[partyboat1586]

I don't understand your conclusion on skinny people getting diabetes.

>People have a "personal fat threshold", when that threshold is reached there's nowhere for the excess to go

Ok with you so far

>and people develop diabetes

Then this leap. How does the fat having nowhere to go lead to diabetes? What's the middle step?

Skinny people can't have a calorie surplus or they would gain weight no?

[bad_user]

No. The adipocytes, aka the fat cells that can store energy, are in limited supply. Some people have a more flexible adipose tissue then others.

Some people can store very little or no subcutaneous fat at all, all of the accumulated fat is stored as visceral fat (around their organs), which is limited, so they look skinny on the outside, fit even, but suffer from T2D nonetheless.

Here are some references:

https://portlandpress.com/clinsci/article/128/7/405/71158/No...

https://diabetes.diabetesjournals.org/content/63/12/4369

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774584/

Basically insulin resistance, high blood glucose and the ensuing loss of beta cell function in the pancreas happen as a result of adipocytes starting to reject excess energy, which then remains in the bloodstream and is being pissed away. Insulin resistance in many circles is understood as the cause of T2D, however insulin resistance is actually a defensive mechanism, in response to energy poisoning.

https://www.pnas.org/content/106/42/17787

And the source of that excess doesn't matter, all macro nutrients can cause insulin resistance, even if via different pathways:

https://pubmed.ncbi.nlm.nih.gov/3421919/

https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2362....

https://pubmed.ncbi.nlm.nih.gov/11872656/

[redis_mlc]

In interviews I've read with nurses over the decades, they invariably say, "Don't get pear-shaped."

What they're referring to is visceral fat (around their organs), so in their experience treating thousands of patients, that's their primary advice.

Something to think about.