Thin Type 2s Disprove that Obesity Causes Diabetes

If you get your medical information from the press, you probably believe that Type 2 diabetes is a self-inflected disease caused by obesity and that it could have been prevented if the lazy gluttons who get it had only watched their weight.

This makes it very easy to view people with Type 2 as greedy layabouts who caused their disease and to begrudge them their share of society's limited health care dollars.

People with Type 1 often express their anger and resentment that they have to share the name of their disease with all those lazy fat people, when the Type 1s disease is not their fault.

But the theory that Type 2s are greedy slobs who cause their disease, though appealing to our prejudices, is crap.

There are many thousands of people who have been diagnosed as Type 2s who are not fat. Last year I attended a get together of a bunch of us who met by posting on an online bulletin board. What we had in common, besides a Type 2 diabetes diagnosis--which is what my doctor still puts on my paperwork--is that we were all of normal weight. There were quite a few overweight people in the cafe with us the afternoon we met, but they weren't the diagnosed diabetics.

And more importantly, despite attaining normal weights, all of us who met that day still have seriously impaired blood sugar. Two of us, in fact, use insulin to get better control.

Part of the reason for the association of diabetes with obesity is that people with diabetes often are very fat. But what gets missed is that their obesity often develops as a result of the very high blood sugars, rather than the other way around.

We know now that blood sugars of 180 mg/dl or higher cause insulin resistance and there appears to be a strong relationship between insulin resistance and the tendency to pack on weight. So when people's post-meal blood sugar control starts to deteriorate one of the first things that happens is that they pack on extra pounds.

This relentless weight gain often happens during the ten years or so that the typical Type 2 is running diabetic blood sugars after every meal but before they get a diagnosis--the same ten years of undiagnosed high blood sugars that ensure that at the time of diagnosis almost half of all "newly diagnosed" Type 2s already have serious diabetic complications, including nerve damage, retinal changes, and early signs of kidney deterioration which take a decade to develop.

Hence, for many type 2s, that overweight that doctors think has caused their diabetes is really just another complication caused by their years of exposure to high blood sugars. Even more important, this weight gain can often be reversed by cutting out the carbohydrates that raise blood sugar, though resuming normal weight rarely results in our diabetes reversing.

Another fact that gets lost when the media, and even doctors, blame people for their diabetes is this: that only a small proportion of even the most obese people ever develop diabetes--something like 1/3 of them. The rest just end up very fat with normal or near normal blood sugars.

That is because a huge body of research has shown that people only develop diabetes when they have underlying genetic conditions that are not well understood, but which are clearly there, since twin studies show a high concordance for diabetes. Even more interestingly, studies of thin relatives of people with type 2 diabetes show that they show subtle blood sugar abnormalities while they are thin and fit--decades before they themselves are diagnosed with Type 2 diabetes.

I have written up some of the more interesting research on this topic on my page:

You Did NOT Eat Your Way to Diabetes

Quite a few people diagnosed with Type 2 diabetes have written to me that this page saved their sanity after diagnosis. Even more have written to me of their anger at doctors who had told them that, if they could just lose ten pounds, their diabetes would reverse when they were at normal weights already.

Similarly, it seems like almost every week I get emails from people who have been diagnosed with Type 2 diabetes who are not fat, but whose doctors are so sure that diabetes is caused by obesity that they can't even take in the evidence of their own eyes.

Even worse, a lot of people, like myself, go for years--in my case 13 of them--without a diabetes diagnosis because doctors take one look at their size 8 slacks and say, "You couldn't have diabetes, you are thin," despite the presence of classic tell tale symptoms like UTIs, yeast infections, fluctuations in vision, exhaustion after eating carbs, and in my case, gestational diabetes during not one but two pregnancies.

I thought for years my situation was unique, but the mail I get makes it clear it is not.

Unfortunately, the media will write up with enthusiasm stories of hugely overweight people who reversed their Type 2 diabetes by losing weight. Some of these people do exist, though in my experience of reading about the experiences of literally thousands of people with Type 2 diabetes online, the people who do this are almost always male. But they are not typical of all Type 2s at all.

It is a shame that the media will not describe the stories of people like me who exercised, kept slim, and developed diabetes anyway. I wish they would. Any journalist who would like it interview me can click on the link by my profile above. Just promise you'll be willing to photograph me in my size 8 pants injecting insulin.