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TOFI - who else is?

Discussion in 'Diabetes Discussions' started by Tophat1900, Mar 2, 2020.

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  1. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    As the title asks, who else is a TOFI (Thin on the outside, fat on the inside) ?

    It seems to me this is an important distinction.... you develop a diabetic condition much quicker and it takes longer to reverse in general for those who pursue LC/KETO or Carnivore lifestyles. It can also result in quite possibly going undiagnosed for a good length of time.

    I think once I knew I was a TOFI, body weight and being very lean no longer had to be a major focus in my eyes. Doctors seemed fixated with weight and a number on a scale and pushed to try and get me to gain weight as though it would be just as easy for me as it would be for anyone else who could gain weight without much effort. It just doesn't really work that way and the practices of eat more bread and potatoes was often the advice from dieticians. Which I had no intentions of following after working hard to get numbers in a decent range for me.

    So, who else is a TOFI on here? Thoughts on being a TOFI you've noticed?
     
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  2. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Whilst I'm not doubting your assertion. I have zero reason to do that, but how was your TOFI status evaluated? Did you have a mid-section scan, or a body composition Dexa, or even a decent body composition scale assessment?

    I'm just a bit concerned that not all slimmer T2s are necessarily TOFI, it is feasible that for whatever reason they are insulin deficient T2s.
     
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  3. Indy51

    Indy51 Type 2 · Expert

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    I've come to the conclusion that I might fit into the insulin deficient category, though of course it's hard to be sure. I do have a genetic SNP (apparently a quite common one) that decreases first phase insulin by 19% as follows:

    rs13266634(C;C) - increased risk for type-2 diabetes - rs13266634 is a SNP in the zinc transporter protein member 8 SLC30A8 gene that has primarily been associated with type-2 diabetes in several studies. This SNP is also known as the Arg325Trp or R325W variant; the (C) allele encodes the arginine (R), and the (T) allele encodes the tryptophan (W). significantly associated p = 0.0073; in 1,630 Japanese subjects with type-2 diabetes and in 1,064 controls. The major alleles of the SLC30A8 SNP rs13266634 and the HHEX SNP rs7923837 associate with reduced insulin secretion, but not with insulin resistance. 46% of European non-diabetic offspring of type-2 diabetes patients are rs13266634(C;C) homozygotes; they are diabetes-prone and characterised by a 19% decrease in first-phase insulin release following an intravenous glucose load.

    It might explain my situation and why I still have post-prandial highs if I go above around 30g carbs in any one meal. I still get normal A1c readings and have done so since losing weight after initial diagnosis. I had a history of getting a pre-diabetic diagnosis every time I quit smoking and put on around 20kgs - happened 3 times in all until finally getting diagnosed as Type 2. I also have an ultrasound showing fatty liver and pancreas about the same time.

    I've had scans since losing the excess weight that show no evidence of fatty liver or pancreas, yet I still don't manage normal post-prandial responses to carbs, even if I'm eating higher carbs for several weeks. I'm about a week away from my 8 year diaversary and presumably all/most of the cells in my body have turned over since diagnosis, yet nothing's really changed. It's one of the many reasons I don't consider myself reversed, in remission or any of those other descriptors. I'm currently at my lightest weight since diagnosis and eating more carbs, but would never feel comfortable going back to the levels of carbs I used to eat pre-diagnosis. I don't plan to ever call myself anything other than 'well controlled by diet'.
     
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  4. surdoux

    surdoux Type 2 · Well-Known Member

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    To be honest, I think I'm a FOFI (Fat on the outside, fat on the inside), but I'm working on it.
     
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  5. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    I'm not suggesting that all t2's are tofi, just curious as to who is or thinks they may be.

    I have a yearly appt with my liver specialist in a few days, I'll see what info I can gather in regards to the recent scans I had done. Liver ultra sound.

    I am insulin deficient these days, been a gradual slide into that state.
     
  6. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    I've not had specific tests, but pretty sure I am/was TOFI. Not only because of my slimness and weight, but because my GP (plus Government & Media) had pushed me onto a very high carb low fat way of eating for over 10years before my HbA1C finally pushed over into the Diabetic range. Had I been Insulin deficient it would have happened much sooner and I would 'd have just popped over the line, I would have exploded over the line!
     
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  7. Rustytypin

    Rustytypin Prediabetes · Well-Known Member

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    As far as I know I have only briefly been in the overweight category (for a few months about 6 years ago). Most of my life I have been quite slim. Four years ago I was diagnosed as "Glucose intolerant". Since then I have one HbA1c in the prediabetic range.
    Eating Keto for at least 18 months, carbs daily 20-25gm.
    I have been testing my BGs regularly. my current 30 day average before evening meal reading is 5.1 mmol, after meal (2hr) is 5.2. However, my average 30 day fasting is 6.5. This is bugging me as I have tried all-sorts to get this down. This has been the pattern for nearly four years. Of course I have no way of knowing if I have always had a high fasting level, it may be that some people just do. That could only be found out if everybody was tested on a regular basis throughout their lives. Can't see that happening. Two of my siblings are also flirting with higher BGs, although not Diabetic.
    It seems to me that TOFIs have greater difficulty with the fasting levels than someone who maybe started off with an A1c much higher and/or with a higher weight. Some of the results reported on here are quite phenomenal with A1cs plummeting from the 100s down to the 30s in a short space of time.
     
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  8. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Not all T1s in adulthood happens quickly. Indeed there are some on here, initially diagnosed as T2 who do OK fora number of years; particularly if they adopt a restricted carb way of eating, before they need to turn to insulin.

    In fact, one such member, Ian DP has written about his journey fairly regularly.

    As my End said to me, as his parting shot, from one appointment, "Be mindful of signs and symptoms of LADA. That's one sneaky devil."

    So far, so good, but who knows what the future holds.
     
  9. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    Quite true, and it is in the back of my mind. Something I am on guard against.
     
  10. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    A quick update.

    Attended my liver appointment yesterday. I asked several times about fat in the liver, all I could get was "there is a little bit there", whatever that means. Obviously beats hearing there is a lot there. This is based on a previous scan however, not the most recent one which they couldn't for whatever reason pull up. They had asked for it to be faxed while I was there, but didn't happen. A copy of the report went to my GP and to the liver clinic, not sure why the liver clinic had to ask for one when they should of had the result.

    I will see my gp soon and see what it says there. The clinic specialist said they'd call if there were any issues with the result. Otherwise, blood work is stable on liver function and there is no progression of disease. I have NASH, so that was obviously really good to hear, but again that is based on the previous scan. So, hoping nothing has changed in 6 months since the previous. I doubt there would be much in the way of change.

    I could credit low carb/keto with the no progression, but I cannot prove it. And that's life!
     
  11. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Thanks for the update Tophat. As people living with diabetes, and I know you have some other very significant conditions in play, I think (and hope) we all appreciate the additional "routine" checks we receive, but there's little doubt that whilst "routine", they do raise our tension levels a bit, leading up to and afterwards.

    Fingers crossed all is well.
     
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