Thin and Type 2: Non-Obese Risk Factors for Developing Diabetes

Emily got quite a surprise when she went for her annual physical exam. The lab tests taken showed that her blood glucose readings were in the range of someone with type 2 diabetes. Since Emily did not fit the usual appearance of someone with type 2 diabetes, her doctor ran the test again and checked for antibodies to insulin and her c-peptide levels, in case Emily was in the early stages of LADA (a slow moving version of type 1 diabetes). The test results were the same, however.

Even though Emily, at 5 feet 2 inches and 115 pounds, had never been overweight in her life, she had type 2 diabetes. Emily was one of the 15 percent of individuals in the United States who develop type 2 diabetes even though their BMIs are squarely in the normal range (between 18.5 and 24.9).

There can be a number of factors that come into play when a thin person develops type 2 diabetes. Genetics play a significant role in determining disease onset. A strong family history coupled with a sedentary lifestyle and poor eating habits can tip the scales in the wrong direction. So too can a previous diagnosis of gestational diabetes or the birth of a baby greater than nine pounds.

Unfortunately for these individuals, their outside appearance is hiding a metabolic profile similar to overweight people who have type 2 diabetes. They are insulin resistant not from excess pounds per say, but from the places where some of their fat cells are stored, and often from a lack of exercise.

Many normal weight people with type 2 diabetes have excess visceral fat.  Visceral fat is the type of fat surrounding the body’s abdominal organs and is highly metabolically active, producing a variety of hormones that influence glucose and fat metabolism.  Fat cells release fatty acids into the blood stream that can damage the muscle cell’s ability to properly attach to insulin causing resistance, as well as affecting the glucose output of the liver.

One way to see if you tend to carry this type of visceral weight is to measure your waist, then measure your hips, and divide your waist measurement by your hips measurement. If your resulting number is .8 or above, you likely have more visceral fat and you may be at increased risk of developing type 2 diabetes even if you never had a problem with weight control.

“Even though you may not have any obvious risk factors for type 2 diabetes, your primary care doctor should do a screening blood sugar and A1c every year,” says Elizabeth Halprin, MD, Associate Director Adult Diabetes at Joslin Diabetes Center.

Weight loss is obviously not the treatment in this case, but exercise and healthful eating certainly is. Aerobic exercise and especially strength training are two import lifestyle measurers that can keep blood glucose in control and help avoid complications down the line. The more muscle you have the greater your uptake of glucose into the cells, where it belongs.

Choosing low-glycemic index carbohydrates such as legumes, fruits and vegetables and limiting added sugars and fats cab help, also. The heart-health benefits of this style of eating are important in people who are thin with type 2 diabetes because some studies have shown that those who develop type 2 diabetes despite being of normal weight have an increased risk of heart disease in excess of those obese people with type 2 diabetes.  The diagnosis may not seem fair, but there are things you can do to control your diabetes and live a long life.

Do you need help managing your diabetes? Learn more about the Adult Clinic at Joslin Diabetes Center


  1. I quit 80 miligrams of methadone cold turkey at 22 years old (I’m 31 now). Withdrawal made me crave sugar plenty. so I had a steady intake of carb-full meals/snacks. month later, I woke up in the ICU being told I’ve been in a coma for 3 days post- sub arachnoid hemmorhage and am now a late onset juvenile diabetic. Thing is though, MY QUESTION: 9 years later I still get away with just using a mathematically produced intake of coverage (Novolog) insulin, no lantus. I’ve maintained a 6.5 A1C despite the fact IAM ADDICTED to drugs (recently got off methadone). I don’t have a problem keeping BGL under control. I’ve read stories of type one they have a hard time maintaining with I LANTUS AND COVERAGE. I don’t remember if they did, but i would think they would in such a situation do all tests required to confirm type 1. I think iam the SELDOM case of a person very thin with type 2 nevertheless.Any opinion appreciated? has paperwork from my hospital stay. Thanks.

    • Late onset juvenile diabetes (type 1) or are you type 2 and confusing them? You don’t often see numbers above 7 in type 2. In type 1, being an auto immune disease and based on how long you’ve had it, numbers are usually above 7.5 I’m not sure I understand your question but Novolog is a fast acting insulin. It immediately responds to your food intake and metabolizes quickly. Lantus acts slowly and lasts 12-16 hours. If you are on the proper diet this can be effective, it’s not often used in type 1 diabetics who don’t produce any insulin. Nonvolog acts more like the pancreas in that when we eat it shoots out insulin. Lantus works with the pancreas in that if you are still producing SOME insulin when you are fasting it helps the liver utilize stored glucose, the Lantus will stay steady and the pancreas can supplement when you eat. It’s not uncommon to be thin and a type 1. Weight and drug use doesn’t effect an autoimmune disease. My mother and brother are Type 1, thin as hell and both were avid alcoholics and drug abusers well after diagnoses. If you were using up to the time of your coma it’s likely that you were not aware of the changes in your body that tell you something is wrong. Unless you are a child, it’s hard to ignore the symptoms of type 1 long. Your blood sugar would have to be above or below a certain amount to induce a coma. It takes months for autoimmune diabetes and sometimes years for Type 2 to cause noticeable symptoms. You would be very sick prior to that coma happening.

  2. In the article above, Thin and Type II, it says Emily’s blood glucose readings were in the range for Type II vs Type I diabetes. How do these ranges differ? My father and brother both have been diagnosed as having Type II and both are 5 ft 10 inches tall. My father weighs 123 lbs and my brother 154. I have had gestational diabetes and my C-peptide was tested and came back at .79. No antibody testing was done on any of us.

    • I was orignally diagnosed as having Type II diabetes . I am thin and tall. I had gestationsl diabetes with my twins so it was assumed that I wa type II. whn my A1C result was 6.2 After e ach medicatin failure, another oral medication was added to help mange my blood glucose, un itl I wason thrree differnt oral medicaitons . I am a nurse and was checking my Bllod sugars before and after meals and blood sugars weer still ranging in 300’s after meals . Fter 6 months, I suddenly lost 20 lbs over 10 days.I called my endocrnilogist. I was then tested for antibodies and c peptide level was checked.I was started immedialty on insulin injections basal /bolus regimen. To my suprise, my antiboides were posotive fro islet cells antiboides and I had a below normal c petide. IN your article, you called this person a type II. My endocrnilogist explained to me that t I am type I due to the autoimmune component. She refered to it as proablby LADA but said it is type I . I am now on an insulin pump and CGM. Canyou explain why you stated person descrbied was type II

  3. About 10% of children who are diagnosed with Type 1 diabetes are autoantibody negative, yet they are still diagnosed with Type 1. Just because an adult who is phenotypic Type 1 is autoantibody negative does not mean the person has Type 2 diabetes, it probably means we have not discovered all of the autoantibodies, or that the person has monogenic diabetes. Misdiagnosis has terrible consequences. “Thin Type 2” is extraordinarily rare or nonexistant.

  4. I am 5″8 and weight between 103 and 105. I live on a plant based diet and exercise almost everyday. I hike and do yoga. My recent blood work showed my blood sugar 6.1. I will be re-tested. I am border line diabetic. How did this happen? What does this mean? Susan Rubin

    • I would think ,if not do to your genetics make up because just as in nature, there all always exceptions to the rule.. You may not get enough protein in your diet and could need to do more weight resistance training above yoga..

    • There are lot of reasons for insuline resistent. One of the reason is fructose . Fructose goes in liver and insuline deposit it as fat these fat cells, interfere insuline to work properly, they block to give signal. So all fruit juice be avoided and honey , fructose corn syrup be avoided. Glucose cells can utilized but fructose becomes fat

  5. I am 80 yeas old and have been diagnosed with type2 diabetes.. I weigh 98 pounds and am 4′ 11″ tall. I have never weighed more and only gained 10 lbs. with each pregnancy. I have always been a small eater, but always health. I play golf, weather permitting 4 times a week and do Pilates weekly.. I am very confused regarding diet. I like potatoes ,rice and pasta, but only eat small amounts. Have you any advice regarding diet?

  6. Just dxd prediabetic..tested low on fructosamine test.
    I’m not overweight…swim 2x/wk..i try To walk when i can’t swim.
    Truly confused as to how to eat…Quitting carbs really hard

  7. I’m wondering if there is a well described syndrome of thin diabetics who are not LADA. This profile would be of someone who has a normal to thin body habitus, eschews a heavy carbohydrate diet and has significant skeletal muscle mass, does weightlifting or signficant exercise but also lacks demonstrated auto-antibodies. They also have a low triglyceride to HDL ratio, suggesting they are not insulin resistant. Are these people Leptin resistant? Do they have fewer Beta cell islets? What do the researchers at the Joslin think?

    • Not sure about your question. Latent autoimmune diabetes of adults (LADA) is considered a form of type 1 that occurs in adulthood, often with a slower course of onset than type 1 diabetes diagnosed in juveniles. Adults with LADA may initially be diagnosed incorrectly as having type 2 diabetes based on their age, particularly if they have risk factors for type 2 diabetes such as a strong family history or obesity.

  8. Thank you for the opportunity to ask a very important question:

    I am a woman of 63 and have had diabetes for 20+ years. In fact it was at your clinic that I was officially diagnosed. I have never needed or used medications of any type during this time, I controlled my sugars by a healthy diet and sporadic exercise (I’m sorry to admit-much more active now). Early on, I developed diabetic nueropathy in both feet and required massive amounts of narcotics, drugged year after year. Until about a year ago, I am off most narcotics I am happy to say. Most of those years, I lived between 7-10+ on the pain scale. This year it is 6-10+, a huge move for me. I was host to years of extremely deep infections in my left heel. Medications, wound care, hyperbaric chamber dives (250+) were used most of the time without any wound closure throughout the years. Last February, I lost my left leg due to this long-standing problem.

    But, my sugar numbers for first thing in the morning, has been in the current range of 60-95. Numbers throughout the days usually remain low too, In fact, my ACI for the past several years has been 5.4-5.6, My primary care doctor has “taken me off being diabetic,” because, if she continued to call me diabetic, “she would be lying.” Does this actually happen? Can I go from being diabetic for years and then not any longer? I have obtained diabetic shoes for years, now I’m not sure Medicare will pay any longer. What about the meds for pain as I still have nueropathy – in both feet (phantom). I have a prosthesis buy it is for surgery that was “for being diabetic and related wounds…” Could someone provide direction for me? Am I now not diabetic?

    Many, many thanks,

    Patsy L. Lorentzen
    12 South Fuchsia Dr
    Rochester, NH

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