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Thin Type 2 Diabetics

Discussion in 'Diabetes Discussions' started by Grateful, Nov 12, 2017.

  1. Grateful

    Grateful Type 2 · Well-Known Member

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    We are a minority (somewhere between 10 percent and 15 percent of Type 2s depending on which source you consult) but there are still lots of us because so many people have diabetes. I've had a lot of thoughts about us ever since I was diagnosed myself a bit over nine months ago and found out belatedly that you could develop Type 2 diabetes even if you are not officially overweight or obese, as measured by BMI.

    Apparently what matters is "visceral fat" and another way I've seen it described on this forum is "thin outside, fat inside." So in my case, I had been putting on weight over the past 15 years or so and ended up with a strange "beer paunch" on an otherwise very thin frame. Plus, some people might have no visible "plumpness" or weight gain at all, but still develop T2D.

    It has also prompted me to rethink the stereotype about overweight people with diabetes. All of my life, prior to diagnosis, I pretty much ate like a horse and that included large quantities of carbohydrates. Although it was a low-fat diet, in retrospect my eating and drinking habits were no "healthier" than other people I know, who happen to be overweight. They seem to balloon with just a little food, whereas my metabolism absorbed large quantities of food without putting on weight, at least until recently.

    On the treatment side, one of the interesting suggestions I read a couple of days ago on this forum was that for thin people like me, going on an extreme low-carb diet is rather like doing the Newcastle Diet. I did lose 10KG in about three months, and it seems all of the fat came from one area of my anatomy, the waistline. My face became very slightly less "jowly" but otherwise, it was all "tummy reduction." As of this morning I am 6 inches less around the waist (down from 40 inches to 34).

    My doctor has never been worried about my weight, but I now feel there could be a medical justification for warning people just on the basis of their waistline, not just their BMI. I have never been even near "overweight" by BMI, but in retrospect I now believe I had allowed a body-shape to develop that did not do me any favors. Whether it really helped "cause" my T2D I will never know, but it is suggestive.
     
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  2. Guzzler

    Guzzler Type 2 · Master

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    I had no paunch. I was straight up and like a washboard. I am now a thinner washboard but admittedly my bodyshape has changed with a small weight loss. Where that has become obvious is the area around my clavicles and to a lesser extent my thighs and waisline. By BMI standards I am underweight but just recently I learned that the committee that put the BMI together centred first on the number that would signify 'Obesity'. When Kendrick investigated BMI he discovered that the number of 30 was literally pulled out of the air by that committee.
    I have come to the conclusion that these calculators are based on whole population measurements and are pretty much useless so I now tend to go by how I feel as a MONW rather than measuring height, weight, waistline or degree in which my ear lobes droop. Too broad a spectrum leads to an awful lot of individuals who are normal but fall outside of the committees guidelines so for me it is one less thing to worry about.
     
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  3. DCUKMod

    DCUKMod I reversed my Type 2 · Expert
    Staff Member Administrator

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    I appreciate you're not in the UK, but over the past couple of years there has been much more talk about shape than before, and in particular concern for those of more apple than pear shaped, and do on.
     
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  4. DavidGrahamJones

    DavidGrahamJones Type 2 · Well-Known Member

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    I saw a program some time ago, three brothers, teenagers, two "normal", one obviously morbidly obese. They ate the same things at home and going to the same school, also ate the same at school. They did a full body scan of the three boys and the two "normal" boys had a large amount of fat in their bodies, especially around their internal organs. whereas their brother showed large amounts of fat in different places..
     
  5. Grateful

    Grateful Type 2 · Well-Known Member

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    A summary of generalities on this topic, from various sources.

    First, a couple of acronyms:
    • Thin Outside, Fat Inside (TOFI)
    • Metabolically Obese but Normal Weight (MONW)
    Some seemingly thin people carry proportionately large amounts of fat compared to muscle. Even with a "healthy" BMI they may harbor larger quantities of "visceral fat" deep in the abdomen. Certain groups are more likely to be normal/thin weight at diagnosis, including Asians and the elderly.

    There is, it seems, no easy way to detect TOFI except with a particular kind of MRI scan. It seems to me this is totally impractical as a way to screen the general population, given the expense and time required. So, perforce, TOFI goes undetected and therefore those people are not informed that their risk of Type 2 diabetes may be greater.

    For those like me who did have a bulging waistline on an otherwise thin frame, the waist-to-hip ratio could be used. In my case, that measure indicated that I was "obese" (!) at diagnosis although my BMI was 21.7. My doctor did not use such a measure and even today, states that I was "not overweight."

    Some have advocated using the waist-to-hip ratio as a warning sign for predisposition to Type 2 diabetes, or even a simpler metric such as "40 inches" being the danger level for men's waists. But as the Wikipedia article on TOFI points out, "indirect methods such as waist circumference are not suitable as individuals with an identical waist circumference can have vastly different levels of internal fat." (https://en.wikipedia.org/wiki/TOFI.)

    These relatively crude measures are in any case useless for those slim/normal "body types" who have not put on any weight around the waist.

    Genetic factors may also, in part, explain why normal/thin weight people develop diabetes. As well as the usual associated lifestyle factors such as lack of exercise, stress, lack of sleep, and poor diet (which apply to all people with T2D regardless of body type).

    I hope this is a fair summary and I invite anyone who finds gaps or inaccuracies to poke holes in it! Thank you!
     
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  6. Guzzler

    Guzzler Type 2 · Master

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    I looked into this very soon after diagnosis to try to start the 'acceptance' phase. Ivor Cummins explains it well showing that the actual shape of the fat cells and their location differs between TOFIs and non TOFIs.
    He also explains that obese non diabetics store excess fat around the waistline differently. This accounts for the fact that people of exactly the same weight with similar body shapes can see different diagnoses.
    I prefer to read or view lectures rather than rely on wiki but then the wiki source/s materials are way better than the entries can be.
     
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  7. Grateful

    Grateful Type 2 · Well-Known Member

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    That's really interesting, I will look it up.

    I got over my personal "acceptance phase" a few months ago. Then I found this forum and ironically it re-opened some recently healed wounds when I realized just how badly Type 2 diabetes is handled by the system, apparently regardless of country. I have now come to the conclusion that this should never be "accepted." It is great to see so many people here expressing their concern (nay, sometimes, outrage) and educating each other.
     
  8. Daibell

    Daibell LADA · Master

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    Hi. I've mentioned this before on the forum but be aware that some if not many of the slim T2s are actually mis-diagnosed T1 (LADA) as some GPs like mine just guess T2 if you aren't young. It musn't be assumed that the cause is visceral fat although it may be. If the pancreas has started to fail on insulin output then the cause can be antibodies, viruses and so on killing the beta cells just as happens in T1.
     
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  9. Guzzler

    Guzzler Type 2 · Master

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    Couldn't "Grateful, post: 1617061, member: 438800"]That's really interesting, I will look it up.

    I got over my personal "acceptance phase" a few months ago. Then I found this forum and ironically it re-opened some recently healed wounds when I realized just how badly Type 2 diabetes is handled by the system, apparently regardless of country. I have now come to the conclusion that this should never be "accepted." It is great to see so many people here expressing their concern (nay, sometimes, outrage) and educating each other.[/QUOTE]
    Couldn't agree more.
     
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  10. Grateful

    Grateful Type 2 · Well-Known Member

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    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!
     
  11. Hotpepper20000

    Hotpepper20000 · Well-Known Member

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    I think it comes down to cost. There are so many people who have type2 and more tests would mean much higher costs for governments and insurance companies.
     
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  12. Kentoldlady1

    Kentoldlady1 Type 2 · Well-Known Member

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    My mums family have a ton of autoimmune disorders, and unfortunately I am following behind. My skinny uncle was told he was t2d but reclassed as lada a few years ago. My mum, always as skinny as a stick and no tummy to mention is t2d. Although thin, she does have a very sweet tooth and would rather eat a pudding, (always sweet and stodgy) than meat and vegetables.

    I was obese on dx, but have several skinny cousins who are also t2d. I absolutely agree that it can be linked to fat, but there is a lot more going on. Otherwise all people who have too much fat in the middle would have t2d, and they dont.

    T2d is not seen as an autoimmune disorder at the moment, but I think its just a matter of time.
     
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  13. JUSTJOKING

    JUSTJOKING Type 2 (in remission!) · Newbie

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    I have read these forums for a while now and the one major issue that people rarely point out is exercise. I honestly believe that thin people can have T2 because although their weight may be okay that have reduced muscle tone so the muscle to fat ratio in thin or fat people is an issue.

    I have never posted before but feel that people of whatever age, weight, size and shape that increase their muscle tone and therfore their body shape including waist size and hip to waist ratio whilst following a low carb or lower carb diet will improve their T2. This does not require weight loss although in obese people there is likely to be some weight loss.

    I myself now maintain a weight that is around 25 BMI a fraction over weight but I have reduced ny bosy size from XL to medium whist losing approx 10lbs. I have reduced waist measurement to below half my height, increased my hip to waist ratio, increased leg and arm sizes. Regular physical activity including some cardio, yoga, pilates and strength training everyday with a diet of only fresh food based on high natural fats and reduced carbs is my regime.

    My last two Hb1AC results have been 37, I have been off all medication for 16 months and I have no doubt losing weight helped but increasing physical activity with regular weight training has been the biggest factor in controlling my T2. I can now eat ice cream pasta, cake etc and still have a BS of below 4.5 two hours later. Note I do not do this very often but very occasionally I have a cheat and then check the effect on bloods.

    More muscle allows more storage of glycogen, the more muscle you have and the more you use the muscles I beleive imroves BS levels along with a low carb diet.

    I rarely see anybody offering increasing muscle tone whilst reducing body fat as an option.

    I had no idea my muscle tone had reduced so much and at 61 male and over weight I have shocked myself at the level of fitness and body fat I have managed to achieve and continue to improve.

    My blood reults improved with weight loss but normalized with improved fitness and increased nuscle tone.
     
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  14. Guzzler

    Guzzler Type 2 · Master

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    You have acheived remarkable success, well done. We are all different, gender and age play a big part as does the length of time between developing IR and being diagnosed with T2. There are otherwise fit, young adults, athletes among them who are diagnosed as T2 so I am not wholly convinced of the benefit of some types of excercise on reducing IR. It is an interest of mine only because as a wheelchair user I cannot partake in excercise and even using resistive bands, which I tried just a short time ago, proved impossible.
    We do what can within the scope of our capabilities. I do beleive that people can lower their bg/IR faster with resistive excercise but ultimately, we cannot outrun a bad diet.
     
  15. Grateful

    Grateful Type 2 · Well-Known Member

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    I have seen some studies that suggest moderate exercise -- such as 150 minutes of brisk walking per week -- has a (modest but useful) effect in reducing/controlling BG.

    Also some other data that seem to show converting fat to muscle (or changing the ratio to more muscle relative to fat) is beneficial in controlling T2D because the muscle is somehow more useful. I forget the exact mechanism.

    This goes via the route of "resistance exercises." I did step up my exercise level a lot after diagnosis, but it is largely "aerobic" and not resistive, apart from some of the home exercises I am now doing with therabands (large rubber bands). I haven't tried weight-lifting yet....

    I know that I was far too sedentary prior to T2D diagnosis. The issue of how much exercise helps post-diagnosis seems a bit "wooly" to me. Exercise has so many health benefits anyway (regardless of the diabetes angle) so I have not problem being enthusiastic about it, for those who are medically able to do it!
     
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  16. caroline_92

    caroline_92 Type 2 (in remission!) · Well-Known Member

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    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...
     
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  17. Cricket_Balls

    Cricket_Balls Type 2 · Member

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    My 1st post, so hope this is not a stupid question or been covered elsewhere

    As someone who is slim & very fit I keep hearing about visceral fat but have no idea whether this affects me; how do you know whether your visceral fat is good/bad?

    Meanwhile, what a great forum - must properly 'introduce' myself soon

    The World's worst cricketer!
     
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  18. Grateful

    Grateful Type 2 · Well-Known Member

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    Welcome! As far as I know, the accurate way to figure out the visceral fat is with a particular kind of MRI where the machine is adjusted to highlight fat. Obviously this is an expensive and time-consuming test, so it is understandable that there is no mass screening for this type of thing.

    There are ways of finding out the muscle/fat balance for the whole body (even some fancy home digital scales that do this) but as far as I know, this will not be able to identify the location of the fat in the body.

    I hope someone who knows more about this can provide more information.
     
  19. hazelo

    hazelo Type 2 · Newbie

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    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.
     
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  20. Grateful

    Grateful Type 2 · Well-Known Member

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    Welcome! You have been a member since early this year, but as that was your first post....

    That reading of 80 was probably from the HbA1c test, which is described here: http://www.diabetes.co.uk/what-is-hba1c.html.

    I apologize if what I am about to say is "old hat" to you, since it is often given to newly diagnosed people on this forum.

    You did not say whether you are taking any diabetes meds. If you are, the suggestions I am about to make should only be followed with medical advice (the meds may need to be adjusted).

    A number of forum members have had great success in reducing their blood glucose levels to "normal" (non-diabetic) levels with a "low-carbohydrate" diet. (I am one of them: see signature below.)

    General information on this type of diet is here: http://www.diabetes.co.uk/diet/low-carb-diabetes-diet.html.

    A good place for food information and recipes: https://www.dietdoctor.com/low-carb.

    It is normal to be confused. By the way, the "low-carb" route is regarded with some suspicion by much of the medical community, so when you see the nurse, you may not get support for trying the diet. But it has worked really well for me, and for many others on this forum.

    Edited to add: You mentioned sugars, but the issue is actually "carbohydrates." These do include sugars, but also a vast range of common foods, even things like bread, rice, pasta, potatos, .......

    Tagging @daisy1 who will provide a useful blurb for newbies.

    Best wishes.
     
    #20 Grateful, Nov 17, 2017 at 4:12 PM
    Last edited: Nov 17, 2017
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