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Lean diabetes: What Is It And Why Does It Need To Be Addressed

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Cases of diabetes are increasing in India and around the world. Type 2 diabetes is the most prevalent form of diabetes in the world, and is usually associated with being overweight or obese. In type 2 diabetes, there is a relative decrease in the amount of insulin produced in the body (insulin deficiency), but also the body’s inability to use insulin to its full advantage (insulin resistance). 

The body requires insulin to handle glucose, and either insulin deficiency and/or insulin resistance can lead to increased blood sugar levels and diabetes. However, in India, it is not uncommon to see diabetes in young, normal weight or thin individuals. This type of diabetes is called lean diabetes.

These individuals may have a body mass index or BMI (height-to-weight ratio) less than 25, but have higher insulin resistance. It is also called ‘thin-fat phenotype’ or ‘metabolically obese normal weight’. In this case, people may present with a normal weight or BMI, and still have increased intra-abdominal and subcutaneous abdominal adipose tissue (fat inside the abdomen and under the skin of the abdomen).

This distribution of fat within the body clusters in abnormal locations around vital organs such as the liver, pancreas, and muscles, which increases insulin resistance and can lead to diabetes.

Sarcopenia, the loss of muscle mass, may also be of particular importance in the Indian population. Research also suggests that individuals with lean diabetes may first progress to need treatment with insulin, indicating that insulin deficiency may also have a component.

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The Facts About Lean Diabetes

We know far less about lean diabetes than the traditionally recognized type 2 diabetes associated with obesity. In urban India, one in three people with diabetes may have lean diabetes. Some research suggests that poverty or poor socio-economic status, childhood malnourishment, or having an early age increase the risk of lean diabetes.

There may also be genetic factors associated with this increased risk. These individuals may present without other conditions called metabolic syndrome that we associate with high blood pressure, abnormal cholesterol profile (especially raised triglycerides), and an increased waist circumference, such as type 2 diabetes.

Despite this, people with lean diabetes may have an increased risk of health problems such as cardiovascular events such as a heart attack and fatty liver disease called NAFLD or NASH.

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Weight Impact of Type 2 Diabetes Treatment?

Treatment of diabetes currently focuses on lowering blood sugar to reduce the risk of complications. There are also treatment approaches to reduce the risk of heart disease in people at high risk of diabetes, particularly microvascular complications, or in those with established heart or kidney disease, not all people with type 2 diabetes have obesity.

But most people with type 2 diabetes have abnormally functioning fat cells, or unhealthy fat, that is driving the metabolic process that results in diabetes in people whose diabetes is primarily driven by unhealthy fats.

These are the people who would benefit from prioritizing weight management in their diabetes treatment, which means not only using medications that control blood sugar but also thinking about which drugs help with weight management as well. can do.

And what other interventions can help with their partner’s weight management such as lifestyle interventions, changes in physical activity, dietary changes, and prioritizing medications, both of which are going to treat their diabetes. But also help them to lose weight.

We need to think about this in most of our patients with diabetes because most of them are not obese, as defined by a body mass index above 30. Most of them would have unhealthy adipose tissue contributing to their disease. process over the years.

It has become much easier to treat diabetes and overweight people with drugs that are becoming increasingly effective in managing the weight of diabetes and other aspects of metabolic health.

So we need to consider the weight impact of the treatment program that we use in our diabetics and prioritize helping them with their weight management while also focusing on treating diabetes.

The Treatment of Lean diabetes

Identifying individuals with lean diabetes is important, as it can allow treating doctors to adapt lifestyles and medications prescribed to address the specific issue of insulin resistance.

Although individuals with diabetes are generally advised to lose weight, people with lean diabetes may benefit from exercise even if they do not lose weight, as exercise is recognized to improve insulin resistance. .

Exercise, especially resistance training, will also increase muscle mass and improve insulin sensitivity in the muscles. There are also some specific medications used for diabetes, called insulin sensitizers, which can reduce insulin resistance and may be particularly suitable for use in lean diabetics.

Precautions against lean Diabetes

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If you have a family history of any kind of diabetes in past, And especially diabetes occurring at a younger age, or in individuals who are normal weight or thin, there are certain precautions you can take to reduce the risk of diabetes or delay the onset of diabetes issues.

  • Exercise regularly
  • Keep your body weight in the normal range.
  • Stay active
  • Eat healthy
  • Have a healthy sleep schedule
  • Do some strength training exercises to preserve muscle mass

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