Diabetes despite bmi 18 and healthy eating

[Charcharm]

Many of the women in my family - my late mum and grandmother included- develop type 2 diabetes in their 60s and 70s. What’s perhaps unusual is that they have all had bmi 17-18 with healthy eating habits. No sweet tooth whatsoever, not because of any particular efforts, but just naturally so. My mum didn’t enjoy sweets or baked goods and preferred fruit. Alcohol only a few times per year.

Yet they all develop out of control diabetes. I can only assume there is some powerful genetics at play?

I am now 50 and am wondering what I can do to prevent diabetes as all the advice I hear centers around making lifestyle choices, which didn’t help anyone in my family. It’s not just the diabetes, vascular dementia followed the diabetes diagnosis within ten to fifteen years in all cases. It was horrific and I don’t want to put my children through anything like that if I can help it.

My gp has no time to discuss any of this, I get the same old advice about watching what I eat etc, so I thought I’d ask here. If anyone has any knowledge to share I’d be so grateful.

Thought I’d add that we are Northern European - I mention this as I’m aware of the Asian Indian phenotype with a slim build but high body fat and its links to diabetes (apparently it’s a thing). That’s not our heritage, body fat is not high.

The vast vast majority of type 2 diabetes is caused by lifestyle issues but there are always going to be people whose genetic makeup causes this no matter what they do.

Its the same with high cholesterol, there is a big genetic component for some people that no matter what they do lifestyle wise, they're going to need statins.

Does HRT help prevent vascular dementia?

Fruit and vegetables still have sugars. Just because they are natural ones doesn't mean they don't impact blood glucose. The same with starchy carbohydrates, even if they're from wholegrains. But, your family may just be unlucky, there are several sub-types of type 2 that can affect people who don't have the classic presentation, e.g. MODY. You can have tests for these types. And although lifestyle may be less important in those cases, regular exercise and a good diet would help type 2 to be well-controlled.

I do think that lifestyle plays a part. However for some people it is caused by genetics.

Interesting re different types of diabetes - I assume one would have to go private to have that looked at? And perhaps it doesn’t make much of a difference as outlook and treatment would be similar?

Good question re HRT. I have yet to look into it in more detail as I’m generally avoiding the whole issue as far as I can - I feel powerless to avoid what may be coming health wise as there are no effective treatments for dementia so I’m putting my head in the sand for now. It terrifies me. But maybe HRT can help delay things. And as dh keeps pointing out, perhaps I haven’t inherited these crappy genes after all, you never know

Benecol and fish oils lowered mine.
No alcohol - lean protein.

I know the research supports HRT being a preventative for dementia but not sure on what type of dementia.

In fact Im hoping a lot from HRT if I ever get it

BMI 17-18 is very small. Muscle mass plays a huge role in regulating blood sugar levels and unless a person lifts weights/eats adequate protein then it’s natural to lose a lot as you age. Another reason why it’s so important to do regular resistance training and eat a high protein diet as we get older to at least maintain muscle. Low muscle mass is linked to increased risk of T2 diabetes. Would be a good preventative measure to help decrease your risk at least.

Creatine (supplement) has also recently been linked to decreased risk of dementia and helps build muscle in the gym too (what it was originally used for but now a whole host of other benefits are being discovered). I think it was higher doses they found this for so you may have to google the best amount to take from that research. Loads of solid evidence backing that supplement too.

I am absolutely not an expert, but having been pre diabetic due to my own poor lifestyle(and it wasn't that bad, when I did a food diary it scored as good) I have managed to completely change my blood test results and now I'm the Good range. The biggest change came when I started doing weekly weight lifting. I already had quite a healthy diet and an active job, easily doing the 10,000 steps a day, but adding in weights made a big difference.

https://open.spotify.com/episode/3Jj7yM1WylDrnHX5mdWmpv?si=br9VlDosQ7aPFTOTYAToKQ&t=0&pi=k-ZwhAuvRvCog

I found this super interesting.

I was diagnosed with diabetes type 2 in my early 50s and I’m not overweight. I’m active and didn’t have a bad diet. There were improvements I could make (cutting sugar completely, going very low carb, maintaining good hydration) and I did that as soon as I was diagnosed, but I still have diabetes. I take metformin and with my careful diet I’ve been able to keep my blood sugars in the normal range for the most part so I hope that will act as some protection against dementia and other diabetes related problems in the future. There’s no history of dementia in the family. My mum got diabetes in her 70s, so there may be a genetic component, I’m not sure. It sucks. Not everyone gets diabetes because of their lifestyle - sometimes it’s just bad luck.

I reccommend you getting a Continuous Glucose Monitor. Even getting a free trial one for a week or two that works with an app on your phone would be good.

Within days you will find out how your insulin spikes in response to the food you eat and will probably learn that you are eating too many carbohydrates and eating too often.

You want to aim for low blood sugar most of the day and for the blood sugar spike after food to not be really high, you want low short peaks.

You may find a big culprit is a certain sauce that is often used rather than the potatoes, white rice or pasta you eat daily for example.

Many people reverse type 2 diabetes by going keto or carnivore.

Plenty of healthy people have cancer, high blood pressure, etc. Lifestyle doesn’t insulate you from everything.

People have given really good advice about reducing your risk, especially by increasing muscle mass.

But since you are fairly likely to get it eventually, making sure that it is diagnosed quickly and managed well is really important. The new diabetes drugs (ozempic, Mounjaro) reduce dementia risk, so the good news is that there’s better and better treatment available now. But get on top of it quickly and well.

Are these free from the GP, I would be interested in this but I have good glucose levels so probably wouldnt be offered it

I was diagnosed with type 2 and treated by Dr Gallen who treated Sir Redgrave about 10yrs ago, in many appointments and conversations he divulged how much they knew and how they suspected genetics play actually a huge part of conditions such as diabetes.

Type 2 diabetes actually has a stronger link to genetics than Type 1! It’s just it also has lots of lifestyle risk factors (unlike Type 1) so people are less likely to think of genetics as an “explanation” for their disease

Probably private for type 2, yes. I was tested on the NHS because I am late onset type 1 with some unusual features. Basically, my pancreas hung on with some insulin production capacity for a long time, so they wondered if I was a type 2 misdiagnosed. I'm not!

All my older siblings got type 2 diabetes, my Mother managed to not get it though was pre diabetic for ages. My siblings did all get overweight. As they are a lot older than me and I saw what happened one thing I also did was really cut down on alcohol. Your families BMI is actually just under the healthy range. I know it’s a bit of a blunt tool but I wonder if being very light is a contributing factor.

Cardio exercise regularly can help control the development of insulin resistance. But if you are genetically predisposed, all you can do is monitor your blood sugar and if it starts to creep up, take all the medical advice available.

I developed pre-diabetes, and went on a support course offered by NHS.

They focused on diet (main things to reduce, sugars, carbs and if you're having carbs make them wholegrain/wholesome ie carrots/potatoes etc with skin on).

Also, more physical activity, trying to keep stress levels down and try and sleep well.

Does walking count?

my maternal grandfather’s family were all slim with type 2 diabetes. Thankfully my mum hasn’t developed it so fingers crossed