Causes of thin people with type 2 diabetes


In this article, we are going to talk about the reflection of the metabolically healthy obese (MHO): the metabolically ill non-obese (MUN). These are thin people with type 2 diabetes complete or some metabolic dysfunction, such as insulin resistance.

Perhaps these people have been overlooked because type 2 diabetes has always been thought of as a disease of gluttony and laziness, a self-inflicted result of overeating and not exercising enough. But the very existence of the MUN phenotype demonstrates that there is more to type 2 diabetes than overeating and a sedentary lifestyle.

It’s a myth that there are no thin people with type 2 diabetes

Remember that one out of three type 2 diabetics is not diagnosed. It is possible that a significant number of these people are thin. They don’t suspect they may have type 2 diabetes because they feel like it’s not a condition that affects thin people. This is one of the biggest dangers of the “only fat people get diabetes” myth.

It is well known that high blood sugar can precede the development of type 2 diabetes for up to ten years. It is during this period that many of the complications associated with diabetes (nerve damage, retinal changes and early signs of kidney failure) begin to develop. This is the reason why it’s so important for skinny people to maintain healthy blood sugar levels as is the case for overweight and obese people.

What causes high blood sugar and type 2 diabetes in lean people

Unsurprisingly, the causes of type 2 diabetes in thin people are similar to the causes in obese people. They can be roughly grouped into the following categories:

  • Genetic
  • Foie gras
  • Inflammation
  • autoimmunity
  • Stress

We will address each of them in turn.

Genetics as a cause of thin people with type 2 diabetes

Studies of healthy lean offspring of type 2 diabetics have found that they are much more likely to be insulin resistant than lean offspring of non-diabetics. One explanation for this is an inherited defect that causes mitochondrial dysfunction. People with this defect are not able to burn glucose or fatty acids efficiently, which causes lipotoxicity and fat accumulation inside muscle cells.

These genetic mechanisms are capable of causing insulin resistance and high blood sugar, whether one is overweight or obese.

Foie gras

men studies slim asian indians found that they had a 3-4 times higher incidence of insulin resistance than their Caucasian counterparts. They also have a much higher prevalence of non-alcoholic fatty liver disease (NAFLD) and hepatic (liver) insulin resistance.

NAFLD is an independent predictor of type 2 diabetes. Cross-sectional studies have shown that fatty liver and metabolic abnormalities occur together. It has also been proposed that fatty liver disease is not only a result, but also a cause of insulin resistance and type 2 diabetes.

Now keep in mind that these Asian Indian men with NAFLD were not overweight. They were thin and in some cases even underweight. This proves that NAFLD occurs in lean people and, together with the above evidence, suggests that NAFLD may be a major cause of insulin resistance and type 2 diabetes in thin people.

If you think NAFLD might be a rare problem limited to East Indian men, know that up to 30% (nearly 1 in 3) of people in industrialized countries have it. This is a worryingly high prevalence of a condition known to progress to severe liver inflammation and cancer in a small percentage of people, as well as contributing to type 2 diabetes and metabolic syndrome.

Although there may be a genetic component that predisposes people to developing NAFLD, we also know that dietary factors play a role.

Rodent studies have shown that feeding high amounts of sugar and industrial seed oils (such as corn, safflower, sunflower, etc.) promotes NAFLD, while saturated fats such as butter do not. and coconut oil. And in human babies, tube feeding industrial seed oils causes severe liver damage, unlike the same amount of fat from fish oil.

Fructose, particularly the high-fructose corn syrup found in sodas, candies, and various packaged and refined foods, is perhaps the most important dietary cause of NAFLD. The liver turns fructose into fat.

The more fructose you eat, the fattier your liver becomes. Feeding rodents large amounts of fructose promotes NAFLD, and consumption of soft drinks (in humans) may increase the prevalence of NAFLD independently of the metabolic syndrome.

High fructose intake can cause fatty liver disease whether you are overweight, obese, or type 2 diabetic. Do you think this might be a problem in a country where soft drinks make up nearly 10% of caloric intake? overall?

Since the liver handles fructose the same way the liver handles alcohol, too much fructose leads to a variety of problems similar to alcohol abuse: high blood pressure, high triglycerides, and low HDL, obesity, cirrhosis and insulin resistance.


In the previous study of lean Asian Indian men with diabetes, they were found to have a 2-fold increase in plasma levels of the inflammatory protein IL-6 compared to lean subjects without diabetes. The associated chronic low-grade inflammation is an important mechanism for decreasing insulin signaling and causing insulin resistance in muscle, liver, and fat cells.

Additionally, inflammation has been shown to precede the development of diabetes. Infusion of inflammatory cytokines into healthy, normal-weight mice causes insulin resistance, and people with other chronic inflammatory diseases are at increased risk of developing type 2 diabetes. For example, about one-third of patients with chronic hepatitis C develop type 2 diabetes, and people with rheumatoid arthritis are also at increased risk.


Until recently, type 1 and type 2 diabetes were considered separate entities. Type 1 diabetes (or insulin-dependent diabetes) was caused by autoimmune destruction of beta cells in the pancreas, resulting in decreased insulin production, while type 2 diabetes was caused by resistance to insulin. insulin from liver, muscle and fat cells.

However, recent research has shown that the line between these two conditions may be much more blurred than previously thought. It is now known that type 1 diabetes, which usually begins in childhood, can develop slowly later in life. This form is known as latent autoimmune diabetes (LADA) or more informally as type 1.5 diabetes.

Studies suggest that type 1 diabetes in adults is often misdiagnosed as type 2 diabetes, and up to 10% of adults with type 2 diabetes may actually have the autoimmune form.

Thin people with diabetes develop type 1 autoimmunity

Even more relevant to this article is the finding that 1 in 4 skinny people with type 2 diabetes produce antibodies against glutamic acid decarboxylase (GAD).), the same pancreatic enzyme that is attacked in autoimmune type 1 diabetes.

These findings suggest that a significant number of lean people with type 2 diabetes they may suffer from autoimmune diabetes. Obviously, this will require a different treatment strategy than the non-autoimmune form. The way to know if you belong to this group is to take a GAD antibody test.

Interestingly, about 5% of patients with autoimmune thyroid diseases also produce antibodies against GAD. Therefore, if you have Hashimoto’s or Graves’ disease as well as blood sugar symptoms that do not respond to dietary changes, you should have your anti-GAD antibodies checked.


Under stressful conditions, the body produces higher levels of the hormone cortisol. Cortisol performs a number of important functions, but one of its main functions is to raise blood sugar. This is an incredibly useful evolutionary mechanism that is part of the “fight or flight” response that prepares us to face a challenge or threat.

However, this mechanism was only designed for short periods of stress.

Chronic stress as we experience it today, like worrying about being audited by the IRS, driving in traffic, and suffering from degenerative diseases, was not part of the lives of our earliest ancestors. This means that our body is unprepared to deal with the effects of chronic stress, which includes chronically high levels of cortisol.

Because? Because cortisol is capable of raising blood sugar to unhealthy levels even when a person is fasting. It also means you can be skinny, eat the perfect diet, and still have high blood sugar (and therefore type 2 diabetes) if you suffer from chronic stress.


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