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

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

  1. Chesie says:

    What can you say is the cause of and existing gluconeogenesis with an increase in fatty acid content.

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