Are you Obese T2 or Thin and skinny T2??
I have been studying the Etiology & mechanism of Obese T2 Vs Thin/Skinny T2 since quite some time.
I have accessed a lot of research papers/ studies on the subject. I find there is a lot of difference between the two and therefore the strategies to be followed need to be different to a great extent.
Today, majority i.e almost 75% of T2's in the world are Obese's with BMI more than 25. Around 20% is thin/ skinny type T2 with BMI of 18-21. Another 5% T2's are between BMI of 22 to 25.
The etiology and mechanism which I have learnt till date- I thought I must share with you...if it benefits you ...☺️
(1) For obese T2, the fasting blood insulin level mostly remains high as high as 15 mIU/ L or even much more.
For thin Type-2, the fasting insulin normally remains very low @ 2 to 5 mIU/L.
(2) The obese type 2 with increased fasting blood insulin level will always have a tendency to put on weight and it is a challenge,though not difficult for an obese T2 to reduce his weight. Once he achieves his weight reduction target, his insulin resistance , Hba1c level can be controlled and so also the diabetes. He can be immensely benefitted by a strict LCHF diet which would help reducing blood insulin level and also his BMI. But he should be able to sustain his weight reduction target with diet and exercise. The LCHF diet and Obese Type-2 are made for each other! 😀
The only precaution for an obese T2 with LCHF diet is to keep an eye if his body inflammation as measured by hsCRP is within normal range. If hsCRP is not within normal range, he needs to experiment and explore with the type of fat he is consuming.... A lot of studies are available and one needs to find out what type of fat best suits him... Persistent body inflammation carries CV risk and gradual Beta cell destruction. If required such a person with persistent body inflammation need to seek medical / nutrition advice !
(3) For thin type T2, he always tends to have extremely lower level of fasting blood insulin level around 5mIU/L.... and insulin is the master hormone which is required for muscle building as insulin is crucial for absorption of all macronutrients such as Carbs, protein and fat....... and therefore he would find it extremely difficult to put on some weight due to very low Insulin level.... Also the skinny or the thin chap does not have enough muscle / body cells to take up the blood sugar...and so the sugar remains in the blood causing high blood sugar.
If the thin T2 is able to put on some weight and attains a healthy BMI.....he has done it...
But the thin T2 may find it difficult to put on weight with LCHF diet , though he may be able to control his blood sugar for sometime with LCHF which may not be sustainable for long... though LCHF may still be a choice to control blood sugar.... And eventually he may need injectible insulin unless he is able to preserve and even reverse the progression of beta cell destruction by some means.....which remains a challenge...keep your body inflammation as measured by hsCRP under control...
It may be worth mentioning here that a Non-diabetic thin person may be able to put on weight with a LCHF diet...but not a thin T2...... due to the reasons as mentioned in point 3 above. !
(4) For an obese T2, the issue is more of "insulin resistance " and may not be an issue of 'Insulin secretion "
For a thin T2, the issue is " inadequate insulin secretion" and less of " Insulin resistance"
So the efforts of an obese should be to improve his Insulin resistance by diet and exercise and the efforts of a thin T2 should be towards preserving his beta cells and enhancing his insulin secretion capacity !
(5) while the primary goal of both type of T2's should be to control blood sugar to avoid diabetic complications, also high blood sugar gradually destroys beta cell. Having said that, it may be easier for an obese T2 to shed some weight and sustain it, improve insulin resistance and improve blood sugar level by LCHF diet and physical exercise.
For a thin type 2, he needs do a highly challenging job of adding some muscles to his body to attain a healthy BMI through a proper diet planning with good quality protein and exercise focussing on resistance training. If required expert Medical advice should be sought.
(5) An obese T2 would carry a more CV risk , but a thin T2 carries two times more risk of death due to Non-CV events..
(6) An obese T2 hates "insulin" and a thin T2 loves " Insulin" because excessive blood insulin for an obese T2 and inadequate insulin for a thin T2 are the root causes of his T2......HIGH BLOOD SUGAR.....
(7) All thin T2's must note that the most popular and effective drug Metformin is designed for Obese T2 to reduce weight ! Unfortunately that is the only effective drug available which is more suitable for obese T2 than a thin T2. If a thin T2 takes Metformin , it will havea weight reducing effect..
However , all insulin secretagouge drugs including injective Insulin will have a weight increasing effect.. .......But unfortunately almost all insulin secretagouges drugs are known to destroy beta cells gradually... carry CV Risks.....risk of hypoglycemia .....Catch 22 situation for Thin type T2's.....
(8) In an extensive study in India on thin T2 diabetes and elsewhere in Korea and Japan , it was observed that all thin and skinny T2's have increased level of DPP4 enzymes which destroys the Incretin/ GLP in the Gut which is responsible for signalling insulin production in the body and so the science has invented DPP4 inhibitors which would breakdown and reduce the DPP4 enzymes which in turn would enable and sustain Incretin for more insulin production . This seems to be a hope for thin type 2's. But again long term safety of DPP4 inhibitors ?? It has landed in to controversy of whether it can create pancreatitis which is being studied.. DPP4 inhibitor such as Sitagliptin has got USFDA approval where as Vildagliptin is yet to clear USFDA approval though all European countries, and India are widely prescribing DPP4 inhibitors ....Vildagliptin ..
I am not a medical practitioner. I have just compiled information from different research papers/ studies and also physical consultation with many Endochrinolgist and Cardiologists.....you may please consult your physician and/or nutrition expert for advice!