T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

[HSSS]

I was one of those sad people who was shocked I had diabetes. Shocked and angry. I could not get my head around the reasons for it. It always struck me that if you are Type 1 , it’s autoimmune and there is nothing you can do. Not your fault. The discourse around Type 2 however, is completely different. Websites list the causes, bad diet, being over weight and lack of exercise. There is an underlying blame attached to these short lists. Had you eaten better then you would not be diabetic. That’s why we get members in a state of distress thinking they’ve brought their diabetes on themselves. Then the medical community perpetuates this guilt by sending you off with dietary advice, and an exercise plan. They tell you to lose weight and here you are take this prescription for Metformin, see you in a year.

I read, very recently, in a comment section on Type 2 diabetes, in a National paper, the poster quipped type 2s spend too long in the crisp aisle. No thought behind the comment, just a buy-in repeating a thoroughly ignorant trope.

I can relate to athletes being shocked at a type 2 diagnosis. Why do athletes get type 2? They see the narratives , bad diet, overweight, in active. No wonder. It’s two sides of the same coin. They are fit, and what do you say to someone who eats a healthy diet and is fit? And outside of the diabetic community who has even heard of insulin resistance or a depleted cell mass in the pancreas. Very few, but the world and its dog can recite bad diet and obesity as the cause. That’s a pretty powerful narrative and it will be a hard one to break.

And If you are thin, lean and very fit where do you go with that diet/weight/lack of activity narrative. There is nowhere to go with it. The reality is if you are thin/lean and very fit and you have type 2 diabetes there are very few options. The only thing that came from my very low carb diet was weight loss that I didnt need to lose. As much as people want to lose weight, one doesn’t want to look like they need A good meal either. I have read too many reports about thin and fit T2 diabetics with very poor outcomes. Contrast this with over weight individuals who can put their diabetes in remission by change of diet and weight loss and their outcome is significantly greater.
With no real clear cut answer from the medical research community as to why some people develop insulin resistance, and no real understanding as to why some people lose beta cell mass, we are no further forward.

I think the majority of newly diagnosed diabetics go through a period of shock no matter how they approached it or even which type they have. It is after all a not insignificant lifelong diagnosis to come to terms with.

You make a lot of very valid points regarding diagnosis when you don’t fit the stereotype and where do you go when you already do all the recommended things which adds a layer of complexity. As you say those with a lot of weight to lose, eat a plethora of carbs and that have sedentary lives have lots of scope to make changes. And I too have seen people in here make comparatively small changes and have huge results. I would note that low carb and even keto doesn’t have to mean weight loss so does leave that door open to you if a type 2. An increase in protein and healthy fats should put a halt to the unwanted losses whilst maintaining the benefits of low carb eating for blood glucose purposes.

Personally I was kind of in a middle ground. I had weight to lose but wasnt obese, I ate relatively few carbs already just through personal preferences and whilst not sporty wasn’t inactive. I was told I didn’t “look like a type 2”. I drastically lowered carbs to keto and lost lots of weight but still only just reached the prediabetic levels. Despite maintaining these changes (with not insignificant and non typical in society dietary choices) for 4 yrs my fundamental carb tolerance /insulin sensitivity didn’t appear to improve much either, although health markers improved and therefore hopefully the risk of long term problems lessened. And the single action of increasing carbs, rather than overall intake, has lead to weight gain and less good bgl. I feel angry we have such poor dietary guidance with regards to excessive carbs, and of the normalising of the processed junk, seed oil laden, anti dietary fat food environment that encourages obesity, lethergy and insulin resistance. I feel offended people assume I stuffed my face with sugar and crisps (I didn’t) because of the limited awareness of causes beyond the obvious.

I am curious though, were you sad and angry because it felt like you had nowhere to go to help yourself or was it because you were being accused of being fat, lazy and brought it on yourself when those things weren’t true? Both would be entirely understandable imo.

Perhaps if it’s the latter though consider that there are others out there feeling as offended by the incomplete list of causes and the implied blame as you. And by the media, the medical profession, the public and even those with diabetes themselves that weren’t the obvious candidates perpetuating the fallacy that this diagnosis is ENTIRELY down to poor personal choices does a lot of people a disservice.

Guilt and self blame are rarely motivational even if there are elements of those choices in play either. What needs addressing is why those poor choices are made in the first place and what other factors are in play that this current blame game is ignoring.

 

[AndBreathe]

I agree change is hard. And that not all follow the existing advice. But.

Change is even harder when we don’t have the appropriate tools, knowledge or understanding why everything we keep trying keeps failing and despondency and a sense of futility sets in.

And whilst some still smoke it’s massively fewer than it used to be and many successful in change did it because of better tools and support, alongside an environment that stopped normalising and enabling the self destructive behaviour.

I agree that the information should be freely available, but the presence of information does not often bring about the level of change we really need.

For every change there has to be a real, clear, "What's in it for me?" Of course, we would say there is one; a healthier future, but for those "at risk", they'll more often than not hedge on the side of "well, lots of people don't get X, and I'm fine."

I am absolutely NOT picking on those who are overweight, but how many folks do you hear say they a fat and fit or "perfectly healthy" despite the obvious sign that's not necessarily the case.

I spent years being paid a lot of money asking for the "what's in it for me", and "why would anybody want to do that?" questions relating to IT and process changes, only to walk out of the room to wait until they'd thought of decent responses.

 

[AndBreathe]

I agree change is hard. And that not all follow the existing advice. But.

Change is even harder when we don’t have the appropriate tools, knowledge or understanding why everything we keep trying keeps failing and despondency and a sense of futility sets in.

And whilst some still smoke it’s massively fewer than it used to be and many successful in change did it because of better tools and support, alongside an environment that stopped normalising and enabling the self destructive behaviour.

For many the most "effective tool" for cessation was/is taxation. I have zero idea how much cigarettes cost (actually the ONS tells me that in June 2024, it was £15.84 for a pack of 20 king size filtered cigarettes), but I do know it's more than a fillet steak a day. Many are simply forced to cut down of give up. Don't start me on vaping, because I reckon that's the next candidate for serious lung disease.

 

[HSSS]

I agree that the information should be freely available, but the presence of information does not often bring about the level of change we really need.

For every change there has to be a real, clear, "What's in it for me?" Of course, we would say there is one; a healthier future, but for those "at risk", they'll more often than not hedge on the side of "well, lots of people don't get X, and I'm fine."

agreed

I am absolutely NOT picking on those who are overweight,

I’m sorry if it looked like my comments on this were directed at you. They weren’t. It was me on my soap box in general.

but how many folks do you hear say they a fat and fit or "perfectly healthy" despite the obvious sign that's not necessarily the case.

Agreed. And that’s largely the point of my comment about normalising environments that enable self destructive behaviour.

I spent years being paid a lot of money asking for the "what's in it for me", and "why would anybody want to do that?" questions relating to IT and process changes, only to walk out of the room to wait until they'd thought of decent responses.

If only change were easy eh?

 

[AndBreathe]

If only change were easy eh?

Quite a bit of it is. Health is often more complex, but....

 

[Chris24Main]

Wow.. I turn my back for a minute...

Lots of incredible insight and experience here.. I can practically feel the catharsis... and you know.. I definitely feel myself that a safe space to vent is just so important with this.

For myself, I was initially diagnosed type 1, and after 6 months re-diagnosed type 2. The only insight this affords is that I was totally aware of the subtle shift of "oh, we need to look after you now" ... into "you just need to do what you're told, because you did this to yourself". Nobody said anything so crass as that, but as an experience of one, then the other.. it was like being in a crime drama where suddenly everyone turns and looks at you.. "oh, it was you all along...?"

@Melgar - I await your insight into Ben Bickman, but I do hope you find answers. Most obviously there are three main drivers of IR - too much insulin, too much inflammation and too much stress hormones. After that it gets complicated, and of course becomes a viscous cycle, but you can easily develop IR while having a perfect diet.

On whether people can change.. this is the tradgedy. My wife is a specialist risk manager and business performance analyst. She is amazing at seeing the positive in people. She also makes the case that people don't easily change. Yet... if you look at the statistics... at the societal level, we have largely taken on board the advice on diet that came out of the '77 recommendations. Almost to the single decimal point, we have shifted away from saturated fats toward carbs in the sense of total energy consumed, according to those guidelines. Smoking has decreased. People do wear seatbelts. People drive drunk less often than when I was a kid. People are less racist and more tolerant. Of course there are exceptions, and your personal experience may not be good. But.. change does come from stories we tell ourselves. The problem is that we've been telling ourselves the wrong story about food for a couple of generations.

On a total aside (but a propos) we had friends over last night. A mother of one of our kid's schoolmates that we all know just up and died last week. Picture of health, and just like a dad we knew maybe 6 years ago. Heart just stopped. Not a heart attack, it just stopped. How tragic, how unfair.. how random and unlucky.. Except it isn't. Human hearts don't just suddenly stop for no reason, but they can if they are starved of energy because of Insulin Resistance, even surrounded by available energy. This is another insidious facet of this thing that we tend to only associate with T2DM..

 

[Chris24Main]

As I was chewing over what I'd written above - a thought occurred along the lines of "I better make sure that I'm not ragging on the health professionals" - and I think this is worth adding - I mean, clearly I have total respect for the Doctors and Nurses themselves - they have little time to think these things through, and they do a difficult job, with huge expectation and stress on them, I want in no way to be coming across as anything other than deeply appreciative.

yet.

They are operating under the same weight of the simple narrative - "fat is bad, fat makes you fat, fat clogs your arteries, fat people develop diabetes"

And I use the phrase deliberately - I mean no offence, precisely because I disagree with the whole thing - fat is really what we've evolved to use for most of our energy management, people with lots of good, well functioning fat storage cells can be larger but also in much better health than a lean person, dietary fat has no link whatever to the state of your arteries, and indeed, avoiding eating fat can be really bad for your arteries, depending on what you replace it with. Finally, the underlying cause of diabetes, Insulin Resistance, drives both obesity and what we call T2DM, but also a whole raft of other things ranging from irritating annoyances, to life threatening conditions.

But - given the weight of that narrative, it's unreasonable to expect deep insight into how carbs drive IR, even a well-meaning specialist consultant who got maybe a week of training on nutrition during her second year, all based on a series of rock solid (but wrong) assumptions and never questioned since ... that person is going to be difficult to convince, particularly when ... people, shall we say... overcook the truth? - I know that almost every time in a doctor's surgery when I've been asked how much alcohol I drink in a given week, I can count the times I was truly honest on one hand...

So the myth is perpetuated. Even in the face of truly horrifying wider scale statistics (like how much diabetes treatment costs at a societal level) - all a GP is really given time to do is - identify the problem, proscribe the drug, check again in time. Next.
Would you question the entire system that drives your profession?

However, at least in my trawling of the net, I think there is one interesting corollary - when doctors themselves get caught up in this - when they are themselves facing the conundrum of "none of these drugs seem to do much more than lead to more drugs, surely there must be something we're missing".. it seems to me that many of them go around the same kind of loop many here do, and come to many of the same conclusions, at least starting with - maybe if too many carbs too often is one of the key drivers, maybe having less can only help...

The rest is gravy (I mean, proper gravy from good fat, none of that stuff loaded with modified starch, and soy extract and dextrose)

 

[AndBreathe]

As I was chewing over what I'd written above - a thought occurred along the lines of "I better make sure that I'm not ragging on the health professionals" - and I think this is worth adding - I mean, clearly I have total respect for the Doctors and Nurses themselves - they have little time to think these things through, and they do a difficult job, with huge expectation and stress on them, I want in no way to be coming across as anything other than deeply appreciative.

yet.

They are operating under the same weight of the simple narrative - "fat is bad, fat makes you fat, fat clogs your arteries, fat people develop diabetes"

And I use the phrase deliberately - I mean no offence, precisely because I disagree with the whole thing - fat is really what we've evolved to use for most of our energy management, people with lots of good, well functioning fat storage cells can be larger but also in much better health than a lean person, dietary fat has no link whatever to the state of your arteries, and indeed, avoiding eating fat can be really bad for your arteries, depending on what you replace it with. Finally, the underlying cause of diabetes, Insulin Resistance, drives both obesity and what we call T2DM, but also a whole raft of other things ranging from irritating annoyances, to life threatening conditions.

But - given the weight of that narrative, it's unreasonable to expect deep insight into how carbs drive IR, even a well-meaning specialist consultant who got maybe a week of training on nutrition during her second year, all based on a series of rock solid (but wrong) assumptions and never questioned since ... that person is going to be difficult to convince, particularly when ... people, shall we say... overcook the truth? - I know that almost every time in a doctor's surgery when I've been asked how much alcohol I drink in a given week, I can count the times I was truly honest on one hand...

So the myth is perpetuated. Even in the face of truly horrifying wider scale statistics (like how much diabetes treatment costs at a societal level) - all a GP is really given time to do is - identify the problem, proscribe the drug, check again in time. Next.
Would you question the entire system that drives your profession?

However, at least in my trawling of the net, I think there is one interesting corollary - when doctors themselves get caught up in this - when they are themselves facing the conundrum of "none of these drugs seem to do much more than lead to more drugs, surely there must be something we're missing".. it seems to me that many of them go around the same kind of loop many here do, and come to many of the same conclusions, at least starting with - maybe if too many carbs too often is one of the key drivers, maybe having less can only help...

The rest is gravy (I mean, proper gravy from good fat, none of that stuff loaded with modified starch, and soy extract and dextrose)

By way of a foreword to my post I will say there are some fabulous medics out there who really do want, and really do try to do the best for their patients - whatever ails them. On the contrary, some of the most dire and damning comments about people living with T2 have come from health care professionals.
I have said several gazillion times already on forum; I am involved with our local NIHR and research in a number of formats.

Being a very slight person, if it is know I live with a diabetes diagnosis, it is almost always assumed the diagnosis is for T1, so tongues wag freely and expect me to join in. When I respond they are quite rightly embarrassed and apologetic, but I doubt their ways will be changed.

The changes you cite, for smoking, seatbelts and drink-driving. Yes, I agree, but two of those elements are governed by law, and to en extent for the drink-driving the ever increasing dependence on cars in either working or day-to-day living. Smoking; my feelings are elsewhere on the thread.

Personally, I would LOVE to know how many GPs are diagnosed T2 and how they approach it, and secondly, again I'd love to know the percentages of health care professionals live with T2 and the proportion of those who managed successfully, based of lifestyle only. I deliberately don't cite low carb because there are folks out there who achieve great result, including remission on diets we would not consider to be low carb.

 

[Melgar]

@HSSS I was angry and sad because I knew little or nothing about diabetes in general. I bought into the whole ‘it’s your fault‘ narrative that we read on social media, and in the press. The lack of information, outside of the diet/weight/sedentary lifestyle narrative, takes people down the road of ‘it’s my fault’ because no other explanation is readily available for the reasons why some people develop T2D. I now make a point of trying to explain why T2 develops.

So I got bent out of shape because that diet/weight/sedentary lifestyle simply didn’t make sense because none of those factors applied to me. I have since become informed and I have now developed an interest in diabetes in general. I can still go there emotionally, but logic does prevail.

As for very low carb diets, I have a fat malabsorption issue. My body has a problem metabolizing fats. I can only have a very small about else I feel nauseous , plus I get
steatorrhea. I believe this is due to damage to my small intestines from undiagnosed coeliac.

 

[MrsA2]

One click @Chris24Main and ‘Why we get sick’ is mine. I’ll have a read of it a bit later. Thanks for the link. Maybe all my questions will be answered.i have many lol

Ben Bikman does several good videos too. I've just watched one on leptin, another hormone closely intertwined insulin.
Lots of pieces of the jigsaw, very close to the whole picture soon I hope
Ps leptin was only identified in 1994, that's nothing in the history of bodies and medicine.

 

[Antje77]

As for very low carb diets, I have a fat malabsorption issue. My body has a problem metabolizing fats. I can only have a very small about else I feel nauseous , plus I get
steatorrhea. I believe this is due to damage to my small intestines from undiagnosed coeliac.

I forgot, are you on creon, or have you been tested to see if you have EPI?

 

[Melgar]

I forgot, are you on creon, or have you been tested to see if you have EPI?

No I haven’t @Antje77 I had to look EPI up - Exocrine pancreatic insufficiency - I’ll take a further look. Since finding out I’m coeliac I have a tendency to put every digestive issue down to that. I will do a bit of digging.

 

[Antje77]

No I haven’t @Antje77 I had to look EPI up - Exocrine pancreatic insufficiency - I’ll take a further look. Since finding out I’m coeliac I have a tendency to put every digestive issue down to that. I will do a bit of digging.

EPI can be a condition all by itself, but in people with T3C diabetes (damage to the pancreas from whatever cause except T1, which specifically attacks the beta cells only) I think EPI almost always comes together with the diabetes.
With your atypical diabetes, this might be something you want to read up on.

 

[Melgar]

Thanks @Antje77 definitely . I really appreciate your info on this.

 

[BadgerPaul]

Hi everyone I’ve just noticed Heck pork sausages 97 meat. Have a lot of trans fat. As I understand one of the worst foods I can eat.
Just thought I should share this.

 

[HSSS]

Hi everyone I’ve just noticed Heck pork sausages 97 meat. Have a lot of trans fat. As I understand one of the worst foods I can eat.
Just thought I should share this.

What are you seeing that makes you think trans fat? I see no hydrogenated fats listed

 

[BadgerPaul]

When I put them into my fitness pal (app) it showed up (a full days allocation). I’ve agree it’s not shown on the packaging ????

 

[BadgerPaul]

I’ve just cross checked it is only 1g on three sausages.
That’s probably why it’s not listed. As it’s on three sausages (0.3 per sausage)

 

[lovinglife]

When I put them into my fitness pal (app) it showed up (a full days allocation). I’ve agree it’s not shown on the packaging ????

I wouldn’t trust Myfitnesspal for things like that as it peer info, could have been added wrongly or Myfitnesspal interpreted it that way. I use Myfitnesspal but don’t use the scanner I input all my info into “my foods” or meals - I only ever add the carbs nothing else - calories of course as it’s mandatory.

At 0.3g sausage every now & then I don’t think they would be a problem, Heck sausages are supposed to be the best available for no added nasties - sausages are a processed food so your never gonna get the perfect sausage of a supermarket shelf. Personally I don’t particularly like the Heck sausages I find them bland & dry & don’t understand the hype around them.

I buy the M&S large pork sausage, there’s 4 in a pack but they are twice the size and the same carb etc as Heck but are far tastier for a treat now & then

 

[BadgerPaul]

Okay thanks I’ll try them