The proof you don’t have to be overweight to get diabetes

It can be linked to stress, pregnancy, even eating low-fat yoghurt and too much fruit — as these five healthy-looking people discovered to their shock

TYPE 2 diabetes is on the rise. More than 2.8million Britons have been diagnosed with the condition, compared with 700,000 two decades ago.

And by 2045, one in eight people worldwide will have the disorder if global obesity carries on at its present rate, according to new Danish research.

But while type 2 diabetes is often seen as a condition of the overweight, it would be a mistake to think that you’re immune just because you’re slim.

‘The more weight you put on, the less able the body is to produce insulin — a hormone that controls blood sugar levels,’ explains Dr Dushyant Sharma, a consultant diabetologist at the Royal Liverpool Hospital. ‘However, around five per cent of people with type 2 diabetes are a healthy weight.’

Type 2 diabetes happens when the body either doesn’t produce enough insulin, or it becomes ineffective at using the insulin that it does produce (known as insulin resistance). This leads to high levels of blood glucose which, over time, can cause serious complications such as kidney damage.

Here, five slim people who were shocked to discover they had type 2 diabetes share their stories. Dr Sharma and Dr Hisham Maksoud, a consultant endocrinologist at Spire Nottingham Hospital, explain why they developed the condition — and what lessons you can learn to reduce your risk . . .

GRANDMOTHER WHO ATE LOW-FAT FOOD

elaine GoldwaTer, 63, an administrator, lives in lancashire with her husband Phil, 70, a taxi driver. They have two daughters and two grandchildren. elaine’s body mass index (bmi) is 23, so within the healthy range (18.5 to 24.9). elaine says: oNE of the biggest shocks about being diagnosed with type 2 diabetes was learning that the low-fat yoghurts I’ve been eating because I thought they were ‘healthier’ could have contributed to my hidden sugar intake and to me then getting the condition.

Two years ago, I started feeling really tired. It was out of character as I’ve always been in good health, keeping an eye on my weight, eating lots of fruit and veg, and being fairly active. I like walking, and at work I’m always on the go.

My GP did various tests, including an HbA1c blood test, which gives a picture of your average blood sugar levels over the previous three months. My reading was in the low 50s, when normal is 42, and he diagnosed me with type 2.

I was shocked, though actually my brother had been diagnosed 30 years ago with type 2 diabetes when he was in his 40s, despite being slim and otherwise healthy.

My GP thought I could control my diabetes without medication and sent me on a course about how to do this. It was a real eye-opener. I thought I ate healthily, but I learned that low-fat yoghurts can be loaded with sugar.

I’ve now swapped them for natural yoghurt, and given up all cakes, biscuits and chocolate.

After a year, I am now classed as pre-diabetic (my blood sugar level is higher than normal but not enough to be considered diabetes). I’d like to get it lower still.

That said, my brother, who since his diagnosis has always had good blood sugar control, is now, at the age of 70, on insulin — so I don’t know what the future will bring.

EXPERT COMMENT: The older we are, the more the risk of diabetes increases, explains Dr Sharma, because cells that produce insulin decline in number and function as we age.

‘Having a family member with type 2 increases the chance of getting the condition as it may be genetic. But Elaine’s brother was diagnosed 30 years ago, so if there was a genetic link you might have expected her to have developed it at a similar age to her brother.’

Elaine’s love of low-fat foods could have had an impact because of the hidden sugar, adds Dr Maksoud. (Manufacturers add sugar to make low-fat products taste better.)

‘Insulin works on supply and demand,’ he explains. ‘You have a reserve of insulin in the pancreas, and if you eat a lot of sugar, more insulin is used, so there is less left in reserve, which can lead to diabetes. People developing type 2 diabetes on a low-fat but sugary diet is something I see a lot.’

BUSINESSMAN WHO WAS SO STRESSED

Simon SaliSbury, 62, a chartered surveyor, lives in manchester with his wife Tina, 56, a special needs administrator, and has three grown-up children. at 5ft 9in and 12 st, his bmi is 24. Simon says: SoMETIMES I convince myself that I haven’t even got type 2. I only found out by chance, after a private health MoT six years ago revealed my blood sugar was high.

The diagnosis seemed to come out of nowhere, with no obvious

symptoms — though, in hindsight, I’d been waking up in the morning feeling thirsty and sometimes at night too. But I wasn’t overweight, my diet was pretty good and I swam and played football.

Nor is there any diabetes in my family, though, sadly, my father died of a heart attack aged 56.

The only thing I could think of was that I was under a lot of stress running my own company.

I saw a diabetes consultant who prescribed metformin and gliclazide, and these, as well as staying active and eating healthily, have got my blood sugar to normal. The thirst, such as it was, has gone and I’m no more tired than the next person.

EXPERT COMMENT: Stress can be a factor in type 2 diabetes, especially if it disrupts sleep, since this increases levels of the hormone cortisol — which normally subside at night — and this, in turn, can increase the risk, says Dr Maksoud.

‘Simon’s father had a heart attack at a fairly young age and I wonder if there was a missed diagnosis of type 2 diabetes — a risk factor for heart attack,’ says Dr Maksoud.

‘The condition can go undiagnosed for years, whilst the production of excess insulin can increase the risk of heart attack or stroke. For this reason, type 2 can be more damaging than type 1 because people don’t know they have it, as symptoms are easy to miss.

‘Because of his family history, Simon should be especially careful about his diet, doing some brisk exercise such as walking for 30 minutes a day, making sure he sleeps well and having his blood pressure and cholesterol checked every year.’

THIRTYSOMETHING GYM REGULAR

FranceSca libra, 32, a writer, lives in manchester with her husband brad, 32, a businessman. Her weight, 9 st, and height, 5ft 7in, gives her a bmi of 20. Francesca says: MY consultant is always telling me that I’m a ‘mystery’. Even he can’t understand why a young woman who is a size 8-10 and does cardio workouts at the gym four times a week should develop the condition.

It was picked up quite randomly two years ago. I’d gone to see my GP for a thyroid test as I’d been feeling tired. He found my blood sugar was a touch high, but because I was such an unlikely candidate for diabetes, he said he’d see me again a few months later to check if it was just a blip.

There is diabetes in my family, but type 1. My father was diagnosed when he was a teenager and has been taking insulin ever since.

Further blood tests a few months later confirmed I did have type 2. (They said it wouldn’t be type 1, as

typically it’s diagnosed younger and makes you ill very quickly.)

It took me about six months to come to terms with my condition — both physically and emotionally. I cut out carbs and ate more protein, such as chicken and eggs, to prevent spikes in blood sugar, but I couldn’t get my levels within the recommended range, so I was prescribed gliclazide and metformin. Now I’m at normal levels.

I can’t help wondering, over and over again, why it has happened

EXPERT COMMENT: Francesca’s situation is by no means typical, since she is not only slim and healthy but also so young, says Dr Maksoud. Type 2 usually happens in people from the age of 40.

Cases like this could be a condition that behaves like, but isn’t, type 2 diabetes. one possibility is maturity onset diabetes of the young, which is a form of diabetes caused by a gene mutation.

or it could be latent autoimmune diabetes of adults — a form of type 1 diabetes that develops later in adulthood and is treated with injected insulin.

‘Alternatively, Francesca may have a health issue linked to insulin production, such as polycystic ovary syndrome, which can cause insulin resistance,’ he suggests.

He advises Francesca raises this with her consultant, so she can get tested for these conditions, just to be sure that she does have type 2 diabetes — as if not, she may need different medication or insulin.