‘obesity Paradox’: Why Being Thin With Diabetes Is A Dangerous Combo
Being overweight or obese is a risk factor for developing Type 2 diabetes, but it turns out that these heavier patients may have an advantage: people who are overweight when they are diagnosed with diabetes live longer than their thinner peers. The so-called obesity paradox, in which being overweight appears to be protective against early death, has been seen before in heart failure and chronic kidney disease. But, says study author Mercedes Carnethon, associate professor of preventive medicine at Northwestern University, that doesn’t necessarily mean that gaining excess weight is a healthy strategy; rather, it may be that people who are thin when they develop diabetes are already be vulnerable to worse health. “We hypothesized that their diabetes may be different,” she says. “They may have developed diabetes for reasons unrelated to obesity. Overall, about 85% of people with diabetes are heavy. Gaining too much weight is a major contributor to Type 2 diabetes, since excess fat cells can affect the way the body breaks down glucose and produces insulin, but some normal weight individuals can develop the disease as well. The elderly and people of Asian descent are more likely to be at normal weight when diagnosed, for example. (MORE: Doctors Should Screen All Adults for Obesity, U.S. Panel Says) For the new study, published in the Journal of the American Medical Association (JAMA), Carnethon and her team reviewed data on five previous studies that were tracking people for heart disease risk factors. The studies, which were conducted between 1990 and 2011, included 2,625 people who were recently diagnosed with diabetes, about 12% of whom were at normal weight. The lean patients looked metabolically similar to those who were obese, with the exception of their weight Continue reading >>
Why Thin People Get Type 2 Diabetes
While it’s true that being overweight is a primary risk factor for type 2 diabetes, it’s also true that slender individuals can develop diabetes. Thin people seem to burn the calories they consume, and don’t appear to have fatty muscles that interfere with glucose delivery. However, because there are genetic and other risk factors associated with type 2 onset, even rail-thin people can have high blood sugar. Genes vs Lifestyle A study published in 2014 compared lifestyle interventions to genetic testing for the prevention of type 2 diabetes. Though it was already known that both genetic and lifestyle factors influence diabetes onset, the researchers wondered if lifestyle factors - such as lack of exercise, or poor diet - raised a person’s genetic diabetes risk. The investigation revealed obesity increased the risk for type 2 diabetes whatever the person’s underlying genetic risk level. Further, it showed that for those who are younger and leaner, genes are more influential than lifestyle factors in the development of diabetes. Muscle and Fat Another issue that may put people of normal weight at risk for diabetes is their fitness level. Not all thin individuals exercise regularly, or even eat well. A sedentary lifestyle, combined with a diet high in processed foods could theoretically make someone thin on the outside, but fat on the inside. Although their actual weight is in the normal range, the ratio between their muscle and fat cells might be skewed enough to instigate insulin resistance. Lean, but otherwise healthy children of type 2 diabetics might also inherit a genetic defect that disrupts their mitochondria's function. People with this defect burn glucose and fatty acids inefficiently, leading to an accumulation of muscle fat that disrupts insulin signa Continue reading >>
Diabetes Can Strike—hard—even When Weight Is Normal
We tend to think of type 2 diabetes as a disease that afflicts people who are overweight. But it can also appear in people with perfectly healthy weights—and be more deadly in them. A study published today in the Journal of the American Medical Association indicates that normal-weight people diagnosed with type 2 diabetes have double the risk of dying from heart disease and other causes than overweight people with diabetes. Such apparent “protection” by excess weight has been called the obesity paradox. It’s been seen with other conditions, like heart failure and end-stage kidney disease. Overweight or obese people with these conditions seem to fare better or live longer than their normal-weight counterparts. That doesn’t mean gaining weight is a healthy strategy. Instead, it probably means that something else besides weight—like the amount of fat around the waist—may be contributing to the onset and severity of type 2 diabetes. Diabetes types There are two basic types of diabetes. Type 1 diabetes occurs when the body stops making insulin. This happens when the immune system mistakenly attacks insulin-making cells in the pancreas. Without insulin, cells can’t absorb sugar (glucose) from the bloodstream. The resulting high sugar levels in the blood damages nerves, arteries, and other tissues. Type 1 diabetes often appears early in life, but can happen later. People with type 1 diabetes must take insulin. Type 2 diabetes occurs when cells become resistant to insulin’s “open up for sugar” signal. Exactly why this happens is still something of a mystery. But excess weight contributes to it, since fat cells affect how the body uses glucose and produces insulin. Lack of physical activity also plays a role. Medications that make muscle and other cells mor Continue reading >>
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Weight And Diabetes
A balanced diet and an active lifestyle can help all kids maintain a healthy weight. For kids with diabetes, diet and exercise are even more important because weight can affect diabetes and diabetes can affect weight. This is true for kids and teens with type 1 diabetes or type 2 diabetes. In diabetes, the body doesn't use glucose properly. Glucose, a sugar, is the main source of energy for the body. Glucose levels are controlled by a hormone called insulin , which is made in the pancreas. In type 1 diabetes , the pancreas does not make enough insulin. Undiagnosed or untreated type 1 diabetes can cause weight loss. Glucose builds up in the bloodstream if insulin isn't available to move it into the body's cells. When glucose levels become high, the kidneys work to get rid of unused sugar through urine (pee). This causes weight loss due to dehydration and loss of calories from the sugar that wasn't used as energy. Kids who develop type 1 diabetes often lose weight even though they have a normal or increased appetite. Once kids are diagnosed and treated for type 1 diabetes, weight usually returns to normal. Developing type 1 diabetes isn't related to being overweight, but keeping a healthy weight is important. Too much fat tissue can make it hard for insulin to work properly, leading to both higher insulin needs and trouble controlling blood sugar. In type 2 diabetes , the pancreas still makes insulin, but the insulin doesn't work in the body like it should and blood sugar levels get too high. Most kids and teens are overweight when they're diagnosed with type 2 diabetes. Being overweight or obese increases a person's risk for developing type 2 diabetes. Also, weight gain in people with type 2 diabetes makes blood sugar levels even harder to control. People with type 2 di Continue reading >>
Obesity Paradox: Thin Not In For Type 2 Diabetes?
Aug. 7, 2012 -- People who are overweight or obese when they are diagnosed with type 2 diabetes appear to live longer than people whose body weight is normal when their disease is detected, a new study shows. Obesity increases the risks for illness and early death. Despite this, doctors have long puzzled over why bigger patients with certain chronic diseases seem to fare better than those who are thin. This so-called "obesity paradox" has been noted in patients with kidney disease, heart failure, and high blood pressure. The new study, which is published in the Journal of the American Medical Association, suggests the protective effect of a higher body mass index (BMI) may also extend to people with type 2 diabetes. BMI is a measure of size that accounts for both height and weight. "This was unexpected given the close association of diabetes with obesity," says researcher Mercedes R. Carnethon, PhD, an associate professor of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago. Excess body fat worsens the body's ability to use insulin properly, which affects blood sugar control. People with diabetes who are overweight are routinely advised to lose weight to help keep their disease in check. Carnethon cautions that this study doesn't mean that people with diabetes who are overweight should abandon their weight loss efforts. Instead, experts say the study suggests that people who are normal weight when they are diagnosed may be at increased risk of poor health outcomes, though doctors don't fully understand why. "If you are normal weight, you may be at higher risk from diabetes, especially if your fitness status is not so good," says Hermes Florez, MD, PhD. Florez is the director of the division of epidemiology and population health scie Continue reading >>
Type 2 Diabetes In Children
For decades, type 2 diabetes was considered an adults-only condition. In fact, type 2 diabetes was once called adult-onset diabetes. But what was once a disease mainly faced by adults is becoming more common in children. Type 2 diabetes is a chronic condition that affects how the body metabolizes sugar (glucose). Over 5,000 people under the age of 20 were diagnosed with type 2 diabetes between 2008 and 2009. Until 10 years ago, type 2 diabetes accounted for less than 3% of all newly diagnosed diabetes cases in adolescents; it now comprises 45% of all such cases. It’s more common in those aged 10-19 and in non-Caucasian populations, including African Americans, Native Americans, Asian/Pacific Islanders, and Hispanics. Being overweight is closely tied to the development of type 2 diabetes. Overweight children have an increased likelihood of insulin resistance. As the body struggles to regulate insulin, high blood sugar leads to a number of potentially serious health problems. In the past 30 years, obesity in children has doubled and obesity in adolescents has quadrupled, according to the CDC. Genetics may also play a role. For instance, the risk of type 2 diabetes increases if one parent or both parents has the condition. Symptoms of type 2 diabetes are not always easy to spot. In most cases, the disease develops gradually, making the symptoms hard to detect. Many people do not feel any symptoms. In other cases, children may not show any obvious signs. If you believe your child has diabetes, keep an eye out for these signs: Excessive fatigue: If your child seems extraordinarily tired or sleepy, their body may not have enough sugar to properly fuel their normal body functions. Excessive thirst: Children who have excessive thirst may have high blood sugar levels. Frequent Continue reading >>
Slim And Healthy People Also Get Type 2 Diabetes
Overweight, an unhealthy lifestyle and old age are factors that many of us associate with people who are diagnosed with type 2 diabetes. But this isn’t entirely true. In fact, the disease can hit the slim, the fat, the young and the old. This diversity of patients does not make life easy for doctors and researchers, as it creates a need for a great variety of treatment forms. For example, lifestyle changes only work for some patients and not for others. The ideal time for an insulin fix also varies greatly, depending on the patient. However, now two Danish researchers have cracked part of this code. Based on data from a comprehensive English study, they have identified three subgroups of type 2 diabetes patients that have different diseases patterns. In addition to showing that diabetes is expressed in a variety of ways, the study surprises by showing that only 25 percent of the type 2 diabetes patients follow the course of the disease that scientists so far have considered to be the most common one. ”This finding is the first step towards more targeted prevention and treatment for patients with the different subgroups of the disease,” says Kristine Færch, a senior researcher at the Steno Diabetes Center, who co-authored the study. Classification determined by blood sugar Insulin is the key ingredient when we’re talking about type 2 diabetes. Insulin is produced in the body and works by transporting the energy from our food into the cells, where the energy is used. Type 2 diabetes occurs either: As a result of insulin resistance, where the insulin gradually loses its ability to transport energy from food to the muscles. As a result of problems with the beta cells, which are those that produce or secrete insulin. It was previously believed that the most common c Continue reading >>
Type 2 Diabetes In Women: Young, Slim, And Diabetic
Stephanie Yi, 29, had a body most women would kill for. She never had to work hard to maintain her long-limbed, flat-bellied frame—weekend hikes near her northern California home and lots of spinach salads did the trick. She could easily afford to indulge her sweet tooth with the occasional buttery, sugary snack. At 5'7" and 120 pounds, she had, she figured, hit the good-genes jackpot. But everything changed two years ago, when a crippling fatigue left her sidelined from college classes. Listless, she dragged herself to a doctor, who suspected a thyroid imbalance. A blood test and a few days later, she received the alarming results: Her thyroid was fine; her blood sugar levels were not. She was prediabetic and on the cusp of developing type 2. Stephanie was stunned. Of course, she'd heard diabetes was a health crisis. (At last count, 26 million Americans had the disease, according to the Centers for Disease Control and Prevention.) But weren't type 2 diabetics fat, sedentary, and on junk-food-and-soda diets? Stephanie hadn't been to a drive-through in ages; she didn't touch meat. Yet, somehow, she'd gotten an illness most slim women dodge. A Growing Threat The CDC estimates that one in nine adults has diabetes and, if current trends continue, one in three will be diabetic by the year 2050. For decades, typical type 2 patients were close to what Stephanie pictured: heavy and inactive. They were also older, often receiving a diagnosis in middle age or beyond. But while such type 2 cases continue to skyrocket, there has been a disturbing increase in a much younger set. The number of diabetes-related hospitalizations among people in their thirties has doubled in the past decade, with women 1.3 times more likely to be admitted than men. Perhaps even more troubling is the e Continue reading >>
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 t Continue reading >>
Skinny People Get Type 2 Diabetes Too: 10st 7lb Man Who Exercised Regularly Is Stunned To Learn He Has The Condition - Which He Then Reversed In 11 Days With New Diet
When I was diagnosed with type 2 diabetes four years ago I was stunned. I’d gone for a check-up, and a routine blood test said it all: diabetes. But it made no sense. As a healthy 59-year-old, who went running, played regular cricket, drank moderately (2 units a week) and only weighed 10st 7lb, I was hardly overweight. In fact, at 5ft 7in, my Body Mass Index (BMI) was a healthy 21. Yes, I did overeat sometimes – I was thin and thought I could eat what I liked within reason – but it was mainly healthy food, few ready meals, semi-skimmed milk, grilled rather than fried food, chicken rather than red meat and lots of fresh veg. But over the past two years I had been under a lot of stress: my dad had recently died from prostate cancer, my job had changed radically, and I’d been on high blood pressure pills for a year. Stress can raise your blood sugar levels. But I still thought my diabetes diagnosis was ridiculous – how could someone with my weight and healthy lifestyle be facing the prospect of all the serious complications of type 2 diabetes in ten years’ time, including sight loss and a much greater risk of early death? My GP told me I could control my condition with diet, and gave me a long list of healthy foods and their glycaemic load (the effect each food has on your blood sugar level). After six months on this, my blood sugar level had dropped from 9mmol to 7, although this was still well above 6, the level at which type 2 diabetes is diagnosed. I wanted to be free of diabetes, not just control it. So I researched online and discovered the work of Professor Roy Taylor at Newcastle University. Type 2 is linked to fat clogging up the liver and pancreas, and Professor Taylor had shown that a very low calorie diet could reverse this. I had to try it. I chose Continue reading >>
Can Normal Weight And Thin People Be Insulin Resistant?
Insulin resistance – if you’re of normal weight or underweight you’ve probably crossed it off your list of things to worry about. After all, insulin resistance only affects people who are overweight, right? Surprisingly, the answer is no. Insulin resistance is less common in people who aren’t overweight or obese but even thin people can have it. The Problem of Metabolically Unhealthy Non-Obesity You’ve probably heard about metabolically-healthy obese people, people who fall into the obese category based on BMI yet don’t suffer from the health problems associated with obesity like insulin resistance. In addition, they aren’t at greater risk for heart disease. Up to 20% of obese people fall into this category. Just as there are metabolically healthy obese people, there are a growing number of normal weight and thin people who aren’t healthy from a metabolic standpoint. They have the same metabolic issues, namely insulin resistance, that plaques overweight and obese people. These people fall into the category of “metabolically unhealthy non-obese.” Unfortunately, people in this category are at higher risk for health problems and most are blissfully unaware of it. They look at the number on the scale and assume all is well. After all, how can they be at risk when insulin resistance is so closely linked with being overweight and obese? Insulin Resistance in Normal-Weight and Thin People: What Causes It? As you already know insulin resistance is a condition where cells become less responsive to the insulin your pancreas produces. Your pancreas produces insulin to help get glucose into cells. When cells lose sensitivity to insulin, the pancreas has to pump out more. As a result, people who have insulin resistance have lots of circulating insulin in their bl Continue reading >>
Type 2 Diabetes Increasingly Affects The Young And Slim; Here’s What We Should Do About It
Type 2 diabetes increasingly affects the young and slim; here’s what we should do about it August 15, 2016 4.07pm EDT It is well recognised that increasing rates of type 2 diabetes are mainly driven by obesity and lifestyle factors. But that’s not the whole story. Genetics and epigenetics – changes in gene expression – also play an important role. We are starting to see an increase in type 2 diabetes in leaner people at a much younger age than usually associated with the disease. This means in addition to focusing on good diet and exercise, we need better awareness of groups most at risk of type 2 diabetes. These include many ethnic groups, women with a history of gestational diabetes and people with a family history of diabetes. In my clinical practice, I have seen teenagers and even children as young as seven, as well as younger patients of Asian, African and Middle Eastern origin with type 2 diabetes. Among Indigenous people in Central Australia, rates of diabetes are some of the worst in the world, at around three times that of non-Indigenous people. Studies in some remote communities suggest a prevalence of type 2 diabetes of up to 30%, compared to a rate of around 5% in the non-Indigenous population. All this indicates lifestyle decisions alone can’t be responsible. We need to stop the blame and shame for a condition that has an association with lifestyle, but for many is a consequence of the toxic mix of genetics and modern life. More than just lifestyle changes Type 2 diabetes accounts for more than 90% of all diabetes cases and affects mainly middle-aged and older people who are overweight or obese. Type 2 diabetes is thought to occur from a combination of factors: when the pancreas can’t produce enough insulin; and when the insulin is unable to do Continue reading >>
When The Type Of Diabetes Isn't Clear:
My child was diagnosed with diabetes. Why can't the doctor tell me what type of diabetes it is? In the past, when a child had diabetes, it was often quickly diagnosed as type 1 (in which the body doesn't make insulin). But today, more and more children are developing type 2 diabetes (in which the body makees insulin, but not enough). Also, we now know that there are more than two types of diabetes. The signs and symptoms of the different types can be a lot alike at first. It can take a while after getting the blood glucose level under control before your doctor can spot differences and tell for sure what type of diabetes your child has. Is there any way the doctor can tell for sure what type of diabetes my child has? Once a child's blood glucose level is under control, the type of diabetes usually becomes clear. Blood tests can help. If blood work shows antibodies to insulin-making cells (which means that these cells are being destroyed), your child has type 1 diabetes and will need to use insulin right away. Children who are overweight or have thick, darkened skin around the neck or on other body parts that are frequently bent or rubbed (a condition called acanthosis nigricans) may have type 2 diabetes. Thin children can develop a form of diabetes that is neither type 1 nor type 2 but can be treated as type 2. Be alert to the term "MODY," which stands for Maturity Onset Diabetes of Youth. This form of diabetes is rare and happens when there are genetic changes that cause problems with how insulin is made or used. It is not uncommon for any child with diabetes who does not need to use insulin to be wrongly diagnosed as having "MODY." Only special blood tests can diagnose this form of diabetes. How does the care of a child with type 2 diabetes differ from that of one wit Continue reading >>
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Can Thin People Get Type 2 Diabetes?
Almost 90 percent of people with type 2 diabetes are overweight or obese, according to government statistics, and it's known that carrying excess weight ups your diabetes risk. The reason is that fat interferes with your ability to use insulin — insulin moves sugar (glucose) from your blood to your cells, which need the sugar for energy. But don't think you're off the hook if you're thin — you still can be at risk for type 2 diabetes, even if you're not heavy. The risk for developing type 2 diabetes may be smaller if you're thin, but it's still real, especially if you're older, says Christopher Case, MD, who specializes in endocrinology in Jefferson City, Mo. It's not known exactly how many thin or normal-weight people have type 2 diabetes, but part of that may be because there is no standard definition for "thin," Dr. Case says. "They may not look obese," Case says, but any excess weight, especially around the stomach, is a risk factor. One of the reasons people can have high blood sugar and develop diabetes whether they're thin or obese is because weight, though a contributing factor, is not the only factor. Type 2 Diabetes Could Be in Your Genes Genetics plays a role in developing type 2 diabetes. Studies show that people who have a close relative (parent or sibling) with type 2 diabetes have a greater than three times higher risk of developing the disease than those with no family history, Case says. Genetics may explain why some people who are thin develop type 2 diabetes and why an obese person might not, he says. African-Americans, Asians, Hispanics, and Native Americans also are at greater risk for type 2 diabetes. Lifestyle Choices Raise Your Diabetes Risk These other risk factors, often associated with people who are overweight, can plague thin people, too Continue reading >>
Think Skinny People Don’t Get Type 2 Diabetes? Think Again.
In the last article we discussed the complex relationship between body weight and type 2 diabetes (T2DM). We learned that although obesity is strongly associated with T2DM, a subset of “metabolically healthy obese” (MHO) people have normal blood sugar and insulin sensitivity and don’t ever develop diabetes. In this article we’re going to talk about the mirror reflection of the MHO: the “metabolically unhealthy nonobese” (MUN). These are lean people with either full-fledged type 2 diabetes or some metabolic dysfunction, such as insulin resistance. You might even be surprised to learn that skinny people can and do get T2DM. They are rarely mentioned in the media, and there isn’t much written about them in the scientific literature. Perhaps these folks have been overlooked because type 2 diabetes has been historically viewed as a disease of gluttony and sloth, a self-inflicted outcome of eating too much and not and not exercising enough. But the very existence of the MUN phenotype proves that there’s more to T2DM than overeating and a sedentary lifestyle. Remember that one in three type 2 diabetics are undiagnosed. It’s possible that a significant number of these people that are lean. They don’t suspect they might have T2DM because they’re under the impression that it’s not a condition that affects thin people. This is one of the biggest dangers of the myth that “only fat people get diabetes”. It’s well-known that high blood sugar can precede the development of T2DM for as long as ten years. It is during this time that many of the complications associated with diabetes – nerve damage, retinal changes, and early signs of kidney deterioration – begin to develop. This is why it’s just as important for lean people to maintain healthy blood s Continue reading >>