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Overweight vs underweight... which is harder to deal with?

Discussion in 'Type 2 Diabetes' started by Valerie_london, May 1, 2013.

  1. Valerie_london

    Valerie_london Type 2 · Member

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    I've been reading the 'blame game' thread, but didn't want to hijack that.

    My mother is an underweight T2 diabetic, who before being diagnosed as diabetic last November, had an extremely sweet tooth... and as she was trying to put on weight, saw absolutely no reason not to indulge it. Now, she obviously has to be a lot more careful what she eats, especially as she still is rarely in single fasting figures. She is doing really well and though she has cut her carb intake down drastically, she really can't go too low, as she needs to try and increase her weight, and there seems to be a physical limit to how much dairy and meat stuff she can activally eat/digest.

    Obviously, those who are overweight and T2 have a completely different struggle.

    My question is a bit tongue in cheek, and apologies if it is a bit too controversial, but... who do you believe has the biggest mountain to climb in controlling their T2 diabetes?

    (I've actually already concluded that both have similar but different problems, but thought I'd post this anyway)
     
  2. Daibell

    Daibell LADA · Master

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    Re: Overweight vs underweight... which is harder to deal wit

    Hi. If we just take the 'Type 2' group which I'm part of there are two sub-groups with a spectrum in-between. These are the overweight who have insulin resistance and the under-weight who have a failing pancreas. I fit the latter sub-group and it sounds like your Mother possibly does as well? The over weight have some chance of bringing sugars way back down if they can have the right diet to enable the weight to come off. They may or may not then need meds but may avoid moving to insulin for many years. The under-weight group can't put on weight easily due to blood sugars going high and may need high levels of meds including insulin to control sugars and enable more normal eating. There are Pros and Cons for each sub-group. The over-weights have a chance of becoming almost normal and controlling their diabetes as long as they don't over eat. The underweights have less control and may well end up on a collection of meds, but don't suffer the tiredness and health risks from being overweight and insulin resistant. If the over-weights need to go onto insulin then it can be difficult initially to get good sugar control due to there already being excess insulin in the blood. I've generalised a lot in the above and will be interested in other people's thoughts.
     
  3. Valerie_london

    Valerie_london Type 2 · Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Thanks Daibell, that was a very considered response and I do generally agree with you. And I'm also interested to hear other thoughts on the subject. :)
     
  4. KennyS

    KennyS · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Hi Valerie,

    While I was slightly overweight at the time of diagnosis, I immediately put myself of a low carb diet. The weight came off very quickly and I was then faced with the dilema of stopping the loss. My wife has very strong opinions about saturated fats and Cholesterol so, while I do not share her opinion.... in deference to her.... ... ah... admonishments :angel: I did my best to steer away, as much as possible from meats and dairy. To make up for those calories I eat lots of nuts, natural peanut butter and olive oil on everthing.... broccoli... pepper, touch of salt and oliveoil.... peanut butter stirred into a cream with olive oil and eated with celery. pork chops baked in olive oil, balsamic and chopped veg,....Cauliflower.... yep, you get the idea. The oil doesn't seriously alter taste and adds quite a few calories.... besides, everyone can do with a lube job now and then :D

    Kenny
     
  5. hanadr

    hanadr · Expert

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    Re: Overweight vs underweight... which is harder to deal wit

    Even for non-diabeics, it's harder for skinnies to gain than tubbies to lose weight. It's even more difficult if you have to restrict your carbs. I suspect that being slightly underweight isn't too dangerous and to try to build a bit of muscle could be an answer.
    I've no idea of your Mum's age, but I do know that even we older folks can improve fitness. My local gym is full of over 50s every Monday. My own gym class is all made up of over 50s, and range up to over 80s. I don't know if anybody is trying to gain weight, but we did have a member who wanted to. Sadly, he died early this year. He was in his mid 80s and had kept his weight up since cancer surgery.
    If exercise won't help, by building muscle, going on to insulin might be the answer.
    hana
     
  6. anna29

    anna29 Type 2 · Well-Known Member
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    Re: Overweight vs underweight... which is harder to deal wit

    Hi All .

    Interesting thread and sensitively thoughtful approach between the variables :thumbup:

    Well explained Daibell - it has taught and shed light on things for me - 'thank you'

    I am tiny and always have plateau with my weight .
    Stay stuck for ages with a certain weight before it moves either up or down a bit .

    They blame my underactive thyroid with this one - [not sure if this 'is' the reason]

    Am on insulin and do watch what I eat both with my diabetes and my diverticulitis bowel disease .
    Its a balance with both conditions to keep all things steady and I do have to 'work' at it too ! :crazy:

    A lot of people cant believe I am diabetic as am tiny , even a DSN commented on the same thing .
    Can only inject on my tummy as am too slender elsewhere legs,arms,bottom are not an option for me .
    Will hit muscle only as no fat .

    Anna.
     
  7. KennyS

    KennyS · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Daibell - Interesting information. I have never heard about weight being a determinate factor in insulin resistance vs deficit.... but then again, I have never had an underweight problem. :( Could you point me to some information on the subject?

    Kenny
     
  8. anna29

    anna29 Type 2 · Well-Known Member
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    Re: Overweight vs underweight... which is harder to deal wit

    Hello KennyS .

    Hope this can help you .

    http://www.diabetes.co.uk/results.asp?q ... 62&sa.y=24

    Anna.
     
  9. Daibell

    Daibell LADA · Master

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    Re: Overweight vs underweight... which is harder to deal wit

    Hi Kenny. Anna's link provides you with some information. There is also a long, deep Wikipedia article on the subject:

    http://en.wikipedia.org/wiki/Insulin_resistance

    It appears to be a complex mechanism and just because someone is obese doesn't mean they will become type 2. I assume there are genetic factors which have to be present as well. There are various NICE and other reports which indicate that around 80-85% of
    Type 2s are overweight and one can assume therefore probably insulin resistant, but a few may just have a failing pancreas or have both conditions. As I understand it, the C-peptide test is the standard way of detecting how much insulin you have in your blood and an indicator of the appropriate treatment regime. You current diet looks pretty good to me and explains how you have been able to manage your weight. Yes, the arguments over saturated fats and cholesterol continue; I predict in another 10 years time the focus on saturated fats will have moved towards carbs.
     
  10. KennyS

    KennyS · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Daibell - I have apparently miscommunicated my question. I’m fairly very well versed in the many theory’s of why people get diabetes and the conditions that can/do result from it. My confusion is in this statement. "If we just take the 'Type 2' group which I'm part of there are two sub-groups with a spectrum in-between. These are the overweight who have insulin resistance and the under-weight who have a failing pancreas."

    I saw nothing in the wiki link that touches on this. There is certainly clear evidence that people who are diagnosed with diabetes tend, by a large percentage, to be overweight but there is nothing in current science that I can find that says being overweight IS the cause of diabetes or indeed insulin resistance. Nor is there any clear science as to why the pancreas diminishes/stops the production of insulin. So I don't understand the clear classifications that you present and have never read anywhere that underweight people who present with diabetes will be more likely to present with insulin deficiency rather than a resistance problem.

    For myself, while I was a bit overweight when diagnosed, I was far from being obese. While I have always had to watch my weight, I have also always kept it in 'reasonable' check. If the proximate cause of insulin resistance is, for instance, cumulative spikes in blood sugar, then a person who is underweight could expose their bodies to the same 'punishments' as an overweight person just because of the types of food they eat and how but would not need to be calorie excessive. Add to that the possible link between a sedentary life style and diabetes.... Thin people are 'more likely' to be more active.... but not all will be.

    Don't get me wrong. I'm not trying to attack your premise, just trying to find out more about it as I haven't seen it before. Just surprised I haven't run across it before.

    Kenny

    P.S. Anna. The link you provided took me to a search page for insulin resistance but nothing else. Attempted to do a search from their but it gave no response.
     
  11. anna29

    anna29 Type 2 · Well-Known Member
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    Re: Overweight vs underweight... which is harder to deal wit

    Kenny .

    Scroll down and click on each heading .
    It will then take you to the site of headed info .
    Just doublechecked it myself and I can access it okay . :thumbup:
    I find it is very helpful and it is explained well also in various info given .

    Anna.
     
  12. pickledpepper2

    pickledpepper2 · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Interesting topic!

    I've always been on the slimish side but did get obese prior to diagnosis. On reflection I should've twigged onto something being seriously wrong because all of a sudden even training hard wasn't helping me lose the weight. I was under a lot of stress at work at the time. I just thought my metabolism had slowed down now that I had hit my mid 30s.........boy was I wrong.

    Then came the sudden weight loss which turned me into a walking skeleton (that's how I felt anyway). Slowly I have gained some weight back on since then (3 years ago), but then I do train everyday (occasionally weights but usually using my own body weight i.e. pushups, squats, chin ups, pull ups).

    Strange thing is that carbs seem to strip my body of what little fat I do have?? Like some sort of thermogenic tablet body builders use to 'cut up'. So even eating carbs doesn't help me put weight on now but has opposite effect?! I'd love an explanation for this if anyone has one?

    What I would suggest to thin people want to put on weight is introducing some good quality protein powder based shakes into their diet. You can get high protein - low carb ones like USN Pure Protein. They are expensive but worth it in my opinion. Especially as a quick meal on the go/breakfast.
     
  13. Daibell

    Daibell LADA · Master

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    Re: Overweight vs underweight... which is harder to deal wit

    Hi Kenny

    Interesting question. I guess much of my diabetes knowledge has been acquired over the 8 years since my diagnosis. I've been monitoring this form for several years now taking on-board an enormous amount of information and download and viewed many articles. So, I suffer an overload of sources, many in conflict, but have a background understanding across the diabetes spectrum. I'll see what I can dig out, but one 1998 research paper (http://edrv.endojournals.org/content/19/4/491.long - note you can download the article in pdf as well) discusses the fact that most T2s start by having insulin deficiency and then develop, additionally, insulin resistance if overweight. This is an interesting view; have a read and see what you think. So, I think you are right in assuming being overweight doesn't cause T2, but the paper suggests that if you are genetically pre-disposed to diabetes then being overweight will bring about insulin resistance following insulin deficiency. This is new information to me. There are several known causes of pancreatic failure to produce insulin e.g. islet cell anti-bodies as in T1 or Late onset T1. There are several identified antibodies such as GAD, II4 if I remember correctly and a few others. Pancreatitis is know problem. Viruses are known to cause problems and I'm sure there are many other genetically triggered causes. Now, taking myself as a sample of one (!) I had a C-peptide test done privately in 2012 and it showed I had virtually no insulin production. This confirmed my suspicions that the tablets I was on were a relative waste of time and I needed insulin which I now have. Now some would say the Gliclazide I was taking killed my pancreas but as it never helped much anyway there probably weren't too many islet cells left to damage in the first place. My private GAD test was negative but it often is and there are other antibodies not tested for. So, I'm one of that 20% sub-group who probably don't have insulin resistance because I'm not overweight; my acquired opinion. Anyway I will dig around a bit more and see what I can find to back-up my 'opinion'. As I said in my OP, I was generalising but that's what the medics do all the time with diabetes so why shouldn't I :)
     
  14. Daibell

    Daibell LADA · Master

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  15. pickledpepper2

    pickledpepper2 · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Hi Daibell, thanks for sharing.

    I was wondering how much a c-peptide test costs?

    Did they make you eat some carbs prior to taking your blood sample?
     
  16. Sid Bonkers

    Sid Bonkers Type 2 · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    I'm afraid its not as black and white as that Daibell as even skinny T2's can have insulin resistance, visceral fat can accumulate around the organs of skinny people just as it does with overweight people so its entirely possible that all T2's will have insulin resistance and many will also have some degree of pancreatic dysfunction too. Visceral fat is not seen by the naked eye but is only visible by scans like CT or MRI scans.

    Visceral fat can be reduced through diet but how many thin people even think about dieting or even consider that they may be fat?!?
    http://www.nbcnews.com/id/18594089/ns/h ... YfNvMqle9I

    There are many other sites that have information on visceral fat and its part in causing insulin resistance in both thin and overweight people, I just posted this one as an example, do a search if you are interested in this subject. I am convinced that the best thing any T2 diabetic can do whatever their body shape is to diet strictly and remove as much of their visceral fat as is possible, thus reducing their insulin resistance which will obviously then lead to better bg control.

    I think the thyroid gland obviously can and does have a large part to play in some cases and there may be other medical reasons too why some are under or over weight. Then there is the emotional side of things to consider and our relationships with food and why some over or under eat.

    I dont think that one group of people be they fat or thin have an easier or harder job to increase or lose weight, I think both body types probably have equally hard roads to travel in their quest for the "perfect" shape.


    A little off topic__but maybe not,,,,,,
    I am currently re reading Paul McKennas book "I Can Make You Thin" which I am finding fascinating, I didnt finish reading it the first time I read it but I feel sure now having lost weight and kept that weight off that I must have subconsciously used some of the techniques he writes about. And I will definitely be revisiting other little tricks that I used to use that I have let slip now.

    A thought provoking book that doesnt go down the diet route at all so can be employed by anyone whatever diet they choose to eat, but looks more at how we see food and how we eat it, knowing when to eat and when to stop eating, I know, it sounds stupid :lol: but it makes sense when you read it, honest! Anyway if its possible to change the way we think about food and eating in order to loose weight I guess it might be equally possible to do the opposite to put weight on too.
     
  17. KennyS

    KennyS · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Sid .... McKenna is heavily involved in the practice of NLP which has been proven quite effective in the hands of a good practitioner. I think that it even has better success rate than hypnosis for breaking habits like smoking. Some 25 years ago I finally kicked smoking. I had tried gum and filters and even an early stab at hypnosis and nothing worked. One day I went into a drug store and there was a stand for some stop smoking program. It only cost a few quid so I picked it up and threw it in a drawer for the day I figured I would have another go. At any rate the program was some herbal pills for the physical bit and a cassette tape... (remember those :) ) The instructions were simple... take the pills per instructions and listen to the tape as many waking hours as you can. At the time I was working the night shift at a telecommuncations center, alone and nothing to prevent me doing my work plugged in to a walkman.... Long and short of it... the tape briefly explained the negatives of smoking (which you know already), talked about the positives of the change, which you know already, and dwelled on your new life without cigarettes. It stressed that you should not leave your friends or places you like, just to enjoy those people and places without cigarettes.... 7 days for 12 hours a day I listened to that tape and never smoked again.

    Point is, I have treated this diabetes thing the same way. I still go to friends parties and places where people are eating and drinking but I chose not to have those things because deep down, I know that they are not good for me and abstaining from them is... I have lost nothing but certain foods (which I no longer call good food), I still have my friends, my enjoyments and my hobbies... minus the damage of a bad habit ( certian carbs have become bad habits). Much of what was one that tape was well delivered NLP....

    Kenny
     
  18. Daibell

    Daibell LADA · Master

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    Re: Overweight vs underweight... which is harder to deal wit

    Hi Pickledpepper2. The cost going with Medichecks (Google it) was not cheap at £179. You get a discount by adding a 2nd test e.g. GAD. I was told to do a fasting test and Googling the web shows views vary on how much fasting you should do with the C-peptide test. I guess with fasting you are checking the background insulin which should always be present not mealtime extra output. Depending upon the insulin failure mechanism you should probably do a range of tests?
     
  19. KennyS

    KennyS · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Daibell. Haven't got to your first link yet but I skimmed over the nice report and two things about it jump out at me.

    1. The nice reports places pancreatic failure in a category other than Type 2
    * Type 2 diabetes

    Diabetes is a group of disorders with a number of common features characterised by raised blood glucose. In England the four commonest types of diabetes are:

    type 1 diabetes

    type 2 diabetes

    secondary diabetes (from pancreatic damage, hepatic cirrhosis, endocrinological disease/therapy, or anti-viral/anti-psychotic therapy)

    gestational diabetes (diabetes of pregnancy).[1]

    The underlying disorder for type 2 diabetes is usually insulin insensitivity combined with a failure of pancreatic insulin secretion to compensate for increased glucose levels. The insulin insensitivity is usually evidenced by excess body weight or obesity, and exacerbated by over-eating and inactivity. It is commonly associated with raised blood pressure and a disturbance of blood lipid levels. The insulin deficiency is progressive over time, leading to a need for lifestyle change often combined with blood glucose lowering therapy.

    2. They offer this diet advice as a first bullet point that fly's in the face of everything I have learned about controlling blood sugars and given that 80% of the type 2 population is over weight... this kills much of my 'warm fuzzy' for many of their conclusions .....

    1. base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible


    I will look at the other link because my understanding and approuch up to now has been that islet damage in the pancreas is preceeded by insulin resistance. If this is new information, I am willing to learn and change my mind.

    Kenny
     
  20. pickledpepper2

    pickledpepper2 · Well-Known Member

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    Re: Overweight vs underweight... which is harder to deal wit

    Thanks for the feedback Daibell.

    Interpreting C-peptide tests seem confusing. Ideally we should be assessing whether our pancreas is creating insufficient amounts of insulin or stonking amounts. Logically speaking the former would indicate a pancreas problem the latter resistance. So in my mind we'd need to have our pancreas react to a certain level of carbs and see how it deals with them. Problem with such tests is that there seem to be no bench marks i.e. x amount of carbs should make us produce about x amount of insulin (factoring in weight/size etc.)


    But it does get slightly more complicated in that some people think a problem occurs with the quality of insulin produced by the pancreas rather than quantity. So the pancreas produces 'faulty' insulin as opposed to too little/much which doesn't act on the receptors which tell our muscles to take up glucose.

    It's nice to know I can get a c-peptide test though.

    We really do need some standard tests for assessing pancreas functioning like the EFGR for our kidneys!
     
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