Even a thin person can get diabetes

By Jeff O'Connell

updated 8:36 a.m. ET May 29, 2008

One of my most enduring childhood images is from a newspaper clipping. The grainy photograph freezes a lanky teen named Tom O'Connell launching a hook shot from his right thigh. Tucker, as he was known, led a team from tiny Merchantville High School in scoring and rebounding during an improbable run to the South Jersey Championship. New Jersey had its own version of Hoosiers in 1952, and for that one season, my father was his team's Jimmy Chitwood.

In February 2008, I arrive at a nursing home in the San Fernando Valley to visit the man in that photograph, a man I've neither seen nor spoken to in 20 years.

Entering his room, I barely recognize the gaunt face. Where his right thigh should be sits a corduroy pant leg, gathered up and bobby-pinned. The spindly arm he extends to greet me is splotched with blood bursts. Once 6'3'' and 215 pounds, he's now a cadaverous-looking 145.

The only cheerful note in the room is a balloon tied to the metal bed frame. His 73rd birthday was last week, apparently. It's a detail I had long since forgotten.

Like a man looking into a foggy mirror, my father strains to recognize me. But if he is staring into his past, I might be peering into my future. I'm 6'6'' and weigh 220, with 12 percent body fat and the outline of abs above a 32-inch waist. Yet diabetes has me in its crosshairs as well.

If you think being thin gives you a free pass from this deadly disease, well, it may have a surprise in store for you, too.

Raging blood sugar
The white curtain flanking my father's bed divides him from a man who speaks only Spanish and another who rambles incoherently all day in English. Yet Thomas Joseph O'Connell Jr. has an epidemic's worth of company. According to the Centers for Disease Control and Prevention, one in every four people in the United States is living with either type-2 diabetes (20 million) or its precursor, prediabetes (54 million). And the incidence of type 2 — the kind of diabetes that people develop over time — has, in the past quarter-century, grown 32 percent faster among American men than among American women.

What's worse, type-2 diabetes is showing up in the young in record numbers. "People used to suffer type-2 diabetes in their 60s and heart disease in their 70s," says James O. Hill, Ph.D., the director of the center for human nutrition at the University of Colorado's health sciences center. "But with teens now developing it, are they going to have heart disease at 25 and need a transplant in their 30s? We've never gone through this before, but based on what we know about what happens once you have type-2 diabetes, the answer is probably yes."

Woe unto them, because raging blood sugar can lead to a litany of ailments biblical in scope: cardiovascular disease, liver disease, kidney failure (my dad needs dialysis three times a week), stroke, amputations, erectile dysfunction, blindness, and nerve damage — everything, seemingly, but a swarm of locusts. Even cancer has a sweet tooth, recent research suggests.

The total amount of glucose in a typical man's bloodstream is just shy of the amount in a teaspoon of sugar. A man crossing over into diabetes has about ¼ teaspoon more. That seemingly trivial amount can make a huge difference as blood glucose (a.k.a. sugar) plays seesaw with your hormones all day. The game begins whenever you eat carbohydrates — be it the sugar in a soda or the starch in bread and pasta. Your body breaks down these carbs so they can be absorbed into your bloodstream as glucose. The seesaw goes up: elevated blood sugar.

Glucose is important stuff — the cells in your muscles and brain use it for energy. But too much of it coursing through your blood vessels, for too long, is ultimately deadly.

"It's kind of like dynamite," says Dr. Mary Vernon, president of the American Society of Bariatric Physicians. "The body realizes it's dangerous, not to be left lying around." That's why people with diabetes are frequent bathroom visitors.

To adjust to a surge of incoming carbs, your pancreas secretes the hormone insulin, which helps glucose enter your cells, where it belongs. This glucose leaving your bloodstream is the downstroke of the seesaw. Problems arise when some of your cells begin to deny access to insulin, and by extension, glucose — a condition called insulin resistance. This situation often goes unnoticed for years, but over time it worsens until the result is chronically high blood sugar and full-blown diabetes.

Here's how it all plays out: Your body tries to clear your bloodstream of excess glucose by signaling your pancreas to squirt out higher and higher amounts of insulin. Eventually, this flood of insulin drives blood sugar sharply lower, which makes you feel hungry and even shaky.

So you reach for the quick fix — more carbs — and they send your blood sugar skyrocketing again, triggering the release of still more insulin and perpetuating the cycle. Instead of gently rocking, the seesaw slams down and bounces back up, over and over, for days, years and decades. "The constant demand on your pancreas ultimately causes it to burn out, so that it no longer releases insulin," says Dr. Vernon. "That's when blood sugar stays elevated for good."

Of course, this insulin system has worked fine for 99.6 percent of human existence. That's because hunter-gatherers derived no more than 40 percent of their calories from carbohydrates, mostly fruit, according to Colorado State University scientists. What your pancreas wasn't designed to handle on a regular basis was the carb load from a Cinnabon washed down with a Big Gulp, all part of the 140 pounds of sugar the average American consumes annually. "The high-blood-glucose response to a high-carb diet is an almost normal response to an abnormal situation," says Ron Raab, past vice president of the International Diabetes Federation. "We've largely created this illness."

An ominous prefix
No single event fractured my relationship with my father. Lacking even the sense of purpose or legitimacy that a blowout argument or fight might have provided, the dissolution of our bond came after my parents divorced in the mid-1980s. Tom O'Connell had essentially been cast out of my mind for two decades until one of my two brothers told me that he was lying in intensive care in a Los Angeles hospital. He had diabetes and had barely survived two amputations on a leg, above the knee and then farther up. At the time, it didn't cross my mind to make the trip from eastern Pennsylvania to Southern California to say farewell.

I wouldn't be let off that easily, though. A week later I visited my own doctor, who had called me in to review blood work done several weeks earlier for a routine physical. He scanned my numbers and looked up. "Does diabetes run in your family?"

Will you become diabetic? Take this self-test and find out The American Diabetes Association singles out the fasting glucose test as the preferred way to diagnose type-2 diabetes, citing cost and ease. While useful, this blood-sugar snapshot doesn't reveal the excessive swings that indicate insulin resistance before your fasting level is elevated to diabetes or prediabetes. For that, you need to take an oral glucose-tolerance test (OGTT), especially if you have a parent or sibling with type-2 diabetes. Being African American, Latino, Native American, or Asian American also elevates your risk. The symptoms of insulin resistance tend to come in clusters, so if you have one indicator, you're likely to have two or three others. However, under the "definitely" category (below), having just a single factor is cause for concern. In this case, contact your physician and schedule a time for an OGTT. You might need an OGTT if . . . — You often wake up with a headache — You often wake up in the middle of the night — You had acne, numerous cavities, and hair loss in your teens/early 20s — You feel cranky or forgetful after a high-carb breakfast You probably need an OGTT if . . . — Your blood pressure is 140/90 mm/Hg or higher — Your HDL (good) cholesterol is less than 35 mg/dl (milligrams per deciliter) and/or your triglycerides are higher than 250 mg/dl — You're thirsty or you urinate a lot — You tire easily and/or nap frequently, especially 1 to 2 hours after a meal — You're overweight (BMI 25 to 29.9) — You're 45 years old or older You definitely need an OGTT if . . . — Your fasting plasma glucose (FPG) is 100 mg/dl or higher — Your hemoglobin A1C is greater than 6 percent — Any random blood glucose reading is 140 mg/dl or higher — You have any history of cardiovascular disease — You're obese (BMI = 30 or higher)

Bad medical news didn't shock me. Both of my parents survived cancer, and my mother has epilepsy. But I write for Men's Health. I've cowritten a book on sports nutrition. I've been the occasional butt of skinny-guy wisecracks in school. Diabetes? Isn't that for grandmothers in wheelchairs?

The doctor slid the lab report in front of me and began explaining the jumble of numbers. One stood out: 116, which quantified the amount of glucose floating in my bloodstream after a 12-hour fast. Under 100 milligrams per deciliter (mg/dl) is good; anything above 126 is diabetes. That meant I was well into prediabetes, a term sugarcoated in more ways than one, since most men eventually lose the prefix.

How the hell did I miss this? I thought. For months, my body had felt like a sputtering car in need of a tuneup. There were the severe headaches I had endured my entire adult life and the naps that left me so groggy it was like emerging from anesthesia. Then I replayed a scene from earlier that year. After months of nearly continuous stress, I woke up one morning feeling like a man who had been lost in a desert for days. I drank a glass of water, and another, and another, all weekend. Gallons, it seemed. Nothing could quench my thirst, a classic symptom of high blood sugar, since you're expelling so much fluid through your urine.

Within minutes of learning the reason for that episode, I would confront another harsh reality: Many physicians really don't have a clue about preventing type-2 diabetes in someone thin like me. My doctor mumbled something about switching from white rice to brown rice and told me to come back in 6 months, even though insulin resistance is a complex metabolic disorder requiring sophisticated, continuous management.

What's more, the typical advice offered makes you wonder if Americans are being given an antidote against or a prescription for the disease. For example, everyone from my doctor to the American Diabetes Association (ADA) tells people with impaired blood sugar, or prediabetes, to make carbohydrate-rich foods such as breads and grains the foundation of their diets. This despite a growing body of evidence that points to carb reduction as the best anti-diabetes strategy. After all, there's another term for people who are insulin resistant: glucose intolerant. Meaning they don't respond well to carbohydrates. The higher the dose of carbs, the more problems those carbs cause.

This year, after decades of resistance, the ADA finally acknowledged low-carb dieting as a legitimate response to diabetes. Which goes to show that if you wait for a health organization to issue a position paper before attacking the disease, you may end up reading that paper from a hospital bed.

This isn't the failing of a single physician or organization. It's the breakdown of the U.S. medical system when it comes to nutrition. "Our medical establishment is set up to treat disease," says Susan M. Kleiner, Ph.D., R.D., a nutritionist in Mercer Island, Washington. "First-year med students rank nutrition among their top priorities. Yet by graduation, nutrition doesn't even make the list, because it's largely ignored." In fact, there are still medical schools that don't offer a single nutrition course.

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