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Taking off my pedantic hat, I think we agree. Meaning in the pragmatic real world, if you can keep weight off it’s better than having the weight on, and no one is doing that in the real world with an all sugar diet.

With that being said, metabolic disease produces lots of skinny diabetics, and that will definitely shorten your life span.

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Definitely getting OT and deep into the weeds here, I wonder how many of those skinny diabetics are due to LADA and not insulin resistance.

When you present with DM as an adult the immediate presumption is DM II not LADA and the insurance companies (and their actuaries) are uninterested in investigating otherwise. Thus endocrinologists are disincented to look as the hospital admin gets very upset when insurance companies deny reimbursement.

The ADA training the insurance companies recommend is weird too. It says, for example, that it’s fine to have a slice of cake, just have half. I assume this is because too large a change will lead to negligible compliance. I was at first shocked, but then wondered what kind of baseline recommendation would actually be effective.

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