The typical risk factors for diabetes have been genetics, ethnicity, diet, and obesity, among others. These risk factors have been enumerated countless times that they are ingrained in our psyche. And yet, we are amazed to note that there are obese people who are not diabetic.

Wait a minute. Did I just say that there are obese people who are not diabetic? Yes I did. And one would ask how do you explain that? A miracle? Well, science certainly does not believe in miracles. Everything needs to have a sound explanation.

And so a collaborative effort of different institutions across the globe has found the reason why some obese people are not diabetic.

And the answer lies in a certain fraction of fatty acids called CERAMIDES. 

Now, wait a minute, ceramides seem familiar. Yes, you may have heard about them in skin creams. Yes, they lie in the skin. They are also a kind of fat derivative in the fat tissue.

So, based on the fats in your diet, your body converts them into different types of fatty acid derivatives – triglycerols, sphingolipids, and glycerolipids. Sphingolipids or ceramides accumulate in the fat or adipose tissue.

In simple terms, your fat tissue may be brown, which is used to burn fat, release energy, maintain glucose levels, and increase sensitivity to insulin. White fat tissue is due to an accumulation of ceramides and has the opposite effect of increasing resistance to insulin. Beige fat tissue is when white fat tissue is converted to brown tissue when the body needs energy.

Scientists at University of Utah College of Health performed experiments in mice. They noted that when a specific protein was inactivated in the mice, then the mice were able to tolerate high fat diets without developing diabetes. In this case, the inhibited protein arrested the buildup of ceramides.

The experiments in the mice indicated that ceramide increase develops insulin resistance and prevents the fat tissue from burning the fats for energy. This is how ceramides influence the body to develop diabetes. 

As part of the collaborative project, gastric bypass patients in Singapore who showed increased ceramide levels were also found to have type 2 diabetes. The collaborative effort that spanned the countries of USA, Australia, Singapore, Brunei, India, and Japan, have shown at length the importance of ceramides in the process of diabetes and fatty liver disease.

Elaborating the action of ceramides explains a lot about why we sometimes notice thin people developing diabetes. Genetics may explain why some people begin to accumulate more ceramides than usual.

This result now has triggered an interest in developing drugs that can target the buildup of ceramides. By arresting the accumulation of ceramides, the drugs may be able to stop the progress of diabetes in its tracks.

In the new age of personalized medicine, identifying the risk factors of each individual will help in determining the appropriate treatment.