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Even Skinny People Are at Risk for Type 2 Diabetes

Even Skinny People Are at Risk for Type 2 Diabetes

With November being National Diabetes Month, there’s more than the usual focus on the epidemic in this country: 25.8 million children and adults in the United States—8.3% of the population—have diabetes, with 7 million of them undiagnosed, according to the American Diabetes Association.

And we have all heard the description of a typical patient with type 2 diabetes. He or she is overweight or obese and sedentary. But you may be surprised to learn that people who are slender and active can develop type 2 diabetes as well, and the symptoms for the majority of those afflicted (normal and overweight) can be subtle.

Interestingly, the risk for diabetes is more about the fat you have inside your body than what is visible. What I’m talking about is visceral fat—the fat surrounding your organs. There is a condition known as Thin Outside, Fat Inside, or TOFI for short. These are people who look trim but have visceral fat, which can lead to inflammation and possibly diabetes.

While normal weight men can certainly develop diabetes, the usual suspects are women who watch their calorie intake to keep their weight down, but they don’t eat quality calories. As an example, skipping breakfast, eating a small bag of potato chips for lunch, pasta for dinner and salad with regular dressing and drinking diet soda all day may be the kind of diet the aforementioned women might eat.  You probably won’t gain weight on this diet, but you will increase your internal fat. The other culprit is yo-yo dieting. When you lose weight, you lose fat and muscle. When you yo-yo back up the scale, fat settles where muscle used to be.

Stress can also contribute to visceral fat. When a person is constantly stressed out there is an outpouring of cortisol and other stress hormones. Your body goes into fight or flight mode, which prompts the need for the body’s metabolic mechanism to store fat so there is some quick energy on hand. To add insult to injury, cortisol increases blood sugar. When blood sugar is out of control, inflammation ensues. This can lead to blindness, limb loss, heart attack and stroke, just to name a few problems if diabetes is left untreated.

Unfortunately, most patients and physicians are not on the lookout for diabetes in an adult who appears to be thin or normal weight. What further complicates matters for diabetes in general, is that the symptoms can be easy to miss. They may include none, one or several of the following: excessive thirst, urination, hunger, fatigue, tingling of the fingers and toes that can be intermittent, blurred vision, frequent colds, yeast infections, cuts that seem to take forever to heal, gum disease and weight loss. Because of the relatively silent nature of diabetes, it is generally recommended that all adults have a fasting blood sugar or hemoglobin a1c checked every three years.

Type 2 diabetes is very treatable with diet, exercise and medications (if need be). It is important that regardless of whether you’re a man or woman, large or small, round or tall, get regular check-ups, pay attention to any changes in your body and report any of the above symptoms to your doctor. If you are in tune, you will be able to pick up these subtle signs before you have full blown type 2 diabetes and your need for care becomes a medical emergency.

Medically reviewed in October 2018.

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