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Why do thin people get diabetes too?

What causes hyperglycemia and diabetes in lean people?

By CustoPublished about a year ago 6 min read
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There is a complex relationship between body weight and diabetes, with obesity being closely associated with diabetes. Therefore, many people have the misconception that only fat people get diabetes, but in fact, diabetes can occur in many thin people.

As we discussed earlier, diabetes is not exclusive to obese people, but some obese people are metabolically "healthy". Since there are metabolically healthy obese people, there must also exist some metabolically unhealthy non-obese people, these thin people either have diabetes or other metabolic disorders, such as insulin resistance. I'm sure you've come across people who are thin and bony who have type 2 diabetes, also known as "thin diabetes".

These people are often overlooked because diabetes has historically been thought of as a disease of gluttony and laziness, a result of eating too much and not exercising enough. However, the presence of lean diabetes suggests that diabetes is not just the result of overeating and a sedentary lifestyle.

A third of people with type 2 diabetes may go undiagnosed, and a significant proportion of these people are thin. They don't suspect they might have type 2 diabetes because they don't think it's a disease that thin people get. This is one of the biggest dangers of the "only obese people get diabetes" fallacy.

It is well known that high blood sugar levels can precede type 2 diabetes by 10 years. It is during this time that many of the complications associated with diabetes begin to appear, including nerve damage, retinal changes, and early signs of kidney deterioration. That's why it's just as important for slim people to maintain healthy blood sugar as it is for overweight and obese people.

Diabetes is not just a disease; it is a symptom. Every person with diabetes, whether they are extremely thin or morbidly obese, has one symptom in common, and that is high blood sugar. Therefore, any factor that disrupts the body's regulation of blood sugar levels can lead to type 2 diabetes.

What causes hyperglycemia and diabetes in lean people?

The causes of diabetes in lean people are very similar to the causes of diabetes in obese people, and they can be broadly grouped into the following categories: genetics, fatty liver, inflammation, autoimmunity, and stress.

Genetic factors

Studies of healthy, slim offspring of type 2 diabetics have shown that they are more likely to develop insulin resistance than the slim offspring of non-diabetics. One explanation is mitochondrial dysfunction due to a genetic defect. People with this genetic defect cannot burn glucose or fatty acids efficiently, which can lead to lipotoxicity and the accumulation of fat in muscle cells.

Fatty liver

One study found significant ethnic differences in the development of insulin resistance, with Asian Indian men having a 2-3 times higher incidence of insulin resistance than other ethnic groups, who also had a higher incidence of nonalcoholic fatty liver and hepatic insulin resistance.

NAFLD is an independent predictor of type 2 diabetes. Cross-sectional studies suggest that fatty liver and metabolic abnormalities occur together, and it has also been proposed that fatty liver is not only a consequence but also a cause of insulin resistance and type 2 diabetes.

Notably, those Asian Indian men with NAFLD were not overweight; rather, they were thin and, in some cases, underweight. Thus, NAFLD also occurs in lean individuals, and this may be a major cause of insulin resistance and type 2 diabetes in lean individuals.

In the last decade or so, the prevalence of NAFLD in China has increased dramatically from 18% to 29%, which is a very disturbingly high prevalence, and in addition to leading to type 2 diabetes and metabolic syndrome, a small percentage of people may develop severe cirrhosis and liver cancer.

While genetic factors may make people more likely to develop NAFLD, we know that dietary factors play a more important role. Studies in rodents have shown that a diet high in fat and sugar promotes the development of NAFLD.

Fructose in some beverages, candy, and refined foods, especially high fructose corn syrup, maybe the most important dietary trigger for NAFLD. The liver converts fructose into fat, and the higher the fructose intake, the higher the liver fat content. Feeding high amounts of fructose to rodents promotes NAFLD, and the consumption of various sugary beverages in humans increases the incidence of NAFLD.

Because the liver processes fructose in the same way as alcohol, excess fructose can produce a host of problems similar to alcohol abuse, such as high blood pressure, high triglycerides and low HDL, obesity, cirrhosis, and insulin resistance.

Inflammation

In the study of Asian Indian men we mentioned earlier, it was found that lean Asian Indian men with type 2 diabetes had levels of plasma inflammatory protein IL-6 that were two times higher than those of lean subjects without type 2 diabetes. We know that chronic low-grade inflammation is an important mechanism that reduces insulin signaling and leads to insulin resistance in muscle, liver, and fat cells.

Moreover, the inflammation usually precedes the onset of diabetes. Injection of inflammatory cytokines into healthy mice of normal weight leads to insulin resistance, and people with other chronic inflammatory conditions are at higher risk of developing type 2 diabetes. For example, about one-third of people with chronic hepatitis C develop type 2 diabetes, and people with rheumatoid arthritis are at higher risk.

Autoimmunity

We know that there is type 1 diabetes and type 2 diabetes, and we usually think of type 1 diabetes as being caused by autoimmune destruction of pancreatic beta cells leading to decreased insulin production, while type 2 diabetes is caused by insulin resistance in the liver, muscle, and fat cells.

However, recent studies suggest that the line between the two conditions may be much more blurred than previously thought. Adult type 1 diabetes is often misdiagnosed as type 2 diabetes, and up to 10% of adults with type 2 diabetes may be autoimmune.

One study in India found that a quarter of slimmer type 2 diabetics exhibited positive antibodies to glutamic acid decarboxylase. Glutamic acid decarboxylase is the rate-limiting enzyme that converts glutamate into the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), and glutamic acid decarboxylase antibodies are an immune marker in the early stages of type 1 diabetes onset and also serves as an indicator of efficacy when type 1 diabetic patients receive treatment. Thus, a significant proportion of slim type 2 diabetic patients may have an autoimmune status.

Stress

Under stressful conditions, the body produces higher levels of the stress hormone cortisol. Cortisol plays many important roles, and one of its main functions is to raise blood sugar. This is a very useful evolutionary mechanism that is part of the "fight or flight" response, helping us prepare for a challenge or threat.

However, this mechanism is only applicable to short bursts of stress. Long-term stress is different, and our bodies are not ready to deal with the effects of long-term stress, including chronically elevated cortisol levels. Because cortisol raises blood sugar to unhealthy levels, you can stay slim but still be potentially hyperglycemic if there is chronic stress.

Finally, remember that just because you're slim doesn't mean you're "insulated" from diabetes; diabetes is not exclusive to obese people; thin people can get it too. Ultimately, it's all about unhealthy diet and lifestyle. Being thin doesn't mean you've bought yourself "insurance", and thin people need to pay attention to diabetes prevention, too.

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Custo

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