Type 2 diagnosis and not overweight? What you should do.

Thin type 2 diabetes

If you follow along with my blog posts you will know I frequently refer to the best treatment for type 2 diabetes being weight loss. It isn’t lost on me however that not everyone with type 2 diabetes is overweight. Some people truly do suffer with the disease due to genetics and/or age.

So I didn’t want to leave all you lovely people out. Therefore, todays blog is for all of you who have had the diagnosis, are not overweight and want to know what to do.

The bad news

This form of type is unlikely going to be reversible but it depends on its manisfestation. If the onset of the disease has truly occurred either because your genetics have played the type 2 card or because as we age things start to wear out, then it’s unlikely.

Those who are overweight and suffer with type 2, the management plan is primarily weight loss. Those who aren’t overweight, there a few considerations you will need to take into consideration to help manage it aside from this. The good news is this is perfectly doable with some simple lifestyle changes.

The good news

The condition is still perfectly manageable. I come across some very frustrated individuals who have been diagnosed despite trying to be healthy.

The dietary advice is mostly the same as to what we tell other patients without the caveat of weight loss.

Therefore, watching your intake of carbohydrate (a topic I have blogged on here) and being physically active are important. As a rule with our type 2’s, in my job, we recommend around 150g of carbohydrates per day. Roughly translated that is about 40g per meal with allowance for snacks. An example of this may look like:

Breakfast: 40g oats with milk

Lunch: Sandwich with filling of choice

Dinner: 40g uncooked rice with large portion of vegetables and protein

Snacks: 2-3 fruits, handful of nuts, vegetable sticks, protein bite, yogurt.

This daily allowance will massively depend on how much carbohydrate your body can tolerate and how active you are. So this isn’t gospel. A good way to approach this is to see how your glucose levels are at your annual review and if they are high, reduce your carbs and increase your physical activity. Then retest.

Choosing slower releasing carbohydrates can also help. Quick wins include replacing white carbs with brown, wholemeal and grainy carbs. Bulking meals out with vegetables, beans, pulses and lentils also helps. Replacing higher carb foods like rice and white potatoes with lower carb foods such as quinoa, bulgur wheat, pearl barely and/or new potatoes are also simple swaps you can make.

More good news

From my experience those patients diagnosed without being overweight are so well into old age – maybe 70+ (this isn’t a strict rule, more an observation). Therefore, without sounding too morbid, they have a lot less time to live with the disease compared to someone diagnosed at 40.

This means, they are also much less likely to suffer long term complications. So we tend to be a little more relaxed with such patients in terms of blood glucose targets. Therefore, although having good control is favoured, we won’t lose our minds if your numbers are hovering between 5-14mmol/l.

Body composition

One patient I encountered recently was rather put out due to his diagnosis as he was not overweight and tries to be healthy. I only encountered this gentleman at group education and so did not get the chance to delve into his daily habits. So I couldn’t confirm if his lifestyle was indeed healthy.

What did strike me though was though by Body Mass Index standards he was not overweight, he did appear to carry a fair mass of fat around his waist.

We’ve probably all known that one friend throughout our lives who was skinny fat. In clothes they appear thin as a rake only to reveal some chub once the beach comes calling.

Then there are those where the fat isn’t visible and is actually on the inside due to an unhealthy diet, genetics, inactivity and/or smoking. Though these people tend to appear skinny on the outside, inside, which is what really counts, they are prone to health issues.

Body composition helps us describe such people. Body composition is the measurement of someones fat free mass (i.e. bone, muscle) compared to body fat. If you have a low muscle value but a moderate to high fat percentage you could be susceptible to such conditions such as type 2 diabetes. This is regardless of your appearance on the outside.

Simple body composition analysers can help give you a rough idea of what’s happening within you. Not all are the most accurate but some pharmacies will have these. I’m sure you’ve seen them where you take your shoes off and hold some handles. If this sounds like you, it could be worth a try.

In this instance, making healthier dietary choices made up of vegetables, lentils, beans, pulses, seeds, nuts and slow releasing carbohydrates and getting active will help.

Summary

If you have been diagnosed without carrying excess weight I hope this has been useful. I hope also you’ll realise this isn’t a death sentence and actually you can live a full and happy life with a type 2 diagnosis.

Watching the carbohydrate intake and remaining as active as possible are two primary management tools to keep your blood glucose levels controlled. This may be alongside some medication. However, if you are good from a lifestyle perspective the need for intensive therapy should be limited.

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