The Curse of Skinny Diabetes

Treating Skinny Diabetes Is Tricky

Getting it wrong can be fatal.


skinny diabetesI often say there are two kinds of type 2 diabetes, pudgy diabetes and skinny diabetes.  I and about 85% of us with type 2 diabetes are pudgies.  For most of us pudgies, the fix is pretty simple, lose the weight, lose the problem. That is what I did.  No drugs required.

For those with skinny diabetes, it’s not so clear cut, so easy to fix, which is what makes this condition so devilishly tricky to treat.

Type 2 diabetes is a result.  Usually the result of being too fat and exercising too little is type 2 diabetes.  The fat surrounding the body’s cells blocks the insulin from delivering the glucose to the cells.  The body overloads on Overweight, obese, exerciseglucose and someone becomes yet another type 2 diabetic. A pudgy.  Happens all over the world these days and is the downside of growing world affluence.

For those with skinny diabetes, the result is the same, too much blood glucose.  Why it happens is rarely simple to explain.

I think it’s often a genetic issue.  The Han Chinese have been proved to have genetic disposition to type 2 diabetes and genetics is probably what caused Jeff O’Connell’s type 2 diabetes.  Jeff was a writer for Men’s Health magazine and now the editor for   This was taken from a piece he wrote for MSNBC.  He is pictured above.  Not your usual portrait of a type 2 diabetic, is it?  We tend to look like the guy below Jeff.

That’s not me.

Other triggers range from psoriasis and eating too fast to just getting old.  That takes in quite a range of triggers and treating it all is tricky.

Jeff’s father and grandfather both died of diabetes’s complications.  Jeff O’Connell is tall and thin and worked out regularly before his diagnosis.  His blood work for a routine check up showed him to be pre-diabetic.  He was having the symptoms of excessive thirst, just never make the connection.

Like me, he decided to attack the problem with diet and exercise and forgo the drugs.  Like me, he thinks too often that diabetic drugs don’t fix the problem, just treat its symptoms.  He does mention a study conducted by the American Journal of Physiology — Endocrinology and Metabolism, showing that insulin resistance dropped more from exercise than taking the leading diabetes drug metformin.  I have to find that one.

He put himself on an increasing popular diet for diabetes, a low carb diet similar to the Atkins and Paleo diets.  He upped his exercise time and efforts.

At first the results looked good. His follow up exam showed an a1c of 5.0 and fasting blood glucose level of 102.  The low carbohydrate diet and higher level of exercise was paying off.

Sort of.

A second opinion and further testing showed that he had a bigger problem.  His fasting blood glucose level was too high to give a rock sold a1c of 5.0.

That indicated his glucose levels routinely went from way too low to way too high.  His a1c happened to be a nice mean over time between the two, not accurate of his true condition.  On further diagnosis,  Jeff was determined to have reactive hypoglycemia.  His “biggest problem”, to quote one of his doctors, “was hypoglycemia –  low blood sugar.”

A nice contradiction there.

Jeff called this condition “diabetes most brilliant disguise.”  His insulin, probably for genetic reasons, does a poor job of delivering glucose to his cells.

After a meal containing a normal measure of carbohydrates for diabetics, his glucose shoots up to diabetic (and heart attack) levels.  His pancreas reacts by releasing a big blast of insulin.  Even after his glucose level drops, his pancreas continues to pump out large doses of insulin.  That causes his blood sugar to drop too low.   From buzzed up on too much sugar to bonking from too little sugar.

Over time, years and decades of this, his pancreas will wear out unless there is some way of balancing the highs and lows.  That is what probably killed his father and grandfather.  Both were considered thin men, not typical for patients with type 2 diabetes.  Yet a worn out pancreas is probably what killed them both.

To control the ups and downs he continues his aggressive low carbohydrate diet regimen, modified by eating many small meals instead of just three meals, and aggressive exercise.  His numbers, the things so many diabetics live by, have improved to normal levels.  His highs and lows came into better balance.

He also knows he has to stay ever vigilant and not slack off.  Slacking off will be fatal.  The good part is that he in the best shape and health of his life.  I really admire him for that.

The bad part is that of the 10 to 15 percent of those with type 2 diabetes, skinny diabetes,  how many may have his condition?   A lot is my guess and that can be a huge problem.  I wonder if they are doing as well as Jeff O’Connell?

My guess is no.



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The Curse of Skinny Diabetes was last modified: September 19th, 2012 by Dave LeBlanc
Posted in Skinny diabetes and tagged , , .

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