We’ve all read about people with Type 1 climbing mountains, dancing ballet, or playing professional football. But people with Type 2 are thought by many to be overweight and sedentary. Last week I learned different. It’s an interesting story.
You occasionally hear from diabetes educators about “thin Type 2s,” but for a long time, I thought they didn’t really exist. I thought they were misdiagnosed Type 1s or 1.5s. I figured they had either LADA (Latent Autoimmune Diabetes of Adults) or MODY (Maturity Onset of Diabetes of the Young).
My reasoning went like this: Type 2 diabetes is driven by insulin resistance. Insulin resistance has many causes, but the main ones are physical inactivity and stress. So how could a very active person develop Type 2?
Well, now I know. If you have the right genes, stress can drive even a very active person to Type 2 all by itself.
Last week, I spoke at a support group for people with Type 2. Two of the group members, one man and one woman, were not only thin, but very active. The man kept tapping his foot and rocking his legs back and forth. The woman kept moving around in her chair. Both the man and the woman talked of exercising a great deal.
In my experience, people with Type 2 don’t move as much as these two do. They don’t fidget. They conserve energy. (Readers — has that been your experience?)
Saving energy is vital to survival where life is physically demanding and food is scarce. In a culture like ours, where food is plentiful and physical activity is discouraged, being an energy-saver can contribute to health problems, including Type 2 diabetes.
Solving the puzzle
At first, I thought, “You guys aren’t really Type 2.” In the past, I had actually helped a number of fit 1.5s by diagnosing them (over the phone!) after their doctors had mistakenly called them Type 2 and refused to give them insulin.
But when they started talking, a different picture emerged. The man spoke of being so worried about being late for the meeting that he had checked and rechecked to-do lists, packed and repacked his lunch, and rechecked the meeting schedule several times. “Every time a bus went by,” he told the group, “I would say ‘Damn,’ I should have been on that bus.”
And all this worry was for a support group meeting, not a job interview or a court appearance! He was a very nice man, but he talked fast and often and seemed stressed, even in the meeting.
The woman told us about getting in an argument on the phone after a light breakfast. It was some kind of political argument, and she said she was screaming by the end of it. Afterward, she checked her blood sugar, and it was 270. She said she is nearly always in the normal range, and thought it must have been the stressful phone call that caused the high reading.
Stress in Action
As readers will recall, stress is the “fight or flight” response. It’s for escaping a wild animal or fighting off a mugger. Stress raises your blood glucose and increases your insulin resistance, so that only cells involved in fleeing or fighting will use the glucose for fuel. It also raises your blood pressure so that glucose and oxygen can get to the muscles faster.
These thin, active people were reacting to the thought of being late, or to a political argument, like it was a life-or-death threat. Their bodies prepared to run or fight, getting all insulin-resistant, but all they were doing was talking on the phone or taking a bus. I saw them, and I realized it was true. Athletic people can develop Type 2.
After that, I steered the meeting to a discussion of stress reduction. One woman talked of a tai chi meditation program she goes to at her hospital. She says 30 minutes of meditation lowers her blood glucose so much that she has to be careful about hypos (she uses insulin.)
I had heard that meditation can help people with diabetes, but I hadn’t realized how dramatically. Probably, meditating reduced her stress, which reduced her insulin resistance, so her cells could take in more glucose.
I was really glad to have met this group. Their stories illustrated the stress/diabetes connection better than any experiment. And I sold three books, too. I hope they invite me back.
My uncle has T2, and is trim and fit. It runs strongly in our family (although I am the outlier, who managed to get T1). He was maybe a little overweight when first diagnosed, and has since kept very fit - and yes, he climbed a mountain - Kilimanjaro, two years ago. Staying fit helped him slow down the progress of the disease tremendously, but it has still progressed - he just started insulin therapy last year.
So yes, there are slim T2s! Now then again, his sister is also a T2, and she fits the stereotype - overweight, sedentary, due to a number of other health issues - and her disease progressed about 10x as fast as his.
Posted by Skipper | Sep 30, 2009 at 10:35 amYes, there are thin Type 2’s. I’m tall and a size 8/10. I exercise five times a week, and I have been exercising for 30 years. I still got Type 2.
Posted by Donna C | Oct 03, 2009 at 11:47 amThanks for writing, Donna and Skipper. Donna, I have two questions: Have you been evaluated for Type 1.5 diabetes (LADA or MODY)?
Also, how stressed would you say you are?
David
Posted by David Spero RN | Oct 06, 2009 at 9:12 pmThe book “Why Zebras Don’t Get Ulcers” is a good layman’s source for understanding the “fight or flight” response and how you can manage it. (I’m a Type 1, but experienced with panic attacks in college–that’s how I heard about it.)
Posted by Chris Opsal | Oct 07, 2009 at 12:47 pmI am a thin type 2. My diabetes is genetic as both my mother and maternal grandfather became type 2 at about age 60, like me. I am not insulin resistant, my pancreas does not product enough insulin. I exercise at least 3 times a week, more in the summer months. I play tennis and softball (doubleheaders) often on the same day. I have been on Lantus for about 5 of the 8 years since I was diagnosed with type 2.
Posted by Bob R | Oct 07, 2009 at 1:21 pmStress is definitely a factor in my blood glucose level but I do not believe it had anything to do with my becoming diabetic.
I have even another angle for you. I was diagnosed about 5 years ago. I am for sure type 2 and started insulin last December. I am not overweight and also pretty active. According to the Veteran’s Administration mine was brought on by exposure to Agent Orange. My civilian endo is a little skeptical of this but there is no history of Diabetes in my family.
I am not a type A personality and the only time I was stressed was many years ago when getting shot at.
Robinhood16
Posted by Robinhood16 | Oct 07, 2009 at 1:28 pmIn my mother’s generation, 7 out of 9 of them had type 2 diabetes. My grandmother, and at least 5 of her 13 siblings (I never knew the rest of them) had diabetes. Only 2 of my mother’s siblings were obese. While not what I would call thin, the rest were normal weight or only slightly overweight. And their diabetes was definitely type 2.
Although I am overweight now, I had gestational diabetes when I was pregnant and not overweight.
I believe type 2 diabetes is really many different diseases rolled into one diagnosis, and some forms have a stronger genetic component than others. The type in my family seems to be strongly influenced by genetics.
Posted by Beth | Oct 07, 2009 at 3:31 pmWhat great stories and comments! It seems that many causes of diabetes remain unknown.
Bob R, I would say you are not Type 2, no matter what your doctor calls it. You say you are not insulin resistant; you just don’t make enough insulin. That’s not Type 2, but I am very glad they have you on insulin. I guess the label doesn’t matter so much.
Robinhood, I knew about the Agent Orange connection and mention it in my book Diabetes: Sugar-Coated Crisis. It’s real; that’s why Vietnam vets can claim Type 2 diabetes as a service-related disability. Other environmental chemicals have also been associated with Type 2.
And as Beth says, there is a strong genetic factor also. There’s a lot more going on here than the “it’s all about eating too much” crowd admits.
Posted by David Spero RN | Oct 07, 2009 at 7:17 pmMy father and sister were (both now deceased) slender type 2’s. Neither were stressed personalities. I’m an obese non-diabetic. My brother was a type 1. His daughter a type 1. My granddaughter is a type 1. Neither of my daughters are diabetic.
Posted by Arlene | Oct 07, 2009 at 11:45 pmDavid: You asked if I have been tested for LADA or MODY. I have not. I was diagnosed as pre-diabetic after an oral glucose tolerance test. I took the test because my sister (who is several sizes smaller than I am) was diagnosed as a diabetic a year earlier. My numbers were 102 fasting, 217 after 30 minutes, 212 after 1 hour, and 170 after 2 hours. My A1c runs about 5.8%. I count my carbs very carefully and I exercise. My stress level is low as a general rule. There are exceptions from time to time.
I’m curious why you asked about the testing.
Posted by Donna C | Oct 09, 2009 at 9:54 pmI am a thin, active, “type 2″. At least that was my diagnosis. I take 4 insulin shots a day of about 2-3 units each. I am not insulin resistant, metformin did not work for me, just diet and exercise caused me to lose even more weight. I had gestational diabetes, even though I gained no more than 20 pounds with each pregnancy. There is no diabetes in my family other than 2 deceased grandparents, none in aunts, uncles, cousins, parents, or siblings. I did not test positive for LADA and have not been tested for MODY because of cost. I hate the expression “you don’t look like you have diabetes.”
Posted by Becky | Oct 10, 2009 at 1:24 pmI too am a “thin” type 2 - I am 47 and 5′5″, weight 1321bs. and have had diagnosed type 2 for 8 years now. My mom was a juvenille diabetic and insulin dependant all her life, I attribute the genes to my condition. I treat it as seriously as any type 1 does and it has kept me on a low drug doseage for many years. the indicator I would end up with type 2 was gestational diabetes when I was pregnant at 20 and the doctor’s proclamation I would end up with onset diabetes regardless of my weight.
Posted by Andrea L. | Oct 14, 2009 at 12:49 pmIM T2 NEED TO LOSE WEGIHT PLEASE SOMEONE HELP I HAVE HAD NO SUCESS IM ACTIVE BUT CANT SEEM TO LOSE PLEASE ANYONE HELP
Posted by francesca hylton | Oct 14, 2009 at 2:50 pmI”M an obese type 2 diabetic and would love to know how to lose weight. Can anyone help?! Could someone tell me what to eat. There are so many conflicting ideas. I”d appreciate any help. I’m desperate. Kathy
Posted by Kathy | Oct 14, 2009 at 4:15 pmI have been diagnosed for a little over 10 years. I am tall and relatively thin (having lost 35 lbs. in the last 18 months). My sugar was under pretty good control on meds but the stress at my job has escalated so much that I have been extremely high in my numbers. I did not realize how much the stress affected me until my boss was out on the office for a week. By Friday, my numbers were down by over 125 points. My doctor wants me to go on insulin. I want a new job!
Posted by Karen | Oct 14, 2009 at 4:33 pmDonna, the reason I asked about LADA or MODY is because too often doctors label people “Type 2″ and refuse to give them insulin, when they really are insulin-deficient. The label doesn’t matter; what counts is that you are getting correct treatment. If your A1C is 5.8%, it seems like you are doing the right things, so not to worry about labels.
Francesca and Kathy, Diabetes Self-Management has published many articles about weight loss — see them here: http://www.diabetesselfmanagement.com/articles/Weight-Loss/
Posted by David Spero RN | Oct 14, 2009 at 6:11 pmBut I would encourage you to focus more on your blood glucose and blood pressure than on your weight. Weight is not as important as those other numbers.
I was overweigt for about a year out of my 50 years, and I’m type 2–although I haven’t been evaluated for the other conditions mentioned. This is nothing more than ignorance on the part of the public.
Posted by rick | Oct 14, 2009 at 10:04 pmI am 77 years old and was diagnosed with type 2 diabetes 30 years ago. I am presently 5″ 3″. 110 lbs. I have never known a “fat” day in my life. I exercise regularly, eat properly, have never smoked, and drink only a little wine on rare occasions. I resent the assumption that it due to my life style that I am diabetic.
Loretta
Posted by Loretta | Oct 15, 2009 at 8:51 amI am a very active woman “of my age” and I have Type 2, and obviously has had for 13 years. I weigh a whole 110 lbs, I was never overweight, I ate heart healthy, I exercised, I hiked and spent hours in the gardens when weather permitted.
I was experiencing ‘odd’ symptoms when I was about 50 years old, not the typical diabetes symptoms - slight weight gain tho diet/exercise the same, I just had the feeling something was not right. My doctors assured me I was fine, my A1C was always 6 or lower (only because I was in control and not realizing it), they would give me a pat on the shoulder and say you are just getting older…slow down, etc etc.
Well when I was about 59 years old I was suddenly going blind (there was stress in my life at this time) and the doctor had nerve to say “I know your family history you are not diabetic, (if she knew, she would see family history of diabetes) eye doctor doesn’t know but if you are concerned, come in next week”…well duh this ole lady showed up next morning, my blood gloucose was over 900 !!! and the doctor was fired.
And I am still that same ole active woman with an now an A1C of 5.2 (controlled with metformin) and a doctor who keeps telling me I am not a teenager, quit acting like one ROFL.
Goes to show not all Type 2 fit your profile.
Posted by Gayle | Oct 15, 2009 at 3:56 pmI am also a thin type 2 diabetic. I am 5 ft 2 in and weigh 115 lbs. I am 42 years old, do not drink more than 3-4 drinks per month, do not smoke, and exercise a few times per week. Last 3 months my A1C was 8.9, and I am now taking 5 shots of insulin per day and about 14-22 units each shot. I had gestational diabetes when I was 28 and it never went away altogether. It is frustrating that everything I read about type 2 diabetes says that losing weight will cure me. I do have a stressful life, and maybe stress is the cause of my diabetes type 2. Does any one know if there are any good soures on thin type 2 insulin dependent diabetes that helps us deal with this or understand it better?
Posted by Kennedy | Jan 11, 2011 at 11:02 pmI have been a diabetic since age 50 and am now 77 I too had blood level of 900 and was 80 pounds over weight, I changed my life style and took meds,, but as year went buy my sugar would go from 140 fasting to now 275 fasting, I am on max metformin and max glucatrol my aic is 11.5 ,I told my doctor that after all these years my desire to have some confort food is back and i can excercise any more as i get chest pain when wlaking and short breath.
Posted by john | Sep 11, 2011 at 6:46 amHow ever my doctor said i have the best blood numbers he has seen with the exception of my blood sugar,,,I told him at my age i dont feel i want to venture into new area like insulin,,,Maybe after it gets to 400 at fasting ,
I know about every thing written on diabetes by Johns Hoppkins and Mayo Clinic and that if i live to age 80 I will no doubt be on a kidney machine, But its my choice that i am tired of the fight and the pills that give me blaot and gas and all the years eating bland and tasteless food, and the constant worry and glued to a glucose meter,
I can see ok and wlak some take my bass boat out and sit and puff my pipe, Every one to there choice is my belief ,,,not the doctors .