of HIITs. I have also taken up weight truing to add muscle and I am sure that also helps glucose absorption.

My problem now is dawn phenomenon which means my fasting BG is definitely not my lowest of the day. I can be anywhere from about 4.8 to 5.5 in the afternoons but mornings now are invariably in the high 6's and other than drinking a lot of red wine the night before (not advisable for other reasons) I haven't found anything that reliably reduces it.

I also realise that had I not learned about the pre diabetes and low carb high fat diets then I'd probably have got fatter and fatter until one day I'd have been diagnosed with T2 and they'd have said - it's because you're fat when in fact I was getting fat because I had a genetic carb intolerance. In many cases I think they have cause and effect the wrong way round.

What upsets me now is that if i'd only known before about low carb and exercise etc i might have been able to help my aunt.

I'm wondering if the timing of the last meal of the day has an effect on fasting bg next morning? My last meal tends to be hours before bedtime, with maybe a little cheese just before bed. Also, if my fasting bg is highish first thing I just wait maybe two hours before having breakfast, by which time it has come down nicely.

 

[seadragon]

I'm wondering if the timing of the last meal of the day has an effect on fasting bg next morning? My last meal tends to be hours before bedtime, with maybe a little cheese just before bed. Also, if my fasting bg is highish first thing I just wait maybe two hours before having breakfast, by which time it has come down nicely.

i don't find the time of eating has much effect for me - I've tried it all. Sometimes if i eat really late it's lower - other times i've eaten earlier and it's lower. If i drink lots of wine it's always lower!

if it's high in the morning it doesn't cmd down if i don't eat and sometimes even goes higher if i don't eat. it's very annoying.

I try not to worry as I know it's never my highest reading of the day despite what NHS believes and I can often be in the high 4's pre evening meal.

When I first went low carb m morning BG was low but a month or so in my pancreas obviously decided i needed more glucose in the mornings and it's been high ever since (18 months or so now).

 

[jrw2007]

i don't find the time of eating has much effect for me - I've tried it all. Sometimes if i eat really late it's lower - other times i've eaten earlier and it's lower. If i drink lots of wine it's always lower!

if it's high in the morning it doesn't cmd down if i don't eat and sometimes even goes higher if i don't eat. it's very annoying.

I try not to worry as I know it's never my highest reading of the day despite what NHS believes and I can often be in the high 4's pre evening meal.

When I first went low carb m morning BG was low but a month or so in my pancreas obviously decided i needed more glucose in the mornings and it's been high ever since (18 months or so now).

There is a variable when measuring fasting glucose that appears to differ from individual to individual. When the plasma glucose drops due to fasting at some stage the control systems decide that it is going too low and start to release glucose into the blood stream from the stores in the liver. This raises the blood glucose above the expected fasting glucose level.

 

[Alexandra100]

i don't find the time of eating has much effect for me - I've tried it all. Sometimes if i eat really late it's lower - other times i've eaten earlier and it's lower. If i drink lots of wine it's always lower!

if it's high in the morning it doesn't cmd down if i don't eat and sometimes even goes higher if i don't eat. it's very annoying.

I try not to worry as I know it's never my highest reading of the day despite what NHS believes and I can often be in the high 4's pre evening meal.

When I first went low carb m morning BG was low but a month or so in my pancreas obviously decided i needed more glucose in the mornings and it's been high ever since (18 months or so now).

There is a variable when measuring fasting glucose that appears to differ from individual to individual. When the plasma glucose drops due to fasting at some stage the control systems decide that it is going too low and start to release glucose into the blood stream from the stores in the liver. This raises the blood glucose above the expected fasting glucose level.

My am fasting bg is often under 5.0, or at worst in the low 5s, but I am noticing that if I then delay my breakfast too long, or if I let too much time pass between other meals, my bg rises unprovoked. So I'm wondering if as well as following Dr B's advice to let 5 hours pass between meals, I should let no more than 5 hours pass on empty. More complications and restrictions! (Sigh!)

 

[seadragon]

My am fasting bg is often under 5.0, or at worst in the low 5s, but I am noticing that if I then delay my breakfast too long, or if I let too much time pass between other meals, my bg rises unprovoked. So I'm wondering if as well as following Dr B's advice to let 5 hours pass between meals, I should let no more than 5 hours pass on empty. More complications and restrictions! (Sigh!)

I've decided not to worry too much and do whatever feels right at the time. After all worry and stress can raise BG too so have decided to worry less and enjoy life more. It's not all about diabetes anymore and I feel thats a good place to be.

 

[Grateful]

It's not all about diabetes anymore and I feel thats a good place to be.

It's great, isn't it? I had pretty much got there then found this forum ... which is a fantastic place but unfortunately reawakened some feelings I thought had been "dealt with" by "reversing" the disease. This time though, it is more like bewilderment at how bad a lot of the medical treatment of diabetes (and education about the disease) seems to be, something of which I was largely unaware until I came here.

 

[Guzzler]

I simply stopped doing fasting readings. Due to sleep disturbance my readings are sometimes all over the shop so I do pre and post prandial only. Far less stressing that way for me.

 

[Roytaylorjasonfunglover]

Singapore is very relevant for you.

1 in 9 have diabetes type, but they have a low bmi compared to the rest of the developed world, low rates of obesity. But for diabetes type 2 everything comes down to genetics. Some may get diabetes by just having 2 kgs extra of fat, others need 10 kgs of fat in order to develop diabetes.

Here is a video that shows an extremely thin singaporean type 2 diabetic, and it is all more remarkable because he is a dancer!

 

[paulus1]

i wonder if the skinny type 2s are really another type of diabetic not properly described. i wonder if we will have a type 2a/b in the future. becausethe obvious advice for your routine fatty type 2 ps im very fat but type 1 may be. is not correct for the under weight type 2s. i bet its much more complex than it is currently believed.