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Thin Type 2s?

David Spero

September 30, 2009

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.



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