Under 40, healthy BMI, but Type 2 Diabetes?

[Rich_036]

@Rich_036 firstly welcome to the forum and like I did when I joined last October, the vast amount of knowledge here is impressive and very helpful.
I was diagnosed last October with a HbA1c of 86 and am now, according the diabetes nurse officially in remission. While I am older than you (63 at diagnosis) I was also around 84kg, wait was around 32/34 and at 6'2" definitely did not feel that I was in the diabetes risk zone. I also ran at least once and often twice a week, while also doing a lot of walking. When I met the diabetes nurse she called me an atypical diabetes patient. I also did exactly the same as you, cut the carbs to less than 50g/day for about a six weeks and upped my exercise levels which led to significant weight loss . I took 1 tablet of metformin reluctantly for 12 weeks following a bout of ill health in mid-November but stopped in mid February this year. My HbA1c is now down to 46 and if I am lucky it will fall further over the coming months.
My diet is a little carb richer now but still less than 130g/day and I have managed to put a about 1kg of weight back on but I am still under 80kg and there are days when it all comes off again and I am in the 73.5 to 74.5kg range. My waist is 31/32 which is a pain as I am slowly replacing my wardrobe to address this fall.
When I looked back at what may have triggered type 2, the fatty liver issue is certainly one possible factor as like you my weight was all around my waist. However, I also realised that my love of bread and rice may not have helped nor the lonely drives between home and the various places my projects took me which allowed me to eat sweet stuff or packaged foods like sausage rolls, Cornish pasties and other such delicacies. I also had to live away due to some projects and this meant eating out on a regular basis. Whether this is the cause of my diabetes I cannot definitively say, but the lifestyle clearly wasn't healthy even though I did some exercise at the time.
The other factor which may have been material for me, is stress. My work was often stressful and particularly the last six years before I retired in December last year. I notice that my BG may go up higher than normal when I get stressed even now (normally a bad round of golf) but in the main my BG tests are pretty good with a fasting level of around 5.4 to 6.4 and two hours after dinner in the 7.8 to 8.4 range.
You need to figure out what level of carbs you need to keep your BG in a good place, but it is likely to be higher than where you are now. Also check your calories to make sure that your intake is enough to maintain your lifestyle. I exercise most days and currently consume between 2,500 and 3,000 calories a day.

Thank you for your story - it’s really helpful to hear and I recognise a lot of myself in it.

Eating such unhealthy foods has definitely been a feature. I have a busy and sometimes stressful job with quite a lot of time pressures, and often finishing late or starting early. Also have a toddler who makes life a joy but also costs me sleep and stress and, couples with my late work finishes and getting her to bed, often meant eating late and unhealthily too.

The more I look on it must just be T2D but I feel unfortunate to be younger and otherwise fit.

Definitely one thing on my mind is how after my crash diet I return to something that is higher carb than now, but also a ‘new normal’ happy medium that isn’t like the bad old days.

 

[Rich_036]

Assuming you have this kind of T2D, losing 10kg is likely enough to have zapped it.

Check out the DUK-sponsored ReTUNE trial, weight-loss remission for people with baseline BMI sub 27: https://www.diabetes.org.uk/about-us/news-and-views/retune-study-lower-body-weight Avg baseline BMI about 25, and avg weight loss required to get to remission 8%.

It took me about 9 months to get there. Based on HbA1c but really I knew things had normalised when my fasting BG was down below 5.0 mmol/l consistently.

That was September 2018, so I've maintained the weight loss & normalised glucose regulation for coming up to 7 years. It hasn't really been that big a deal, but that's because I got lucky with my genes in terms of hunger & satiety.

That’s good to hear! Well done, too!

I have already lost 10kg on my diagnosis weight but haven’t regularly been getting fasting BG below 5. Always in the 5s though. 2 or 3 times in the 4s. But it’s only been 2 months (and only really 1 month of serious dieting) maybe I need some more time maintaining this lower weight still? I am also still on Metformin…

One thing I worry about is that 10kg down is an unsustainable new weight to maintain. I was as normally about 87-89kg in recent years, then about 85kg on diagnosis. Now at 73kgish and can see my rib cage all too easily. Hoping a couple of kg up won’t hurt once returning to a ‘new normal’ diet.

Have read about ReTUNE, and Roy Taylor’s work is what inspired me to diet hard. Really pleased to hear it worked for you! Hoping against hope I can achieve similar

 

[JITR]

Definitely one thing on my mind is how after my crash diet I return to something that is higher carb than now, but also a ‘new normal’ happy medium that isn’t like the bad old days.

Yes that's the worry.

Problem is you may have lost some muscle mass ("Now at 73kgish and can see my rib cage all too easily"). If so you'll need to restore it with exercise and resistance training (e.g. weights).

As for diet, I have followed nutritionist Ian Marber's maxim for weight loss. Every meal should be one third of plate each of protein, vegetables and carbs AND you can always replace the carbs with more vegetables.

I have carried on with that formual adding healthy fats (e.g. olive oil), dairy (yogurt, cheese, milk), nuts and seeds, some oats and barley, plus berries and other fruit from time. Maybe I should add some more whole grains but I feel better when I keep my weight down.

Good luck.

 

[Martin.A]

One thing I worry about is that 10kg down is an unsustainable new weight to maintain. I was as normally about 87-89kg in recent years, then about 85kg on diagnosis. Now at 73kgish and can see my rib cage all too easily. Hoping a couple of kg up won’t hurt once returning to a ‘new normal’ diet.

I was 87kg at diagnosis and dropped to 68kg, but I thought that was too low - like you, ribs showing. I've gone back up to 72kg and have had no problem maintaining that weight for the past 3 years. In fact I'm only a couple of kgs short of the weight I was when I met my wife 36 years ago (though not in such good condition).

 

[JITR]

The more I look on it must just be T2D but I feel unfortunate to be younger and otherwise fit.

I think it would help many healthy people to stay healthy were annual blood tests, including HbA1c, to be made available to all over 30s on request.

You might be surprised how many would find they are pre-prediabetic or prediabtic with HbA1c in the range 39-45+. An early warning of the need to eat well to maintain good health.

I would probably not have taken up the offer voluntarily, but my wife says she would have nagged me until I did.

 

[Rich_036]

Yes that's the worry.

Problem is you may have lost some muscle mass ("Now at 73kgish and can see my rib cage all too easily"). If so you'll need to restore it with exercise and resistance training (e.g. weights).

As for diet, I have followed nutritionist Ian Marber's maxim for weight loss. Every meal should be one third of plate each of protein, vegetables and carbs AND you can always replace the carbs with more vegetables.

I have carried on with that formual adding healthy fats (e.g. olive oil), dairy (yogurt, cheese, milk), nuts and seeds, some oats and barley, plus berries and other fruit from time. Maybe I should add some more whole grains but I feel better when I keep my weight down.

Good luck.

Definitely have lost some muscle mass. Challenge will be to make sure when I come off the crash stage of the diet, and try to rebuild the muscle a bit, that I don’t add to the fat.

That’s some good tips on diet, thank you!

 

[Rich_036]

I was 87kg at diagnosis and dropped to 68kg, but I thought that was too low - like you, ribs showing. I've gone back up to 72kg and have had no problem maintaining that weight for the past 3 years. In fact I'm only a couple of kgs short of the weight I was when I met my wife 36 years ago (though not in such good condition).

That’s great! Glad to hear you had no problem going back up a bit and maintaining it

 

[Lucyr]

have a pretty active lifestyle (football once a week, cycling to work (6 miles) at least once a fortnight).

I do though have a sedentary desk job

I am by no means active myself due to disability but that sounds like your definition of active isn’t quite right? Football once a week, a bike ride once a fortnight and a sedentary desk job means very little movement going on. Perhaps something you could work on? I understand we should be active at least 5 times every week

 

[Rich_036]

I am by no means active myself due to disability but that sounds like your definition of active isn’t quite right? Football once a week, a bike ride once a fortnight and a sedentary desk job means very little movement going on. Perhaps something you could work on? I understand we should be active at least 5 times every week

I was probably being too conservative. My avg daily step count pre diagnosis was 9,000, which I don’t think is bad? I walk my daughter to nursery most days, 25 mins, and cycle more than once a fortnight, too (but not always all the way to work - which is a 14 mile round trip). Pre diagnosis I could turn up and do Park Run without much effort, my last time in March being 27:25. I last did a half marathon in 2021. By some people’s definitions I would say I’m active, but by others not. After having a baby 2 years ago it has been harder to fit in regular exercise into my life.

But I certainly see room for improvement though. Since diagnosis I have rejoined a gym and am trying to go on lunch breaks from work. I’ve been reading about muscle strength and insulin sensitivity and think my body type probably hasn’t helped - naturally weak upper body/arms. Definitely something to work on!

 

[Maz2]

I was normal weight when I was told I was pre-diabetic at 42. Got it back to normal. It is not always weight related. I was told I could have increased insulin resistance due to age - I was 63 at the time. This would not be the case with you though as you are young.

I don't know anything about Cpep and antibodies as mentioned by Everyday Ups and Downs but he knows a lot more than me. Hope you sort out what is causing it.

 

[Lucyr]

My guess would be you may be on the cusp of type 1 but I am not a medical professiona

my Cpep number was 964 pmol/L. On my NHS app it shows the GAD test, but the result says ‘not tested. Negative for GAD antibodies by Diabetes screen’. As this suggests, there is also a result for a Diabetes AB screen (GAD, IA2, ZNT8), and the result there gives an Islet cell antibody level (reading of 2 U/mL). I must admit I don’t quite understand the result, but it gives a reference range of 0-20. From what I have read a reading of 2 isn’t high enough to indicate the presence of antibodies?

High cpeptide and normal antibody tests is definitely type 2 not type 1