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What do you think about this specific sentence I read on a blog post, I want your guys opinions on this.

A

Ali Akin

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Type of diabetes
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Treatment type
I do not have diabetes
“If you do not have the genes for insulin resistance, you can not become diabetic, even if you gain weight”

What do you think about this statement. Btw this statement was made by a cardiologist, NOT an endocrinologist or anything so keep that in mind. He is a cholesterol expert. I think it’s very important to have the ability to be able to interpret information properly on the internet.
 
Ali Akin said:
If you do not have the genes for insulin resistance, you can not become diabetic
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For starters, it's only T2 and sometimes gestational diabetes that have a correlation with insulin resistance.
You can easily develop T1, MODY, LADA, steroid induced diabetes, T3C, CF related diabetes, or MIDD without being prone to insulin resistance at all.
So this statement is plain wrong unless this blogging cardiologist also made it very clear they were talking about T2 only.

Ali Akin said:
“If you do not have the genes for insulin resistance, you can not become diabetic, even if you gain weight”
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Some people get fat and never develop T2, others are of weight considered 'normal' and still develop T2.
Which to me looks like like you indeed need to have a predisposition to developing T2 or you won't get it.
However, as far as I know, there is no clear answer to which genes are responsible for this predisposition. For all I know, environmental circumstances in the womb, growing up, or as an adult may play a role as well.
 
Antje77 said:
For starters, it's only T2 and sometimes gestational diabetes that have a correlation with insulin resistance.
You can easily develop T1, MODY, LADA, steroid induced diabetes, T3C, CF related diabetes, or MIDD without being prone to insulin resistance at all.
So this statement is plain wrong unless this blogging cardiologist also made it very clear they were talking about T2 only.


Some people get fat and never develop T2, others are of weight considered 'normal' and still develop T2.
Which to me looks like like you indeed need to have a predisposition to develop diabetes.
However, as far as I know, there is no clear answer to which genes are responsible for this predisposition. For all I know, environmental circumstances in the womb, growing up, or as an adult may play a role as well.
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The poster was only talking about type 2 diabetes. However I do want to mention something. Majority of people with Obesity do have Insulin resistance but not all are type 2 diabetic. This suggests to me insulin deficiency is more important than insulin resistance in type 2 diabetes. Meaning the people who get insulin resistance and can’t compensate due to genetically impaired beta cell function are the ones that get type 2 diabetes. This is what I was thinking. Also one more thing the people of Normal Weight according to Professor Roy Taylor still have obesity in the inside, meaning they have Fatty liver AND also fatty pancreas. I don’t consider obesity to be cosmetic, true obesity is the fat in the Liver and Pancreas and also visceral fat. According to studies only about like 6 to 10% of obese people are Metabolically healthy, meaning that they don’t have any component of the Metabolic Syndrome or Syndrome X, or more accurately the “Insulin resistance syndrome”. So we can say vast majority of Obese people based on Data do indeed have IR, but only ones who can’t compensate get type 2.
 
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Ali Akin said:
The poster was only talking about type 2 diabetes. However I do want to mention something. Majority of people with Obesity do have Insulin resistance but not all are type 2 diabetic. This suggests to me insulin deficiency is more important than insulin resistance in type 2 diabetes. Meaning the people who get insulin resistance and can’t compensate due to genetically impaired beta cell function are the ones that get type 2 diabetes. This is what I was thinking. Also one more thing the people of Normal Weight according to Professor Roy Taylor still have obesity in the inside, meaning they have Fatty liver AND also fatty pancreas. I don’t consider obesity to be cosmetic, true obesity is the fat in the Liver and Pancreas and also visceral fat.
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Ali Akin said:
“If you do not have the genes for insulin resistance, you can not become diabetic, even if you gain weight”

What do you think about this statement. Btw this statement was made by a cardiologist, NOT an endocrinologist or anything so keep that in mind. He is a cholesterol expert. I think it’s very important to have the ability to be able to interpret information properly on the internet.
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It's a circular argument. What he is saying (I think) is that "if your genetic makeup will prevent you from developing diabetes, you won't develop diabetes".

There are many obese people who are not diabetic. I have a good friend who is grossly overweight and has been for thirty years, but has always had a low HbA1c. Public Health England have published figures indicating that while only 12.4 % of obese people are diabetic, 90% of T2 diabetic people are obese. That indicates to me that obesity doesn't cause diabetes, but it seems that T2 contributes to obesity.
 
Ali Akin said:
The poster was only talking about type 2 diabetes. However I do want to mention something. Majority of people with Obesity do have Insulin resistance but not all are type 2 diabetic. This suggests to me insulin deficiency is more important than insulin resistance in type 2 diabetes. Meaning the people who get insulin resistance and can’t compensate due to genetically impaired beta cell function are the ones that get type 2 diabetes. This is what I was thinking.
Click to expand...

KennyA said:
It's a circular argument. What he is saying (I think) is that "if your genetic makeup will prevent you from developing diabetes, you won't develop diabetes".

There are many obese people who are not diabetic. I have a good friend who is grossly overweight and has been for thirty years, but has always had a low HbA1c. Public Health England have published figures indicating that while only 12.4 % of obese people are diabetic, 90% of T2 diabetic people are obese. That indicates to me that obesity doesn't cause diabetes, but it seems that T2 contributes to obesity.
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Well In my Honest opinion a1c Does not tell you about Insulin resistance. Yes your friend is not diabetic even though he or she has been overweight for 30 years. But they don’t check Insulin levels in the blood. A1c being “Low” does not mean insulin resistance is absent, people fail to understand this. As I mentioned majority of Obese individuals based on studies have insulin resistance but majority don’t become diabetic, this is because they can compensate for the insulin resistance by just making more and more insulin over the years, and THIS is the thing that is actually genetically determined, not insulin resistance. Many studies have indicated this that I have read. Conversely when you tell non diabetic obese people to loose body weight their insulin Area Under The curve lowers. Dr Robert Lustig took “non diabetic” obese children with Metabolic syndrome and made them reduce fat from their liver and visceral fat, by the end of the study their Insulin Area under the curve during an oral glucose tolerance test was reduced by 25%, now what does this tell you? Have a little think about it. They made 25% less insulin during the test but their glucose values barely changed, only a little bit. But yes I totally agree with you obesity doesn’t cuase Type 2 diabetes, type 2 diabetes is caused by a Genetic inability to compensate for insulin resistance which is primarily due to excess fat in the wrong places. Btw I’m not making this up let me send studies showing very little of obese people are metabolically healthy meaning they have no components of the Metabolic syndrome which is also called Insulin Resistance syndrome.

Here’s the link:

Final Note:
Lots of people with excess weight or even normal weight may have very normal a1c but have sky high levels of insulin, I have seen this with my friends and my obese father who have Normal a1c but fasting insulin is super high. My father has a1c of 32 mmol/mol but is very insulin resistant with fasting insulin of 20 uUmol/L, and has fatty liver confirmed by Ultrasound, he is just able to make so much insulin to compensate that’s why his a1c is normal. On the Other hand we have my mother of a1c around 37.7 mmol/mol (a little higher end but still its OK) but has fasting Insulin of 7.08 uUmol/L, and theres not even a lick of fatty liver. I am a researcher of Metabolic Health Btw, this is my Hobby, I find it fascinating! Also one last thing I want to end of at, I am NOT here to judge anyone about being overweight or Obese or anything, I am just following simply what the studies say, nor do I have any intentions of Blaming anyone for obesity, Insulin resistance or Type 2 diabetes. I aware that the things I have mentioned (obesity, overweight, Type 2 diabetes, etc) are not always in peoples control, there can be a lot of genetic, environmental, hormonal factors of Obesity/overweight which are NOT always in ones control. Personally for me loosing 28kg has fully revesed my Fatty liver confirmed by a Fibroscan, ALT went down significantly, same with Trigylcerides and all other Insulin resistance biomarkers, so this is just my experience and I dont want to make it seem like this will work for everyone. But strong evidence showed it worked for me.
 
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I do see your point. Most T2 people in the UK will not have had their insulin measured at any time - it's not routinely done. Until around 25 years ago, diabetes was often differentiated into "insulin dependent diabetes mellitus" and "non-insulin dependent diabetes mellitus". It was often suggested that there was a progression from one to the other. That's all changed these days, but a lot of the old thinking is still around. Many people are still convinced that a feature of Type 2 is a net lack of insulin rather than insulin resistance associated with an excess.

I don't consider this as a hobby. For those of us with T2, it's a bit more important than that.
 
Yes Insulin levels are not routinely tested and you need to go to a private lab to get it tested, or a specialist clinic. However based on Many studies show that mean Insulin levels is Obese individuals is higher than mean insulin levels in normal weight individuals even if their a1c and fasting glucose levels were the same level. The point I’m trying to make is that if you have a genetic predisposition to not be able to compensate for insulin resistance due to excess fat stored in the wrong places, it’s important to maintain healthy weight and exercise in order to avoid insulin resistance altogether. This will make it so you never need to challenge your pancreatic endocrine beta cells and reveal their genetic weakness, it’s simple really! I think it would be good for Doctors to explain to their paitents with a Family history of T2 this exact concept I explained, as they can prevent the disease from happening as much as possible, possibly forever. Again simple point is dont Stress the Beta cells which are genetically weak, I think this concept is quite simple for paitents to keep in mind.
 
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I do agree with the general principle that you are very unlikely to develop T2 diabetes with insulin resistance alone. There has to be some issue with your pancreas’ ability to produce sufficient insulin. Whether it’s genetic , an insult on your pancreas’ beta cell mass due to an illness or simply your beta cell mass is naturally not as dense and when challenged with high carb diets or and a depleting muscle mass is not able to cope and up go your blood sugars.
My mother was obese. She was in a wheel chair due to RA. She was not diabetic. In fact her blood sugars were on the low side.
It is a complex issue. I myself have low normal c-peptides therefore very little insulin resistance, I’m thin and fit but struggle with blood sugars. Part of the problem, and this is my personal opinion, is that type 2 is far too broad and many people are diagnosed that do not fit the classic type 2 category of insulin resistant , overweight or those who have internal fatty organs and have metabolic disease.
 
Well it would be good to emphasise this further on Paitents with a family history of type 2 diabetes and explain in this way, so they really can understand. Just my opinion! Doctors can try to explain it as much as in simple terms as possible but I feel this will educate the Paitent even more so they know why specifically they are maintaining a healthy weight and exercising. Just my opinion!
 
Melgar said:
I do agree with the general principle that you are very unlikely to develop T2 diabetes with insulin resistance alone. There has to be some issue with your pancreas’ ability to produce sufficient insulin. Whether it’s genetic , an insult on your pancreas’ beta cell mass due to an illness or simply your beta cell mass is naturally not as dense and when challenged with high carb diets or and a depleting muscle mass is not able to cope and up go your blood sugars.
My mother was obese. She was in a wheel chair due to RA. She was not diabetic. In fact her blood sugars were on the low side.
It is a complex issue. I myself have low normal c-peptides therefore very little insulin resistance, I’m thin and fit but struggle with blood sugars. Part of the problem, and this is my personal opinion, is that type 2 is far too broad and many people are diagnosed that do not fit the classic type 2 category of insulin resistant , overweight or those who have internal fatty organs and have metabolic disease.
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I absolutely agree with you, type 2 diabetes is indeed extremely complex and can happen due to many reasons. In fact some studies even suggested insulin resistance is NOT a requirement for type 2 diabetes and it can simply happen only due to beta cell dysfunction without insulin resistance. This has also been show to happen in lean and fit people like yourself, who otherwise have great metabolic health (no fatty liver, no visceral fat, etc) but only problem is they can’t make enough insulin so they have elavated glucose levels in the blood. Also one more thing is many T2s are also misdiagnosed when they in fact have LADA, which is a slow destruction of the beta cells in the pancreas, can present with Low-normal c-peptide level with high blood sugars. However others don’t have LADA but genetically as I mentioned very low beta cell function, it only takes a little bit of challenging to reveal this predisposition, stress, high carb diets as you mentioned, and other factors. Btw your mother has had blood sugars on the low side because she was producing too much insulin, in a way she was overcompensating for the insulin resistance she may have had. This is seen in a lot of people with insulin resistance, also something called reactive hypoglycaemia happens where you get low blood sugars after a meal because your pancreas overshoots due to years of overproducing insulin, can’t regulate how much insulin it makes kinda.
 
@Ali Akin, I would stress that insulin resistance is by far the main driver of classic T2 coupled with a pancreas that is unable to respond to a diet high in carbs and a lifestyle that is sedentary. Then of course the liver is involved too.
 
Melgar said:
@Ali Akin, I would stress that insulin resistance is by far the main driver of classic T2 coupled with a pancreas that is unable to respond to a diet high in carbs and a lifestyle that is sedentary. Then of course the liver is involved too.
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Yes, relative insulin deficiency however is mostly required for classic type 2 diabetes to happen, as you mentioned in your first sentence to my reply. However I do want to mention even without having type 2 diabetes but having significant insulin resistance with a pancreas that is able to compensate by making a lot of insulin can still have negative health effects. It can create a viscous cycle in the liver, causing damage to the liver. High insulin levels / insulin resistance without diabetes can still cause arterial damage and contribute to cardiovascular disease. It is known that insulin resistance without diabetes is a risk factor for development of cardiovascular diseases, based on studies. Also it can cause damage to the kidneys also, Dr Robert Lustig has mentioned in a video of his that obese individuals with normal glucose tolerance who have insulin resistance and sky high insulin levels were spilling protein into their urine. This means they had kidney damage, spilling protein into urine is NOT normal. Also I do want to mention there are a lot more people who are insulin resistant than we think who don’t have diabetes or prediabetes, even many many normal weight individuals. This is because those people who look skinny may have fat in their organs and visceral fat which causes insulin resistance to occur, so really it’s very nuanced. Insulin resistance is not something limited to only obese people, anyone can get it, it just matters where you have the fat stored. Also It’s quite uncommon but you can be obese and be metabolically healthy because you have the ability to store fat only under the skin where it safe, instead of inside the organs, again this is mostly genetically determined I have to say, although not always, sumo wrestlers do this by hard exercise. Really I am so fascinated by the complexity of all these topics, and love to consider things from all types of angles.
 
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Ali Akin said:
factors. Btw your mother has had blood sugars on the low side because she was producing too much insulin, in a way she was overcompensating for the insulin resistance she may have had. This is seen in a lot of people with insulin resistance, also something called reactive hypoglycaemia happens where you get low blood sugars after a meal because your pancreas overshoots due to years of overproducing insulin, can’t regulate how much insulin it makes kinda.
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Actually no @Ali Akin my mother took phenobarbital she suffered from epilepsy. It actually increases insulin sensitivity, it acts on the insulin receptors.
 
Melgar said:
Actually no @Ali Akin my mother took phenobarbital she suffered from epilepsy. It actually increases insulin sensitivity, it acts on the insulin receptors.
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Oh wow that’s very interesting, that’s why she has blood sugar on the lower side I presume. Never knew a medication could do something like this, you learn something new everyday!
 
You started by saying, that insulin resistance might be the driver for T2 diabetes.
In my research of my condition I came across multiple different causes of T2.
Insulin resistance is just one. But one of the basic tenets of metabolic conditions are inflammation.
Many T2s have hyperglycaemia, hyperinsulinoma.And very high level of circulating insulin.
And you have missed in all your posts, that for the majority of T2s, it isn't obsity, it isn't the genes, it isn't the lifestyle. It is food.
The numbers of people effected by food allergies, intolerance, eating disorders, hormonal imbalance, even some organ and glandular conditions are a direct result of the food we have. The latest figures is somewhere between 15% and 20%. That is a staggering number.

I have a hypoglycaemic condition, of which there are many types, though rare, it is fascinating that you are not taught about just how bad it is.
And from a different perspective.
It is always different when you have a condition that your doctors especially GP's, don't understand, or know how to treat.
Eat healthy carbs, I kept getting told.
Well, it was healthy carbs that was putting me in hospital and if I followed their advice, would definitely not be here now.
Some just can't get the science why it happens.
"You cannot not eat carbs, you need continuous glucose for good brain function"
I proved that to be total BS.
I now eat very little, I feel better not eating. I only use fresh food for nutritional value.
And I wouldn't touch anything that is factory fodder, it is full of....!

Advice.......
Always look at the individual, their journey and symptoms, test, test and keep testing.
And if you believe it could be insulin resistance or T2 or the majority of metabolic imbalance conditions, hormonal imbalance etc. Check insulin levels as well as hba1c. You will find a different approach, an individual approach to that patient.
A tailored diet is far better than any or all medical thinking at this time.
Have an open mind.
 
Lamont D said:
You started by saying, that insulin resistance might be the driver for T2 diabetes.
In my research of my condition I came across multiple different causes of T2.
Insulin resistance is just one. But one of the basic tenets of metabolic conditions are inflammation.
Many T2s have hyperglycaemia, hyperinsulinoma.And very high level of circulating insulin.
And you have missed in all your posts, that for the majority of T2s, it isn't obsity, it isn't the genes, it isn't the lifestyle. It is food.
The numbers of people effected by food allergies, intolerance, eating disorders, hormonal imbalance, even some organ and glandular conditions are a direct result of the food we have. The latest figures is somewhere between 15% and 20%. That is a staggering number.

I have a hypoglycaemic condition, of which there are many types, though rare, it is fascinating that you are not taught about just how bad it is.
And from a different perspective.
It is always different when you have a condition that your doctors especially GP's, don't understand, or know how to treat.
Eat healthy carbs, I kept getting told.
Well, it was healthy carbs that was putting me in hospital and if I followed their advice, would definitely not be here now.
Some just can't get the science why it happens.
"You cannot not eat carbs, you need continuous glucose for good brain function"
I proved that to be total BS.
I now eat very little, I feel better not eating. I only use fresh food for nutritional value.
And I wouldn't touch anything that is factory fodder, it is full of....!

Advice.......
Always look at the individual, their journey and symptoms, test, test and keep testing.
And if you believe it could be insulin resistance or T2 or the majority of metabolic imbalance conditions, hormonal imbalance etc. Check insulin levels as well as hba1c. You will find a different approach, an individual approach to that patient.
A tailored diet is far better than any or all medical thinking at this time.
Have an open mind.
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Yeah I totally agree the food we eat is largely driving all our chronic diseases. And yes inflammation is something that really can cause lots of disease, and this inflammation is largely due to our lifestyle and the foods we consume. Personally I make all my foods at home and don’t eat outside very much, only about once a week. There’s a saying called “all disease begins in the gut”, personally I like this saying! Btw I’m not a doctor lol Im an 18 year old boy who is interested in Metabolic health and I do research on these topics. I also do a lot to optimise my own health and pay careful attention, cuz I think a healthy lifestyle is a happy life!
 
Ali Akin said:
Yeah I totally agree the food we eat is largely driving all our chronic diseases. And yes inflammation is something that really can cause lots of disease, and this inflammation is largely due to our lifestyle and the foods we consume. Personally I make all my foods at home and don’t eat outside very much, only about once a week. There’s a saying called “all disease begins in the gut”, personally I like this saying! Btw I’m not a doctor lol Im an 18 year old boy who is interested in Metabolic health and I do research on these topics. I also do a lot to optimise my own health and pay careful attention, cuz I think a healthy lifestyle is a happy life!
Click to expand...
As I said through my experience and my research for my condition. The gut is as important, as what we put in in it. The bacterial make up of each individual, is in the trillions of different bacteria. Good and bad.
I believe that my condition, the root cause was food which in turn became an infection in my gut.
Helicobactor pylori. Was found.
And my intolerance to certain foods is part of my diagnosis.
And for years, what was presented as stomach ulcers, turned out to be an infection.
And anti biotics did work but a few years later after so much struggling with my body, just being so unwell, I got to see an endocrinologist. He did through diagnostic testing get to a true diagnosis.
Endocrinology covers a lot of diverse conditions, a lot that is still not known.
In fact, my endocrinologist told me, that if I had presented myself to his mentor. I would not have got the tests for my condition, as his mentor would not have recognised that it existed.
hypoglycaemia in non diabetic people, is still very rare, but that is because of the specialty of having to understand the condition. There isn't many specialists that specialises in non diabetic hypoglycaemia or other unusual rare similar conditions. And even though, they occasionally, do see the symptoms, and diagnose it, the treatment is similar to other metabolic conditions. And wrong!
keep an open mind.
 
Lamont D said:
As I said through my experience and my research for my condition. The gut is as important, as what we put in in it. The bacterial make up of each individual, is in the trillions of different bacteria. Good and bad.
I believe that my condition, the root cause was food which in turn became an infection in my gut.
Helicobactor pylori. Was found.
And my intolerance to certain foods is part of my diagnosis.
And for years, what was presented as stomach ulcers, turned out to be an infection.
And anti biotics did work but a few years later after so much struggling with my body, just being so unwell, I got to see an endocrinologist. He did through diagnostic testing get to a true diagnosis.
Endocrinology covers a lot of diverse conditions, a lot that is still not known.
In fact, my endocrinologist told me, that if I had presented myself to his mentor. I would not have got the tests for my condition, as his mentor would not have recognised that it existed.
hypoglycaemia in non diabetic people, is still very rare, but that is because of the specialty of having to understand the condition. There isn't many specialists that specialises in non diabetic hypoglycaemia or other unusual rare similar conditions. And even though, they occasionally, do see the symptoms, and diagnose it, the treatment is similar to other metabolic conditions. And wrong!
keep an open mind.
Click to expand...
Wow very interesting condition you have, never heard of this kind of reactive non diabetic hypoglycaemia. I agree the gut is very important and people don’t pay much attention to it.
 
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