Even a thin person can get diabetes

1st June 2008

Even a thin person can get diabetes

Jeff O’Connell writes for Men’s Health magazine and is the co-writer of at least four books on sports nutrition and fitness. A self described “thin” guy, O’Connell’s even been made the butt of skinny-guy wisecracks in school. All of which makes his diagnosis of type-2 diabetes all that more perplexing. After all, don’t only fat people develop the disease?

Medical misunderstandings about diabetes abound, even by those whom we trust to have an accurate grasp on the disease. In a Men’s Health story reprinted on MSNBC.com, O’Connell writes:

I’m 6′6” and weigh 220, with 12 percent body fat and the outline of abs above a 32-inch waist. Yet diabetes has me in its crosshairs as well. If you think being thin gives you a free pass from this deadly disease, well, it may have a surprise in store for you, too.

Many physicians really don’t have a clue about preventing type-2 diabetes in someone thin like me. What’s more, the typical advice offered makes you wonder if Americans are being given an antidote against or a prescription for the disease.

After receiving a diagnosis of prediabetes, O’Connell embarked on a stringent low-carb diet approach and vigorous six-day workout schedule and while he lowered his blood sugar, his doctors still expressed concern. They later diagnosed him with reactive hypoglycemia, a relatively obscure and difficult-to-detect condition O’Connell describes as “diabetes’s most brilliant disguise of all.” As he explains:

Your body does whatever’s necessary to protect your brain, and that includes breaking down muscle tissue so that it can be converted to glucose… Because our insulin resistance results in frequent periods of low blood sugar, our bodies spend a good chunk of the day eating our own muscle.

As a result, we stay thin instead of gaining weight, as is often the case for people with insulin resistance and type-2 diabetes. In fact, insulin resistance is typically thought to cause weight gain, and vice versa. All of which makes the “thin man’s diabetes” that much more perplexing. “If you look at distributions of large numbers of people, it’s striking that not only do the overweight tend to be insulin resistant, but 10 percent to 15 percent of non-obese people are, as well,” says Donald W. Bowden, Ph.D., director of the center for diabetes research at Wake Forest University school of medicine. Clearly, no one should assume he’s immune to this disease.

Reactive hypoglycemia isn’t widely recognized amongst the diabetes organizations he contacted, writes O’Connell. But according to Dr. Keith Berkowitz, a New York medical director who specializes in treating patients with serious blood-sugar irregularities, it’s a “huge problem,” one that he says, if left untreated, will eventually and without a doubt, lead to a diagnosis of diabetes.

O’Connell now seems to be doing well in managing his disease, but his story illustrates the price we pay when we exaggerate and over-dramatize the tenuous influence of obesity in type-2 diabetes. O’Connell’s grandfather, also a thin man, died from type-2 diabetes. His estranged father, once a formidable 6′3″, 215-pound basketball star, is now a cadaverous-looking 145-pound amputee, who, because his weight placed him beyond suspect of the disease, will also likely die from type-2 diabetes.

As O’Connell’s article reveals, diet and exercise do play a pivotal role in prevention and management of diabetes, but as his experiences also show, genetics and heredity also play equally pivotal forces. In gauging our likelihood to develop diabetes, perhaps a better litmus would be to look more at our dietary choices and our family tree, rather than our scales.

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This entry was posted on Sunday, June 1st, 2008 at 12:23 pm and is filed under Fat Bias, Health/Nutrition. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

1 On June 1st, 2008, Rene

said:

Lordie, Men’s Health is such a messed up source for anything resembling good medical information. There is no such thing as prediabetes and those with it are no more or less likely to go on to develop diabetes. Their article read like another in the current low-carb marketing campaign.

But fat doesn’t cause diabetes. And, having managed adult diabetic patients, those who are fat have far fewer diabetes-related complications than the thinner ones.

posted on June 1st, 2008 at 2:19 pm

2 On June 1st, 2008, peggynature

So sad that so many people might go undiagnosed for such a serious illness because of their weight. But interesting how fat hatred cuts both ways, eh? Yet more proof that it harms more than just the fat people.

One thing though confuses me with this concept of reactive hypoglycemia — why would insulin resistance result in low blood sugar? I always understood that insulin resistance resulsted in high blood sugar, but since the sugar was not making its way into the cells, that was the reason the body catabolized its own muscle for glucose. Are there any good articles you found on reactive hypoglycemia while writing this? I work in a diabetes clinic, but I’m only just starting to learn about this stuff.

posted on June 1st, 2008 at 4:25 pm

3 On June 1st, 2008, Kimu

This article inspired my brother-in-law (who is thin but has a family history of diabetes) to start paying attention, and he also discovered that his fasting blood sugar is elevated and that his oral glucose tolerance test results are out of normal range. So I have to thank Jeff O’Connell for that, even if the article was not all that I would hope for on the topic.

posted on June 1st, 2008 at 5:29 pm

4 On June 1st, 2008, Meowser

Peggynature, I have PCOS and frequently have low blood sugar. My understanding is that it’s common in the early stages of insulin resistance to have lowered blood sugar because you’re pumping out so much insulin, but once your pancreas starts crapping out on you from overuse then blood sugars start to creep up. That is why women with PCOS are often given metformin/Glucophage, in order to prevent that from happening.

posted on June 1st, 2008 at 5:34 pm

5 On June 1st, 2008, Rachel

Peggynature: I didn’t do outside research on this post, and so I’ll just refer to what O’Connell writes in the piece. And according to him, it sounds as if there’s a dearth of literature on the subject. O’Connell writes that high and low blood sugar are two sides of the same insulin resistance, but adds that most diabetes orgs he contacted don’t even think about the low side where type-2 diabetes is concerned. He also adds that the CDC acknowledges reactive hypoglycemia, but has no data for it amongst men in the U.S. with diabetes. The anonymous CDC spokesman quoted by O’Connell said this: “No data provide sufficient evidence that reactive hypoglycemic leads to diabetes.”

So, I don’t know if it’s a case of data not supporting the claims, or the fact that there exists little to no data on the subject itself.

posted on June 1st, 2008 at 5:56 pm

6 On June 1st, 2008, MrsDrC

“…a free pass from this deadly disease…” For some reason this bothers me. Diabetes is NOT a death sentence. Now Mr. O’Connell has great reason to fear as his Grandfather had died, and it looks like his Father just might die of the disease. Diabetes is nothing to take lightly, but it’s also not full blown AIDS. I dunno, I’m not the one with the diagnosis, maybe I’m being harsh. Frankly the idea that I’ll be told this some day scares the daylights out of me. My Mom was diagnosed around 50 yrs old. She’s now in her early 80’s and getting by…she does not manage her disease well IMO. While it scares me, it doesnt scare me to death.

I’m really glad this is getting some attention. Type II is not a fat person’s disease and I hope this story gets noticed.

posted on June 1st, 2008 at 6:54 pm

7 On June 1st, 2008, Jordana

A diagnosis of type 2 diabetes usually comes along after years of blood sugar instability, as the pancreas becomes less able to regulate, as Meowser points out. “Prediabetes,” or reactive hypoglycemia, can be determined by a glucose tolerance test (long version, preferably).

posted on June 1st, 2008 at 8:59 pm

8 On June 2nd, 2008, wellroundedtype2

That article make me want to say “ARGH.” Some good information, but ARGH. The part about taking pills for diabetes being the “easy way out” — he clearly has never taken metformin, which has some nasty side effects but is the first medication prescribed to most people with diabetes. And people who take diabetes medications aren’t addicted to them, they are doing the best they can to avoid complications and are to be commended for taking care of their health, not labeled as lazy. People can and do go off of diabetes medications, or reduce the amount of medication, although because of the progressive nature of the disease, most people end up needing more, not less. This is not a weakness.

One thing that’s interesting to me is the idea that the OGTT is a 75-gram glucose test, but many people regularly eat 75 grams of carbohydrates per meal (glucose and carbs are not identical, by any means, and fiber and other things eaten at the same time have an impact on how quickly and how much sugar enters the blood stream). Or, how many people drink two regular sodas back to back, and yet, don’t have hypoglycemia afterwards? There’s a strong genetic component to diabetes, but the author of the article has a strong need to see it as something he (and by extension others) can control.

Diabetes varies from person to person, some people find it much easier to control than others do.

posted on June 2nd, 2008 at 1:05 am

9 On June 2nd, 2008, MrsDrC

Wellroundedtype2, That is an excellent post thank you!

posted on June 2nd, 2008 at 10:29 am

10 On June 3rd, 2008, Andrea

Thin people can get diabetes. Anyone who is genetically predisposed to get diabetes has more risk of developing the disease. However, 80-90% of Non Insulin Dependant T2 Diabetics are obese. So while thin people can develop diabetes it is far more common for an obese person to develop it. Please read the following extract by Dr. Thomas M.Walter, M.D (http://en.allexperts.com/q/Endocrinology-including-Diabetes-968/diabetes-diet-thin-people.htm)

“Many maturity onset diabetics (M.O.D - Type 2 diabetes - Non Insulin Dependant Diabetes Mellitus) are obese. Epidemiological studies of NIDDM provide evidence that over-eating, especially when combined with obesity and under activity, is associated with the development of NIDDM.

Obesity is the major risk factor for diabetes. 80-90% of NIDDM patients are obese. Insulin resistance is a pervasive feature of obesity. Insulin resistance is more strongly linked to intra – abdominal fat then to fat in fat depots.

Obesity probably acts as a diabeto-genic factor (through increasing resistance to the action of insulin) in those genetically pre-disposed to develop type 2 diabetes. In obese patients adipocytes sensate a number of biologic products (leptin etc ) that modulate processes such as insulin secretion and its action.

The definition of the genetic abnormality of type 2 dm remains a challenge because the genetic defect is insulin secretion (or) action may not manifest itself unless an environmental event or another genetic defece such as obesity is superimposed. Insulin resistance associated with obesity augments the genetically determined insulin resistance of type 2 DM.

The normal BMI is 18.5 to 24.9. For lean patients with NIDDM, caloric intake should be adequate to maintain body weight.

Weight maintenance diets for individuals with a normal body mass index should be high in carbohydrate and low in fat. As diabetes is a risk factor for macro vascular disease, the intake of fat should be restricted to 30 – 35 % of energy”

posted on June 3rd, 2008 at 4:22 am

11 On June 3rd, 2008, Andrea

If you know you are eating unhealthy or are sedentary, obese, or have genetically pre-disposition of developing diabetes please get tested! It could save your life! Especially if you are genetically pre-disposed, get tested. Diabetes can go on for years before it starts presenting any symptoms and at that time it means that it is too late. High levels of insulin in the blood are extremely toxic so please do not just wait to see until you get the symptoms, a glucose tollerance test takes approximately 2 hours and it only takes an overnight fast.

Diabetes can be managed but if it can be prevented why wait??

Anyway, I hope this helps.

posted on June 3rd, 2008 at 4:29 am

12 On June 3rd, 2008, Jackie

It is true! Someone who worked for my dad at one time, was thin as a rail. He had the kind of Diabetes where you had to inject insulin into yourself. So it wasn’t even like he had the mild form of Diabetes.

posted on June 3rd, 2008 at 8:49 pm

13 On June 6th, 2008, forever_dreamer21

In high school there were two kids in my class who were quite thin and were taking insulin for diabetes so yes it does affect even thin people. It’s sad but it’s true and it’s a shame that people only tend to focus on and harass overweight people who are quite healthy while people who are thin with diabetes are dying without the needed medical attention.

posted on June 6th, 2008 at 12:05 am

14 On July 27th, 2008, Sara Stone

I don’t believe a glucose tolerance test will pick up diabetes for the first 10 years or so. However, if you tested for high levels of insulin, that would work.
My understanding is that your body produces more insulin to cope with the fact that you are insulin resistant. You don’t actually “get” diabetes until your pancreas starts to ” burn out” AND then your glucose levels rise. Until that time your glucose levels are normal.
I’ve also been told that EVERYONE who is “overweight” is hyperinsulemic. Apparently some people’s pancreas’ don’t burn out and they are able to keep producing enough insulin to keep the glucose levels down. However, they gain weight instead and they are hyperinsulemic.
So if high insulin levels are toxic, what does the medical establishment do??? They give you MORE insulin thus contributing to your increasing your weight! Apparently they think high glucose is MORE TOXIC than high insulin.
The only defense they have against high insulin is metformin (which helps you utilize the high levels of insulin you already have), exercise (which helps you use insulin) and SMALL MEALS.
So, testing early (for insulin NOT glucose) means you get to start dieting and exercise Earlier. Presumably this will keep your beta cells from burning out but I don’t believe this is a given. Although studies suggest taking Metformin early (before diabetes) will either delay or prevent development of diabetes - BUT NOT HYPERGLYCEMIA!

posted on July 27th, 2008 at 11:05 am

15 On August 27th, 2008, Carb Lover

My father who is average weight has diabetes and I also had the misconception this was a fat person’s disease. I’m not sure how I got this impression but it’s a pretty common assumption. Unfotunately like many other health topics, more public education is needed from the right sources.

posted on August 27th, 2008 at 1:36 pm

16 On September 18th, 2008, Diabetes Blog

I think Diabetes is not predictive anymore and it can be anywhere. Especially Type 2. I was very normal 10 years ago and having nothing wrong with body but then I diagnosed as Type 2 Diabetic. Perhaps that was the worse day of my life when I came to know that am going to live with it forever.

posted on September 18th, 2008 at 11:27 am