This blog post brought to you by my massage therapist: “Yea, it’s so weird, you and my uncle both have diabetes, AND you’re both skinny!”

The conversation is inevitable; I get massages frequently, and of course, my pump and CGM are visible. I tend to stick to the same few massage therapists so that I am not constantly explaining that I’m not a robot and you can touch the devices without something blowing up. People are typically very afraid of touching or hitting my device mistakenly. You really can’t do them much harm by grazing your hand past them. I love talking about diabetes in almost all circumstances; one circumstance that I do not want to feel obligated to provide education is when I’m trying to relax doing something like a massage… so, I bite my tongue, respond minimally, and try to get back to my zen… 

New flash: skinny people get diabetes, too. Like many, my massage therapist views diabetes as a fat-persons’ disease. While diabetes is associated with obesity, this is not the whole story, and it represents a poor understanding of the disease. 

Years of research has led to the discovery of multiple types of diabetes – not just type one and type two. However, for our purposes, and for purposes of standard classification, diabetes typically falls into one of three, maybe four, categories. They are: type one diabetes (T1DM), type two diabetes (T2DM), gestational diabetes (GDM) and either medication or procedure induced diabetes. If you’re trying to wrap your head around the medication/procedure induced diabetes – think of someone on chronic steroids that already has insulin resistance or other risk factors that put their blood glucose into the pre-diabetes or diabetes category. Medical procedures like the Whipple can cause diabetes. There are numerous other circumstances – the preceding are just a few examples. Onward… 

Let’s discuss the thought process that is standard in most peoples’ head about how you “get” diabetes. In my experience, very educated individuals, even those in the medical field, are often misinformed about the differences between T1 and T2. T2 accounts for 90-95% of the diabetes in our country; naturally, people know the most about T2. There are numerous risk factors for T2; genetics play a large role. Lifestyle plays a larger role in the onset of T2 than in T1. Diet and exercise (the lifestyle piece) are two of the most modifiable risk factors for T2. That’s why we put so much emphasis on diet and exercise when we discuss diabetes prevention. Individuals with T2 often already have one or several cardiovascular comorbidities like hypertension, hyperlipidemia or hypertriglyceridemia. T2 and cardiovascular health go hand in hand, because cardiovascular health is largely determined by lifestyle as well. Therefore we circle back to a few of the same risk factors for each of these diseases. Make sense? At diagnoses, many are overweight, which is typically defined by having an elevated BMI. Here is where the assumption that everyone with diabetes is “fat”. There are so many T2 risk factors to discuss, but I cannot fit it all in here. I’ve touched on diet and exercise primarily because those are the risk factors that relate most to what the topic here is. 

T1 is super complicated. Research is developing in this area, and I am certainly not as on top of the research as I’d like to be. For the most part, T1 is thought to be an immune disease, which is much different than T2. We think T1 is caused by a combination of environmental factors. T1 is a disease in which the beta cells are attacked and destroyed (these are the precious cells that make the hormone insulin). Beta cell degradation in T2 is typically caused by insulin resistance, which is typically caused by excess body fat.

Can someone with T1 be obese? Sure! Can someone with T2 be thin? Sure! Nothing written here are absolutes. There are always exceptions. Also, regarding the above, I’d like to note that I am fully aware that cardiovascular health is determined by numerous other factors than just diet and exercise; the above was stated to reinforce the relationship between diabetes and heart health. I am attempting to write about these topics in ways that make them easy to understand, rather than focusing on some small details or outliers.

The interesting thing is that when T2 is diagnosed, the individuals are most times overweight. Ideally, diet and exercise are addressed and weight loss ensues. For the person that is diagnosed with T2 and is not overweight (yes, this DOES happen!), diet and exercise may not make as much of an impact as in those that have weight to lose. Follow me? Paradoxically, when T1 is diagnosed, the individual is often underweight, cachectic even. A classic symptom of undiagnosed or untreated T1 is weight loss, which is associated with ketoacidosis occurring in the body – a very dangerous condition that will lead to death without medical intervention. Once treatment begins, these individuals tend to gain weight! 

Hope this post was helpful! Hit me up with your questions!