Why Are People Diabetic-shaped?

[DavidGrahamJones]

I see a fit man with ... externally-visible visceral fat.

That's interesting, so he does. There's one interesting photo of him with three other rowers who don't have the same amount of "padding".

I actually bumped into Steve Redgrave (literally) at the Marlow Sports Centre, just after he won his first Gold. He was showing his medal to the people he knew at the sports centre.

 

[Rachox]

OK? This is getting interesting.. My dad was T2. ("was" as in, unfortunately no longer with us.) The guy was slim (like me) & active for his age. He also sang Opera.. I could still knock one out! I sing too. But heavy metal.
Now i'm currently "refreshing" with a diagram of the human body.. & what i (cough,) know about singing. (Though i did start off sounding like a choir boy. Having lessons in my yoof.)

Could visceral fat actually be restricting the diaphragm?

Tagging in @Contralto From memory a bit of a "singist" too?

A quick Google says yes! Here’s one article straight away, see the sleep apnoea paragraph:
https://hcahealthcare.com/hl/?/40480/The-Dangers-of-Hidden-Abdominal-Fat

 

[first14808]

OK? This is getting interesting.. My dad was T2. ("was" as in, unfortunately no longer with us.) The guy was slim (like me) & active for his age. He also sang Opera.. I could still knock one out! I sing too. But heavy metal.
Now i'm currently "refreshing" with a diagram of the human body.. & what i (cough,) know about singing. (Though i did start off sounding like a choir boy. Having lessons in my yoof.)

Could visceral fat actually be restricting the diaphragm?

Tagging in @Contralto From memory a bit of a "singist" too?

I guess if an increase in visceral fat was progressive, it should show as reduced lung capacity.. And for a singer or musician, not being able to hold a note for as long.

I'm also thinking it has to restrict, ie there's a limit to ribcage expansion, and any extra volume in the abdominal cavity would restrict the diaphragm's downward range.. Or just mean more effort is needed. Those scans seem to show a clear reduction in volume though, especially if the patients were given the usual breathe in/out instructions while being scanned.

 

[first14808]

Spirometry assesses things like asthma and doesn't help much with assessing other respiratory issues. Training how to breathe is great for daytime, but does nothing to help while asleep. I know you didn't mean literally that apnoea is ever fun, but as OSA is a distressing and potentially life threatening condition you might want to keep that in mind.

Yep, I totally understand that it's no fun for people affected. Apparently I deep breathe even while sleeping though! But this sounds like it might be an interesting diagnostic check for apnoea sufferers that might mean they don't have to sleep with a mask/tube.

 

[Rachox]

It was necessary given the type of sleep study they were doing (there are several types). The gold standard is to have the person video recorded during the whole night, and to have a qualified sleep tech on site in case something goes wrong, such as the person dropping below an SpO2 of 75%, which occasionally happens. Scary level, right? I never went below 82, thankfully. My longest event was 32 seconds... not good.

The kind of testing you administered would be excellent for the early stages of investigations but in some people they would need to repeat it with the kind of study I had.

Interesting stuff, we did have video recording and alarms if O2 levels dropped too low but the data was analysed after the event.
Not a sleep study patient but scary fact, the lowest I ever saw a patient O2 level go was 42%, not a well man but lived to tell the tale thankfully.

 

[Jenny15]

Yep, I totally understand that it's no fun for people affected. Apparently I deep breathe even while sleeping though! But this sounds like it might be an interesting diagnostic check for apnoea sufferers that might mean they don't have to sleep with a mask/tube.

Spirometry? No. Sleeping with CPAP is easy for most people. Like diabetes, there are all kinds of snake oil claims for treating OSA. None of them work. Only CPAP, other types of PAP, or surgery if indicated, or a tiny fraction of the mouth splints on offer can treat OSA.

 

[Jenny15]

Interesting stuff, we did have video recording and alarms if O2 levels dropped too low but the data was analysed after the event.
Not a sleep study patient but scary fact, the lowest I ever saw a patient O2 level go was 42%, not a well man but lived to tell the tale thankfully.

Wow, that is low! It's a horrible feeling having low O2.

 

[zand]

You sound a bit 'fruity' Zand

 

[briped]

but my shape is altering and my tummy is the place the weight is going,

Funny, I seem to be noticing that in myself too, and was wondering if it was 'just me'. Have only lost just under 10kgs, and still need to lose at least 30, so at this rate I'll resemble a sawn lady by the time I'm done.

 

[AdamJames]

As well as the Steve Redgrave observation, I thought something similar when this article in everyone's favourite newspaper was highlighted in a thread recently. The article was intending to prove the 'shocking news' that you don't have to be 'overweight' to have T2:

http://www.dailymail.co.uk/health/article-5805317/The-proof-DONT-overweight-diabetes.html

I thought: yes, all of the people look normal, but I see significant visceral fat in 4/5 of them. In my society, normal = visceral fat, especially in middle-aged people and beyond. Just goes to show what a crude measuring stick BMI is, and what a very blurry concept the idea of being 'overweight' is.

 

[KK123]

Yeah, I never meant to imply that all type 2s are shaped this way. “Some people” would be a better description



How do I escape my shape then...? I have visions of running as fast as I can while it huffs and puffs behind...!

It's when it overtakes you that you have to worry.

 

[first14808]

Spirometry? No. Sleeping with CPAP is easy for most people. Like diabetes, there are all kinds of snake oil claims for treating OSA. None of them work. Only CPAP, other types of PAP, or surgery if indicated, or a tiny fraction of the mouth splints on offer can treat OSA.

Spirometry's just a general way of measuring lung volume and performance. Then comparing with 'normal' volumes for that patient, and should show if there's lower than normal capacity, tidal volumes etc. If, and that's a big if, visceral fat increasing makes breathing harder, then 8 weeks on ND may be a more convenenient way to increase lung performance and avoid surgery. But there may be a variety of reasons behind a patient's OSA that drive the best treatment regime.

And of course my results were very good, despite being a smoker and generally unfit at that time.

It's still interesting, but we're debating pretty much on just the one scan from that TOFI page. Plus various bits of anectdotal evidence, ie me breathing better as I lost weight. I think anything that improves lung capacity and performance would generally be a good thing though.

 

[Struma]

So question for someone better at interpreting scans than I.. The images on the wiki TOFI page also seem to show a considerably reduced lung volume?

@first14808 I will attempt to answer your question ...
I think there is no true reduction in lung volume. Look at the cardiac outline left, and great vessels on the right, the lower lung fields are consistent with these. In fact, on right heart looks absent. Upper fields are good, have good height. Overall appearances are OK. But I think there's some distortion of view, slightly raised at head end possibly.
There're many slices available for analyses, the author chooses that which displays to the best what he wants. This means distortion occurs. The majority of both femurs are absent. I think, there is no external genitalia shown.
I hope this little insight helps. I am by far no expert in MRI, now CT is a different ball game!

 

[first14808]

Thanks.. And I see what you mean, so lung area differences being due to different slice depth. Which also explains the other missing features. Or also blows out the high visceral fat = small brain theory

But after doing a bit of zoom and enhance in Photoshop, and being a geek.. Being able to see what's inside a patient is pretty awesome. Also something I've found interesting when being worked on myself. Watching a needle being guided towards my spine was a little disconcerting, but the discs looked nice & healthy!

 

[Tabbyjoolz]

Years before I was diagnosed and before I went through menopause, I was always being asked: "oh, when's your baby due?", or being congratulated.

These days I don't have a bump and seldom get offered a seat on the Tube.

 

[AloeSvea]

Yeah, the visceral/belly fat thing is a real b****.
"Apple shaped" sounds much nicer though, IMHO, than "truncal obesity".
"Diabetes shaped" - oh dear! I don't like that at all! No one has said that to my face, thank goodness.

Another way of looking at the 'diabetes shape' (omg!) is that when not encumbered with fat deposits is often the same as 'athletically shaped' . For me as a woman, it's shoulders wider than hips, which is commonly associated with athletically inclined/more muscley women (and the ones more prone to insulin resistance/PCOS when young etc etc).

Although I hate the idea of talking about a diabetes shape, I am delighted to note my daughter's tiny waist, for low T2D risk reasons, and my waist has never been tiny, even when slim, relatively speaking, and the waist hip ratio is a ridiculous thing to measure re health for a woman who has the athletic body type (ie when waist measurement goes down, so does the narrower hips, so the ratio is always 'wrong' for health indication). But what is 'wrong' in that regard does very well on the netball court, on the track, doing shot put and in the boxing ring, if you know what I mean. Anyway, when I look at her tiny waist (inherited by the other side of her family, not mine) I do say she is very unlikely to get the kind of insulin resistance at the same age (mid 20s) that I was plagued with, in the food environment we are all in. So, I am in fact talking about a diabetes shape, which in my case is an athletic/strong build fallen afoul of food. (A powerful trunk or centre is great for heavy lifting, very dangerous when covered in the dangerous visceral body fat.)

 

[kev-w]

A diabetic shape's a new one on me but the old "you don't look diabetic" isn't, I've had that line recently in the pool when a lass asked what the white thing was on my arm (she thought it was a training device )

 

[carty]

I am thin/ skinny all over any extra me is skin that didn't twang back after my last pregnancy !!
Carol