Thin Diabetes, Fat Diabetes

What’s in a name? A rose by any oth­er name would smell as sweet. But when we are talk­ing about dia­betes, we should choose names that make sense. The French do. They use the term “thin dia­betes” (dia­bète mai­gre) to refer to a cat­a­stroph­ic dis­ease that results from fail­ure of the pan­creas. They use the term “fat dia­betes” (dia­bète gras) to refer to a milder, cur­able cause of high blood sug­ar. Fat dia­betes tends to occur in over­weight peo­ple, and it’s made worse by fat in the diet.

When peo­ple talk about dia­betes, they almost always mean dia­betes mel­li­tus, which is some­times called sug­ar dia­betes or just plain sug­ar. Dia­betes insipidus is an unre­lat­ed con­di­tion in which the body can’t con­serve water.

The most obvi­ous symp­tom of untreat­ed dia­betes mel­li­tus is exces­sive thirst and fre­quent uri­na­tion. The word dia­betes came from the Greek word for siphon, because water seemed to pass right through these patients. Their urine was loaded with sug­ar. Because they were los­ing calo­ries through their urine, they tend­ed to lose weight.

By the 1870s, doc­tors in France divid­ed dia­betes mel­li­tus into two cat­e­gories. Thin dia­betes was a rel­a­tive­ly rare but cat­a­stroph­ic, incur­able dis­ease that tend­ed to hap­pen in chil­dren and young adults who tend­ed to be thin to begin with. These patients rapid­ly went into a coma and died, regard­less of treat­ment. At autop­sy, it was often clear that some­thing had gone wrong with their pan­creas. In con­trast, fat dia­betes was a com­mon, rel­a­tive­ly mild con­di­tion that tend­ed to hap­pen in mid­dle-aged to elder­ly adults. It could be cured if the patient ate less and exer­cised more.

Eng­lish-speak­ing doc­tors didn’t like the terms thin dia­betes and fat dia­betes. Instead, they used the terms juve­nile dia­betes and adult-onset dia­betes. These terms are mis­lead­ing because “juve­nile” dia­betes can strike adults, and “adult-onset” dia­betes can occur in an over­weight child. After the dis­cov­ery of insulin in the 1920s, Eng­lish-speak­ing doc­tors start­ed to refer to thin dia­betes as insulin-depen­dent dia­betes mel­li­tus and fat dia­betes as non–insulin-dependent dia­betes mel­li­tus. Peo­ple with thin dia­betes would die with­out insulin ther­a­py. In con­trast, patients with fat dia­betes often respond­ed poor­ly to insulin ther­a­py.

Now that so many peo­ple with fat dia­betes are tak­ing insulin, it’s con­fus­ing to refer to their con­di­tion as non–insulin-dependent. Instead, Amer­i­can and British doc­tors now refer to thin dia­betes as type 1 dia­betes. Fat dia­betes is called type 2 dia­betes. Unfor­tu­nate­ly, these names are mean­ing­less to the lay­man.

In the 1930s, a British researcher named H.P. Himsworth found that he could induce a con­di­tion that resem­bled fat dia­betes in healthy vol­un­teers by feed­ing them a high-fat diet for only a week. After a week of eat­ing a high-fat diet, the vol­un­teers were giv­en a glu­cose tol­er­ance test. This meant that they were giv­en a dose of glu­cose in water and had their blood sug­ar mea­sured every 15 min­utes for sev­er­al hours. When the vol­un­teers had been eat­ing a fat­ty diet for a week, they got a huge spike in blood sug­ar after drink­ing the glu­cose; but when they’d been eat­ing a starchy, low-fat diet for a week, their blood sug­ar lev­els stayed low and sta­ble after they drank the glu­cose. Himsworth’s review of these exper­i­ments was pub­lished in the British Med­ical Jour­nal in 1940 [1].

When I talk to peo­ple who have fat dia­betes, they typ­i­cal­ly don’t remem­ber whether their dia­betes is type 1 or type 2. Some of them have been tak­ing insulin at least occa­sion­al­ly, so the term non–insulin-dependent makes no sense to them. Most of them have been told that they have to cut back on eat­ing car­bo­hy­drates. Unfor­tu­nate­ly, that means eat­ing lots of pro­tein and fat instead. Trag­i­cal­ly, that also means that they are injur­ing their already dam­aged kid­neys with the over­load of waste prod­ucts that come from burn­ing pro­tein for ener­gy. It also means that they are prob­a­bly mak­ing their insulin resis­tance worse, by eat­ing too much fat.

One solu­tion to this mad­ness is to start using the term fat dia­betes to refer to type 2 dia­betes. The sec­ond solu­tion is to shift the focus in the man­age­ment of type 2 dia­betes. Instead of telling patients to avoid eat­ing car­bo­hy­drates to avoid blood sug­ar spikes, shouldn’t doc­tors be teach­ing their patients to shift to a low-fat, high-car­bo­hy­drate diet to restore their nat­ur­al sen­si­tiv­i­ty to insulin? As the results of Himsworth’s stud­ies sug­gest­ed, clin­i­cal stud­ies of a high-car­bo­hy­drate, low-fat diet have shown great suc­cess in help­ing peo­ple with fat dia­betes shed pounds, con­trol their blood sug­ar, and reduce or elim­i­nate their need for pre­scrip­tion drugs [2,

One warn­ing: If you have dia­betes or any oth­er health prob­lem or are tak­ing pre­scrip­tion med­ica­tion, talk to a dia­betes edu­ca­tor, reg­is­tered dietit­ian, and your pre­scriber before mak­ing any major change in diet.

Ref­er­ence List

1. Himsworth HP. Insulin defi­cien­cy and insulin inef­fi­cien­cy. Br Med J 1940;1:719–722. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2177399/pdf/brmedj04143-0003.pdf
2. Barnard ND, Cohen J, Jenk­ins DJ et al. A low-fat veg­an diet improves glycemic con­trol and car­dio­vas­cu­lar risk fac­tors in a ran­dom­ized clin­i­cal tri­al in indi­vid­u­als with type 2 dia­betes. Dia­betes Care 2006;29:1777–1783. http://care.diabetesjournals.org/content/29/8/1777.long
3. Barnard RJ, Jung T, Inke­les SB. Diet and exer­cise in the treat­ment of NIDDM. The need for ear­ly empha­sis. Dia­betes Care 1994;17:1469–1472. http://www.ncbi.nlm.nih.gov/pubmed/7882819?dopt=Citation


Note: You can find more infor­ma­tion about dia­betes in my book Thin Dia­betes, Fat Dia­betes: Pre­vent Type 1, Cure Type 2.

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