Any thin Type 2s with normal metabolic profile?

Hi everyone,
I'm fairly new here and have posted 2 other questions on other forums. I'm a 40 yr. old female. My Dr. says I'm "likely pre-diabetic" based on my fasting numbers (100-116) and slightly elevated post meal numbers(120-180 at 1hPP/normal at 2hPP). My A1C is only 5.2 so he says I'm not fully prediabetic, but "on my way." I have a family history of T2.

However, I'm wondering if it's more likely that I'm in the very early stages of T1 (LADA) because I don't fit the T2 profile. The only T2 risk factor I have is family history. I am underweight (inexplicably lost 10 lbs. 2 yrs ago and haven't been able to gain it back--I'm 5'5 and 100 lbs.) and have normal cholesterol (158), triglycerides (53), HDL (81) and LDL (66) and normal-low BP (110/68 last check). I also have autoimmune disease in my family (including possible celiac in myself and my son).

Are any of you Type 2s thin with no metabolic syndrome? I know there are thin Type 2s, but I'm wondering if they typically still have higher cholesterol/BP, etc.? I know there is no "typical" in diabetes, but I wanted to get a general sense if I may be on the right track of thinking I'm more likely moving toward LADA vs. Type 2 based on my normal metabolic profile.

Thanks so much!!

LADA is something I would look out for. LADA T1's are often misdiagnosed as T2 simply because of their age. That said there are also thin T2's and at this stage it may be hard to tell the difference without antibody testing, even then a negative antibody test would not rule out LADA T1.

I am a thin type 2 without metabolic syndrome, I am 5'7 and 110 pounds. I take amaryl and eat very low carb, but sadly, it's getting harder to control,which my endo told me would happen, because it is a progressive disease. Best of luck!

Hi Kittywitty: It's possible that you are pre-Type 2 diabetic, but based on your description and autoimmune history, it is far more likely that you are pre-Type 1 diabetic/LADA. True thin Type 2's are rare (Dr. Richard Bernstein, author of "Diabetes Solution" says they don't exist); most are people who either are adult-onset Type 1/LADA or MODY. Even at this stage, you can get autoantibody testing (Glutamic Acid Decarboxylase Autoantibodies (GADA), Islet Cell Cytoplasmic Autoantibodies (ICA), Insulinoma-Associated-2 Autoantibodies (IA-2A)). I wrote a blog of my top ten tips for the newly diagnosed adult-onset Type 1 diabetic; maybe that would be useful to you? Best of luck to you!

Thanks, Stemwinder. I have an appt. with an endo in April and I am planning to bring up antibody testing. I'm worried they will think my numbers aren't "bad" enough to warrant further right now, but we'll see. Thanks again! :)

Thanks for sharing, momto3! Do you mean your blood sugar is getting harder to control? Have you ever been tested for antibodies? Thanks again!

Melitta, thanks so much for your reply! I've been reading so much about LADA these past few weeks and it seems like a real possibility. My fasting and post meal numbers have gone up in the last 2 yrs., but I still stay between 120-180 most of time. I used to go low--2 yrs ago I would regularly go down into the 50s and 60s. I don't think I've had a reading below 85 (and mostly in the 90s as my lowest #) in the last month. If this is LADA, it sure is slow moving!

As I mentioned in a reply above, I have an appt. with an endo in April and want to ask about Type 1 and antibody testing, but I'm worried they will want to wait to see if my numbers get worse before they take that route.

Thanks so much for sharing your top ten tips--it's fantastic!

Thanks for sharing! :)

yes blood sugars are over 200 after meals and fasting are in the 130s without meds. I have had to increase the dosage of my meds in the last month too:( I have had antibody testing and it came back negative so im one of the rare ones I guess. My endo said I could be mody but that the testing for that is very expensive and really not of any use because I wouldn't be treated differently than what I am now.

Another thin type 2 here and diagnosed at 28 years old. I do not have metabolic syndrome or fit the profile for type 2. I had gestational diabetes when pregnant with my son at age 19 and weighed 80-90lbs until the last few months of the pregnancy. I sure surprised the doctors. I do not have a strong family history.

My cholesterol and trigs are all in normal range and BP is normal as well. I'm 5'2" and fluctuate between 102-110lbs depending on carb intake. Based on my diagnosis OGTT, I seem to have high insulin levels. This makes me think I'm not LADA, but I have not had anti-body testing at this point so it's not completely ruled out. Would like to do them one of these days.

I seem to have normal fastings, but a problem with post-meal numbers. I'm very sensitive to carbs. I have reactive hypos occasionally after high-carb meals.

Here are my diagnosis labs if anyone would like to have a look:

Azurah, Thanks so much for sharing your story (and your labs)! Yes, your high insulin level points more to Type 2 (from my understanding--I'm still new at this!). I'm surprised your A1C wasn't even higher. What do your post meal numbers run? I was having reactive hypos after high carb meals, but since going lower carb 18 mos. ago, that seems better. The last few weeks, I haven't been going below 85 and usually not below 90s as my lowest of the day. I guess I'm really sensitive to carbs, too, since that's what really spikes my BG. Thanks again for sharing! Maybe someone else will chime in about your labs. Best of luck! :)

I was briefly dx as type 2 by my primary care dr, I also previously had gestational diabetes with both of my pregnancies, I am thin about 5'4" 120 at the moment, that is my normal weight. After my pregnancies I would go back to normal levels however last year I had routine labs that showed a glucose of 356, PCP started oral meds but I wasn't satisfied with that so I went to an endo, had antibody and additional testing and was officially dx LADA. I was GAD antibody positive, also in comparison to the poster who linked her labs my glucose was 220 and insulin level 8 at the time of draw, def low. I was immediately started on insulin but am on fairly low doses. I think thin type 2 can happen for sure but I also think some drs (especially PCPs) tend to wave off type 1 in older people (I was 37 when dx) I think it is good you are seeing endo! My endo is awesome! Good luck!

I aim for keeping my post-meal numbers below 140, but now and then I eat something higher in carbs and my BG will go over 180, even over 200 depending on what I eat.

I think my A1c is low because the lows sort of negated the highs when everything averaged out.

My lab results seem to strongly point to type 2, but in all other ways I don't seem to fit the profile. I'm very curious if it's possible to go from where I'm at to an eventual LADA diagnosis. I'm really interested in antibody testing, but I no longer have the insurance that the endo accepts so I'll probably have to wait until after I graduate and find a job.

Hi kimmiejo! It's great you sought out an endo and got the testing done. I'm hoping the endo I see is familiar with LADA! :)

Azurah,Yes I've heard that lows and highs can average out to an OK A1C. It sounds like you're handling your BG levels pretty well with your diet. If it is LADA, eventually your numbers will rise no matter what you're eating and hopefully you'll be able to get the antibody testing done at that time. Best of luck with graduation and job hunting! :)

I definitely don't fit the "profile"! 20 years old, reactive hypoglycemia probably since I was about 12 but only diagnosed when I was 16. I was finally diagnosed as insulin resistant last month. HDL, LDL, BP, triglycerides all normal. I'm juuuust overweight (5'2", about 140 pounds), but I walk miles every day and I eat fairly well. My c-peptide is high, though, even if my A1c is normal (5.1 at last count), and it's nearly impossible for me to lose weight (that's a sign of insulin resistance). My post-meal BGs hung around 160 to about 200 for hours after eating, until I started Metformin.

I don't have a family history of T2, and I have a major family history (and personal history) of allergies and autoimmune issues. But because of my negative antibody tests and high c-peptide, I have to agree with my endocrinologist--IR it is.

However, if it weren't for the high c-peptide, I'd swear I was LADA. I'd recommend that you get those antibody tests and a c-peptide, too.

Thanks, guitarnut! Yes, interesting with your autoimmune history and normal cholesterol, etc., that you're T2, but it certainly sounds that way. I guess that's why testing is so important.

I sort of wish I hadn't caught this business so early, b/c I feel like I'm in too early of a stage for Drs. to take it seriously and I worry they'll think my numbers aren't "bad" enough for them to do further testing. I feel like I'm going to be in limbo for awhile waiting for my numbers to go up so I can get a diagnosis which is so frustrating! Thanks again for sharing! :)

Well, my last A1c was 5.1 without meds, so it was also caught very early with me. My endocrinologist denied a diagnosis for years, before my insulin level finally went up enough to diagnose me with IR.

Being in limbo is tough. I was in limbo from the minute I questioned my diagnosis of reactive hypoglycemia until a month roughly three years. I've been in limbo for other conditions (unrelated, of course) for years. No one will ever say it's easy--it's frustrating and hard and downright scary sometimes. The important thing is to keep your head above water and never give up.

Thanks again, guitarnut. I feel better knowing someone can relate! I hope you get clarification on your other conditions soon as well. I feel like, "If I'm going to have something, let me just get it so I can deal with it!"

Another question...I'm often at my highest BG at 30 min PP. Sometimes by 1 hr. I've already started to drop. I've read that a 30 min. reading doesn't matter--only the 1 hr. But if I'm regularly hitting 130-160 at 30 min. doesn't that make a difference? Why does it matter if my peak is at 30 min. or 60 min.? I thought any number over 140 was undesirable--no matter how long PP. I'm wondering if I should stop testing at 30 min. altogether. (Of course, today I was at 167 1 hour after lunch--42g carbs). :P Thanks again!

You might want to try pre-bolusing by 15-20 minutes kittywitty to prevent those early spikes.

Hi Zoe! Thanks for chiming in. Well, at this point, I'm only labelled "probable pre-diabetic" based on FBG in the 100-116 range and slightly elevated PP numbers. I don't think they will give me insulin yet. I have an appt. with an endo in 3 weeks. I'm half thinking of going back to eating higher carb so I can show the endo how my BG acts with a "typical" diet. I can avoid spikes by eating low carb, which I do most of the time and which is why my Dr. doesn't really think I have anything to worry about. He didn't see that many high numbers on my logs b/c I don't eat that many carbs! :P I think I can control my BG right now with diet and exercise, but I'm hoping to get antibody testing b/c I'm highly suspicious of LADA. I just want to know so I can be prepared, you know? :)