TOFI

Thin on outside, fat on inside. Populations who genetically are predisposed to not adding subcutaneous fat but instead most of the fat goes visceral (organs) are the worse kind of diabetics. They can look thin and trim mostly on the outside and have terrible organs on the inside. A telltale sign is an otherwise trim body but a beer belly. Expanded belt line. It is a good indication of fatty liver disease as the liver becomes huge and protrudes the belt line out.

Skinny diabetics have the hardest time controlling their blood glucose levels. When you hear of someone who runs marathons and is the picture of health but dies suddenly of a heart attack, most likely they have been insulin resistant for many years. All sorts, some say all, metabolic diseases are either caused or aggravated by insulin resistance. Insulin resistance for 10 or 20 years usually ends up full blown diabetes.

A Kraft test, 2 hour glucose tolerance test or a fasting insulin test will tell the tale. HbA1c does not always tell the tale till it is too late. It tells nothing about glucose spikes and other confounding factors can make it inaccurate.

Probably 2/3 of the US population have some degree of insulin resistance. It is just a matter of time till it catches up with them. It is fixable by diet change.