Obese T2 DM Vs Thin T2 DM

[namaha]

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 ..

Disclaimer:

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!

[HOBIEONE]

I think its like a car engine, Put a rug over it , it gets hot & does not run efficiently. I have been T1 for 50 odd years, still go to work because its good for me.

[namaha Administrator in reply to HOBIEONE]

👍May God Bless you !

It is an inspiration for all diabetes....

T1's / T2's should not get scared..... Face the situation ....

And finally people can live for 100 years thanks to insulin ....😀

[klgksharma]

Good useful analysis. I fall under thin T2 but happy with Lantus insulin and not having much problem with 40 minutes average walk per day

[don9999]

Interesting. This shows we need more appropriate categories of T2D and related medical treatments or diet plans. Even though the symptom of High Blood Sugar may be same, but the cause may be totally different.

[sandybrown in reply to don9999]

There was a post giving details of 5 clusters of diabetes.

[namaha Administrator in reply to sandybrown]

👍Possible ! There could be many more classifications of diabetes such as .. gestational diabetes for women,...drug induced diabetes e.g statin can induce Diabetes ...

But the percentages could be low ....

We are discussing the most common 2 types.......

[sandybrown in reply to namaha]

Please take a look at this link:

bbc.co.uk/news/health-43246261

[namaha Administrator in reply to sandybrown]

👍It is further deep dive in Sub- classificatíon in to clusters.

But what we have discussed 2 major broad classification !

[namaha Administrator in reply to don9999]

True ! You have got it right !

[Praveen55 Moderator]

Excellent post namaha ! I would like to add the following:

1. In many cases, insulin resistance is preceded by reduced insulin production. This happens where diabetes condition remains undiagnosed for a long time. Also, the traditional approach to diabetes management where carb is not restricted and BG is controlled through medication results in gradual reduction in insulin production and finally become dependent on external insulin.

2. Fasting insulin level alone may not be sufficient to diagnose damage to beta cells and insufficient insulin level to overcome insulin resistance. Postprandial insulin measurement is also required.

3. Some T2D with normal weight may not be having insulin resistance but still losing beta cells despite leading a healthy lifestyle. Genetic disorder.

4. LCHF dietary approach does not improve insulin production capability but it reduces the demand on insulin level. If pancreas cannot meet even the reduced demand of insulin, external intervention would be required. Still, LCHF approach will result in lower dose of external insulin as in the case of T1D following LCHF approach.

5. Regarding your statement ''Another 5% T2's are between BMI of 22 to 25.''

I was not aware that only 5 % of T2D are in this BMI range ( 22 - 25). I always assumed more than 50% T2D are falling under this BMI range particularly in India, Japan and perhaps in China.

[namaha Administrator in reply to Praveen55]

Agree with your points 1,2,3 & 4- logically all good points !

With reference to your point no 5:

The basic cause of diabetes among the subjects seems to be a permutation & combination of Genetic, Food habits, life style , lack of physical exercise.

Though I identified a 3rd catagory of 5% with healthy BMI, I presume eventually it would land up in to either a Thin type 2 or gets upgraded to Obese T2 depending upon the treatment the body receives-The literature & study talks about the Obese T2 with severe IR & high level of circulating insulin in the blood or thin type 2 with Inadequate circulating insulin level and low level of IR..

[don9999 in reply to namaha]

My BMI is 22. I am trying to control sugar on diet and exercise and not taking medicines. I have not tested insulin level so far. From above information, my insulin level could be low. Is it correct?

[namaha Administrator in reply to don9999]

Yes, along with your blood sugar level fasting and PP , you should also check insulin level which would give an indication of circulating insulin level in the blood....

If Your fasting blood sugar and fasting insulin level is known , you can check your Insulin resistance status and also Beta cell status by the following formulae :

HOMA IR=FI×FG ÷ 405

HOMA B= 360×FI÷ (FG-63)

Where FI is fasting insulin in mIU/L and FG is fasting blood Glucose in mg/dL.

Also , you should check hsCRP which would indicate your body inflammation level.

These are all simple tests would indicate your health status ....

[namaha Administrator in reply to Praveen55]

Dear Praveen55

With reference to your point number 4, you are absolutely right . Thin type 2

should be aware that LCHF does not help increase insulin production but reduces the demand for it.

But he (thin T2) must also be aware that with restricted production of insulin, the metabolism of Macro's including Protein & Fat is also getting affected to some extent..... though he may be able to control blood sugar to some extent with LCHF. However, he may still continue to remain slim and skinny with restricted absorption of protein , Fat due to limited insulin... The skinny and thin body may continue to remain fragile which is not sustainable .... Which eventually may get converted into a T1DM....So the challenge here is - can he reverse his progression ? Can he increase body muscle mass ? Can he arrest his beta cell destruction???

To my understanding, Yes, A T1 DM with LCHF will be able to cut his Insulin requirement. The situation here seems better as he is supplementing with insulin.... He is able to get protein fat into his body. If he is a thin type 2, he can increase his body weight now !😀

[DRH-sangli Star]

Very good study and observation namaha.I am 68, with A1c 5.6,and fasting Insulin 6.0,at BMI of 24.50.( Diabetic for over 28 years) and on moderate LCHF... Pls guide.

[Praveen55 Moderator in reply to DRH-sangli]

You have excellent control over BG. How long have you been following LCHF dietary approach?

[namaha Administrator in reply to DRH-sangli]

Dear DRH-sangli!

You seem to be doing extremely fine even with Moderate LCHF! 👍

Please keep it up!

To be on the safe side, please also measure hsCRP ( a simple blood test ) to measure if your body has inflammation....

It should be less than 1 mg/ L for low CV risk and also that your beta cells are healthy....

For all our benefit, can you please tell us if you are on some medication?

[DRH-sangli Star in reply to namaha]

Dear namaha.. my current medication (1) Galvus 50.. 1-0-0 .. (2) Reclimate(500)..1/2-1/2-1/2...No other medications except Tab Supradyn ...No other complications..pls guide.

[namaha Administrator in reply to DRH-sangli]

Dear DRH- Sangli

In my view, at your age, there is no need for such a tight blood glucose control with the help of three sugar reducing medicines. Rather, I would prefer to reduce the doses and make some more dietary modification and exercise post meal.... Reducing few kilos wt........ Even if I maintain Hba1c at 6 to 6.3 is ok....with reduced dose... It is ok..

While I am not a medical practitioner, it is my hobby to keep track of all diabetic related pharma drugs and its effectiveness /side effects ..... please remain in touch with your Endochrinolgist.

You are taking Galvus which is Vildagliptin that belongs to DPP4 inhibitor which is yet to get USFDA approval, though it's Cousin named Sitagliptin has been approved by USFDA. However, Vildagliptin has been cleared by all European countries, many Asian countries including India, Korea & Japan.... It is considered otherwise safe, though DPP4 inhibitor's casual relation with Pancreatitis is being investigated....

The other drugs named Reclimate contains Metformin 500 mg and Gliclazide both of which are in WHO's list of essential medicines.

Having said that Gliclazide is the best among all available Sulfonylurea class of drugs which is an Insulin secretagouge. Secretagouge means it whips the pancreas to produce insulin...so the long term effect of such drugs may not be that good.....

With Gliclazide , watch out for Hypoglycemia...

Nevertheless, as of now you seem to be doing fine...

I think your supradyn - a multi vitamin tablet may not be required, try to get all your vitamin needs from vegetables and low glycemic fruits , nuts /seeds..

Only you may need vitamin b12 and vitamin D for which you need to supplement since Metformin is notorious in depleting B12.... And all diabetes carry vit D deficiency risk which you can test and find out if you are deficient.....

May God bless you !

[DRH-sangli Star in reply to namaha]

Thanks a lot for your very good guidance.

[GVGnanasooriyam]

Very useful presentation…as if made especially for me. I am on strict LCHF since 2014.

“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 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”.

All are crystal clear except..hsCRP! Kindly detail this as well for me to discus with my Endocrinologist during my next visit.

[namaha Administrator in reply to GVGnanasooriyam]

hsCRP is High Sensitivity C-Reactive Protein- a simple low cost blood test will reveal if you have chronic inflammation in side your body.. it will tell you if you carry any CV risk....if all your organs including pancreas are healthy and are not getting affected by the chronic inflammation.

A lot of studies indicates that there is a strong correlation between inflammation and all metabolic diseases such as obesity, CV and T2. ..

Inflammation in the body would Indicate that whatever you are eating , if it is resulting in to Pro- inflammatory markers as bye-product... such as ...Cytokine.

The inflammation could be because of excessive Carbs for some people and excessive Fat and nature of fat for others (SFA, MU FA, PUFA, EPA, DHA, ALA, LA, ). It could be because of some Protein also .... e.g Gluten , Soy, Egg , Peanut, some kind of meats, etc - it varies from individual to individual.....

Even among SFA's, we have SCFA, MCFA, LCFA and then we have plant based fat and animal based fat........ and all are metabolised differently by our body and some of these may result in to inflammation in some people.. .which damages the body organs gradually....

hsCRP s should be less than 1mg / L....if it is less than one , you are perfectly fine and carry on with your party......

If it is more than 1 mg/ L, it needs investigation and we need to figure out the cause by experimenting...and avoid/ modify that food....

Alternatively your doctor can put you on some medication to counter your body inflammation....

Fortunately, for those people who are on some kind of medication, the medication helps in controlling body inflammation ....

Also please read my post on hsCRP few weeks back. .

[namaha Administrator]

Dear StillCincerned!

Appreciate yourviews !

I think we are talking in similar lines.....

I never meant obesity is the cause of diabetes. Rather, there are many Obese's without diabetes and vice versa, though Obese' may carry a future diabetic risk due to obesity and gradual development of IR...... the entire episode of Obesity, IR, Diabete - Doctors called as metabolic Syndrome.....

Yes , I agree with your statement that intensive exercise including Resistance training could induce muscle growth- but this is true with a Person whose insulin levels are in normal range....

But a thin T2, who has already very low level of circulating insulin... Half of his beta cells are destroyed ...... He would find it extremely difficult to put on weight.....

The reason is once we talk of Insulin, people in general relate it to Sugar/carbohydrate metabolism...... Very few people understand that Insulin is the master Anabolic Hormone.... It is the Insulin which also shuttles the Protein / aminoacids / fats in to your cells apart from carbs/Sugar....just see what is happening...... There are 1000's of examples where a thin built Person T2 with impaired beta cells....... the person keep losing weight day by day........ whatever diet you follow .... and BMI gradually comes down from 22-23 to 18-19....

Weight from 60 kg to 47- 48kg within 3-4 years....and the decline is not arrested.....

Life is not sustainable ... No wonder , research indicates that thin built T2's carry 3 times death risk than a Obese T2....

Having said that , yes an obese T2 can be immensely benefitted by intensive exercise.... Resistance training .....Reduce his weight...... The visceral fat reduce.... lean muscle mass builds .. adiposity improves .... thanks to the healthy beta cells producing good amount of insulin levels of this class of Obese T2's.... in the process he improves his IR.... and brings down his very high insulin level to a normal healthy level....

Agree with your views on eating frequency and insulin raising tendency of different food items which is again true for obese T2's ...

Thanks..

[sandybrown]

When I saw ACCORD, I thought it was Honda.

This morning I spent time reading the study. One of the report took me to UKPDS.

Very interesting reading. Thank you.

Below is one of the points in conclusion:

"The UKPDS provided evidence-based targets for the treatment of type 2 diabetes (Barnett, 2004). The intensive control group maintained a lower HbA1c level by a mean value of 0.9% over a median follow-up of 10 years from diagnosis of type 2 diabetes. Mean HbA1c in the intensive group was 53 mmol/mol (44–66 mmol/mol; 7.0% [6.2–8.2%]) compared to 63 mmol/mol (52–73 mmol/mol; 7.9% [6.9–8.8%]) with conventional therapy (UKPDS 33, 1998a)."

Some of the HbA1c levels are confusing!

[namaha Administrator in reply to sandybrown]

UKPDS - any latest report??

I know they have been doing a good job of studying diabetes for the last 42 years very scientifically (1977- till date ). They keep publishing report of their follow up with diabetes at regular intervals ...

[namaha Administrator in reply to sandybrown]

Dear Sandybrown

Any latest update on UKPDS ?

[sandybrown in reply to namaha]

I am afraid I am not looking for any latest updates from UKPDS, as it is not part of my research! When I read ACCORD, I came across UKPDS, and responded with one point in conclusion as an interest, which was confusing to me. If you like I can delete or edit my response?

[sandybrown in reply to namaha]

I do not wish to respond with information that can confuse members!

[Activity2004 Administrator in reply to sandybrown]

It's useful information. It's not confusing, sandybrown . If anyone has any questions, they can let everyone know.

[namaha Administrator in reply to sandybrown]

Dear Sandy

Don't worry. I got all the research papers of UKPDS.

I am going through it. May be I would post it tomorrow in a new post.

It would be very useful information for all diabetes. 😊

[GVGnanasooriyam]

Thank you very much for your prompt response!

[gangadharan_nair]

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels

Links:-

en.wikipedia.org/wiki/Metab...

medlineplus.gov/ency/articl...