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Diabesity…you think you don’t have it? Think again!!

on May 11, 2014


Obesity in children has risen dynamically over the last couple of decades associated with increased risk of Diabetes. Hence the term ‘Diabesity’. It may be misleading that only obese people suffer from diabetes, which is not true. Thin people suffer from diabetes too but their metabolism behaves as if they are obese. These are the “skinny fat” people. They are “under lean” (not enough muscle) and often carry a little extra weight around the middle

To understand what is happening inside the body, let’s understand the basics.


Our body produces two kinds of hormones: Anabolic (building up…eg Insulin) and Catabolic (breaking down…eg Glucagon) hormones. Insulin and Glucagon are both produced by the pancreas and they work in harmony to maintain metabolic balance inside the body.

Insulin is produced after a carbohydrate or protein meal. It promotes glucose uptake and storage, protein synthesis (increasing lean body mass) and triglyceride uptake by fat cells meaning it increases overall body stores of carbohydrates, proteins and fats.

Juvenile onset, Insulin Dependent, Type I Diabetes is usually due to deficient or decreased production of Insulin caused by autoantibodies produced against cells of pancreas. Age of onset is less than 30 years and body build is usually thin. This is because the anabolic (body building) effects of insulin are absent,decreasing the body stores of fat and the catabolic effects of glucagon have overpowered, increasing the blood levels of sugar and fats.

Maturity onset, Non-Insulin Dependent, Type II Diabetes is due to Insulin resistance caused by chronic elevated levels of Insulin in blood leading to down regulation of the glucose transporters and insulin receptors in the target tissues. It is almost entirely induced by environmental and lifestyle factors. Age of onset is more than 40 years and body build is obese.

When the diet is full of empty calories and an abundance of quickly absorbed sugars, liquid calories (sodas, juices, sports drinks or vitamin waters), and refined or starchy carbohydrates (bread, pasta, rice and potatoes), the cells slowly become numb to the effects of insulin, and need more of it to balance the blood-sugar levels. This problem is known as insulin resistance.

A high insulin level is the first sign of trouble. The higher the insulin levels are, the worse the insulin resistance. Hypoglycemia, or low blood sugar, is often an early symptom of insulin resistance.


Official definition of Obesity is when our body mass index (BMI) is greater than 30. BMI is ratio between our height (in feet) and weight (in lbs). BMI less than 18.5 is considered underweight and greater than 25 is considered over weight.

Obesity is the cause of and result of Diabetes Type II leading to a viscous cycle. The more we eat, the more insulin is produced, more fat storage, more weight gain, increased insulin in blood, more fat storage, more weight gain…..and so on.

Weight reduction of as little at 4-7% has enormous effect on peripheral insulin sensitivity. Exercising muscle does not need insulin for glucose to enter. 25%of patients can be kept off medications with diet and exercise alone. The effects of weight loss can last for many years.


A new word, “diabesity,” describes the continuum of metabolic imbalances and diseases that range all the way from mild blood-sugar imbalance to insulin resistance to full-blown diabetes. So if you have diabetes, you have diabesity. But if you are borderline pre-diabetic, or even have symptoms, you could be suffering from diabesity.

Nearly all people who are overweight (almost 70% of Americans) already have pre-diabetes, which is an earlier stage of diabesity that carries with it significant risks of most chronic diseases in the 21st century. There is an increased risk of heart disease, stroke, dementia, cancer, high blood pressure, blindness and kidney failure.

Unfortunately, most people who are suffering from diabesity have no idea that it is a deadly condition or that it is 100% reversible. There are no national screening recommendations, treatment guidelines, approved medications, and no reimbursement to healthcare providers for diagnosing and treating anything other than full-blown diabetes.


1. All age groups, male and female can be affected by this disease.

2. Family history; if parents, grandparents, siblings or first cousins have diabetes, yearly screening is recommended. There is a very strong genetic predisposition to diabesity.

3. Weight; thin people with strong family history or those losing weight out of proportion are at risk for Type I Diabetes. Overweight (BMI more than 25) are at risk for insulin resistance, hence Type II Diabetes. Waist circumference greater than 35 inches for women or greater than 40 inches for men is a worrying sign.

4. Gestational Diabetes; a pregnant woman not able to maintain fasting or post-challenge glucose levels in the blood. It is due to diabetogenic effects of human placental lactogen (hPL), placental insulinase, cortisol and progesterone. 35% of women with gestational diabetes will develop overt diabetes within 5-10 years of delivery.

5. All underlying diseases and hormonal causes leading to obesity are risk factors for diabesity.

6. High blood pressure, high cholestrol, heart disease, sedentary life style are also associated with diabesity.


Symptoms to look out for are:

1. Excessive urination
2. Excessive hunger and thirst
3. Sugar cravings and fatigue after meals
4. Difficulty losing weight
5. Abnormal weight loss especially in children (type I diabetes)
6. Visual disturbances
7. Numbness and tingling in hands and feet
8. Sexual dysfunction, infertility
9. More prone to infections
10. Very dry skin

Abnormal Blood Tests:

1. RBS/ RBG ( random blood sugar/glucose levels within 2-4 hours of eating)
160 mg/dl or more prediabetic
200 mg/dl diagnostic for diabetes

2. FBS/ FBG ( fasting blood sugar/glucose after 6 hours of eating)
100-125 mg/dl is prediabetic
126 mg/dl or more is diagnostic of diabetes

3. HbA1c (demonstrates control of blood sugar in preceding 6-8 weeks)
5.6%-6.4% is prediabetic
6.5% or more is diagnostic of diabetes

4. Fasting Lipid Profile
Triglyceride more than 100 mg/dl
HDL (good cholestrol) less than 40 mg/dl
Total cholestrol more than 200 mg/dl
Triglyceride/HDL ratio greater than 5
Total cholesterol/HDL ratio greater than 6

5. Glucose in urine (normally not found)

Summary: If there is a family history, belly fat, BMI more than 25 (overweight), high blood pressure, high cholestrol, frequent urination, excessive hunger and thirst, even one abnormal blood test or urinary glucose found during routine screening…you are suffering from diabesity.

(Normal values are mentioned at the end).

(leading to coma/ death)

Ironically, medical practitioners do not pay attention to mild symptoms or prediabetic blood work findings until patient has full blown diabetes. Asymptomatic individuals may end up discovering they have full blown diabetes with these life threatening conditions.

1. Diabetic Ketoacidosis (DKA), blood glucose more than 350 md/dl

It is a serious condition that can lead to diabetic coma or even death. When the cells don’t get the glucose they need for energy, body begins to burn fat for energy, which produces ketones. Ketones are acids that build up in the blood and appear in the urine when the body doesn’t have enough insulin. High levels of ketones can poison the body.

Warning Signs of DKA:

DKA usually develops slowly. But when vomiting occurs, this life-threatening condition can develop in a few hours. Symptoms include:

Thirst or a very dry mouth
Frequent urination
High levels of ketones in the urine
Constantly feeling tired
Dry or flushed skin
Nausea, vomiting, or abdominal pain
Difficulty breathing
Fruity odor on breath
A hard time paying attention, or confusion

2. Hyperosmolar Hyperglycemic State, blood glucose more than 600mg/dl

In contrast to DKA, serum glucose levels in HHS are extremely high, but a metabolic acidosis is absent or mild. Altered mental status is also more common in HHS than DKA. DKA has been associated with Type I Diabetes, whereas HHS has been associated with both.

Symptoms include:

Increased thirst
Altered mental status
Neurologic signs such as sensory or motor impairments, seizures or motor abnormalities like flaccidity, depressed reflexes, tremors
Hyperviscosity and increased risk of thrombosis
Coma leading to death

3. Hypoglycemia, blood glucose less than 70mg/dl

It is usually first sign of insulin resistance, produced by too much insulin in the blood stream.

Symptoms include:

Double vision or blurry vision
Fast or pounding heartbeat
Feeling cranky or acting aggressive
Feeling nervous
Shaking or trembling
Tingling or numbness of the skin
Tiredness or weakness
Trouble sleeping
Unclear thinking


Diabesity IS preventable, curable and reversible unlike what we originally knew. You are NOT destined to suffer progressive decline. The only cure is :
Life Style Change !

1. Healthy Diet:
Our nutrient-poor, calorie-rich, low-fiber, high-sugar diet has led to overfed but undernourished people. There is an epidemic of nutritional deficiencies that promote the development of diabetes, including vitamin D, magnesium, zinc and antioxidant deficiencies. Controlling portion sizes, including fruits, vegetables, legumes, monounsaturated fat, such as olive oil and raw nuts, fish, poultry, meat substitutes, low fat dairy products and fresh home cooked food can be the most potent medicine you can use to prevent, treat and reverse diabesity.

2. Controlling underlying health issues:
Most of the weight gain and metabolic imbalances are because of hormonal imbalances. Be it sex hormones, stress hormones or thyroid etc. Many of the underlying issues can be diagnosed and treated preventing obesity and diabesity. Controlling blood pressure and blood cholestrol levels are key to preventing diabesity.

3. Exercise:
The importance of physical exercise has always been highlighted with people finding no time for it. Walking 30 mins a day is enough. Resting muscle needs insulin for glucose entry but an exercising muscle does not. 25% patients were kept off medications just with diet and exercise. The purpose is not just to lose weight but also to regulate the digestive system as well as lowering stress.

4. Lower your stress:
Stress makes you fat and contributes to the development of diabesity. Chronic stress increases our levels of insulin, cortisol and inflammatory compounds. This drives the relentless metabolic dysfunction that leads to weight gain, insulin resistance, and diabetes. Hence, managing stress whether through relaxation therapies, meditation, yoga, massage, exercise, laughing or anything else is a critical component of obesity and diabetes treatment.


Since diabesity is not considered a real disease until you are diagnosed with full blown diabetes, (usually)with or without complications, it is recommended that early testing for anyone who has a family history of diabetes, increased waist size, or abnormal cholesterol be done. A recent study showed that anyone with a fasting blood sugar of over 87mg/dl was at increased risk of diabetes. Yet most doctors are not concerned until the blood sugar is over 110 mg/dl or worse,126 mg/dl, the level that technically signals diabetes.

Normal values of blood tests:

1. RBS:
Less than 140 mg/dL age less than 50
less than 150 mg/dL ages 50–60;
less than 160 mg/dL age 60 and above

2. FBS:
Less than or equal to 100mg/dl

3. HbA1c less than 5.5% is normal

4. Lipid panel :
Total cholesterol (ideal < 180 mg/dl),
LDL (ideal < 70 mg/dl),
HDL cholesterol (ideal > 60 mg/dl),
Triglycerides (ideal < 100 mg/dl).




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