How Insulin Resistance Leads to Diabetes

Both prediabetes and type 2 diabetes are caused by insulin resistance. Insulin resistance is now accepted to be closely associated with the accumulation of fat within our muscle cells. This fat toxicity inside of our muscles is a major factor in the cause of insulin resistance and type 2 diabetes, as it interferes with the action of insulin.

Iíve explored how fat makes our muscles insulin resistant, how that fat can come from the fat we eat or the fat we wear , and how not all fats are the same. Itís the type of fat found predominantly in animal fats, relative to plant fats, that appears to be especially deleterious with respect to fat-induced insulin insensitivity. But this insulin resistance in our muscles starts years before diabetes is diagnosed.

In the video above, you can see a graph of fasting blood sugars in the 13 years prior to the onset of diabetes. Insulin resistance starts over a decade before diabetes is actually diagnosed, as blood sugar levels slowly start creeping up. And then, all of the sudden, the pancreas conks out, and blood sugars skyrocket. What could underlie this relatively rapid failure of insulin secretion?

At first, the pancreas pumps out more and more insulin, trying to overcome the fat-induced insulin resistance in the muscles, and high insulin levels can lead to the accumulation of fat in the liver, called fatty liver disease. Before diagnosis of type 2 diabetes, there is a long silent scream from the liver. As fat builds up in our liver, it becomes resistant to insulin too.

Normally, the liver is constantly producing blood sugar to keep our brain alive between meals. As soon as we eat breakfast, though, the insulin released to deal with the meal normally turns off liver glucose production, which makes sense since we donít need it anymore.

But filled with fat, the liver becomes insulin resistant like our muscles, and doesnít respond to the breakfast signal, and so keeps pumping out blood sugar all day long on top of whatever we eat. So the pancreas pumps out even more insulin to deal with the high sugars and our liver gets fatter and fatter. Thatís one of the twin vicious cycles of diabetes. Fatty muscles, in the context of too many calories, leads to a fatty liver, which leads to an even fattier liver.

Fatty liver can be deadly. So the liver starts trying to offload the fat by dumping it back into the bloodstream in the form of something called VLDL, and that starts building up in the cells in the pancreas that produce the insulin in the first place. So now we know how diabetes develops. Fatty muscles lead to a fatty liver, which leads to a fatty pancreas. It is now clear that type 2 diabetes is a condition of excess fat inside our organs.

The only thing that was keeping us from diabetes, from unchecked skyrocketing blood sugars, is that the pancreas was working overtime pumping out extra insulin to overcome insulin resistance. But as the so-called islet, or Beta cells in the pancreas, are killed off by the fat buildup, insulin production starts to fail, and weíre left with the worst of both worlds: insulin resistance combined with a failing pancreas. Unable to then overcome the resistance, blood sugar levels go up and up, and we have type 2 diabetes.

This has implications for cancer as well. Obesity leads to insulin resistance, and our blood sugars start to go up, so our pancreas starts pumping out more insulin to try to force more sugar into our muscles, and eventually the fat spills over into the pancreas as well, killing off the insulin-producing cells. Then we develop diabetes, in which case we may have to start injecting insulin at high levels to overcome the insulin-resistance, and these high insulin levels promote cancer. Thatís one of the reasons we think obese women get more breast cancer. It all traces back to fat getting into our muscle cells, causing insulin resistance: fat from our stomach or fat going into our stomach.

Now it should make sense why the American Diabetes Association recommends reduced intake of dietary fat as a strategy for reducing the risk for developing diabetes.

The reason Iím going into all this detail is that Iím hoping to empower both those suffering from the disease and those treating sufferers so as to better understand dietary interventions to prevent and treat the epidemic.

In health,
Michael Greger, M.D.

PS: If you havenít yet, you can subscribe to my free videos†here†and watch my live year-in-review presentations†Uprooting the Leading Causes of Death,†More Than an Apple a Day,†From Table to Able, and†Food as Medicine.

How to Prevent Prediabetes from Turning into Diabetes
Lifestyle Medicine Is the Standard of Care for Prediabetes
Is White Rice Responsible for the Diabetes Spike in China?


Kathleen G
Kathleen Gray17 days ago

After my DIABETES TYPE 2 diagnosis, I had typical symptoms of thirst, lethargy, severe tiredness, urinary frequency, hearing loss and ringing in the ears, vision problems, dehydration and weight gain. I was placed on metformin twice daily for several months, the symptoms only seemed to worsened. I began to do a lot of research and learnt about a DIABETES HERBAL TREATMENT from Rich Herbs Foundation and their success rate with the Diabetes treatment, i immediately started on the treatment, i started experience decline in major symptoms, the severe thirst, dry mouth, tiredness, urinary problems, dehydration and fatigue. My doctor took me off the metformin and other medications i was placed after the diabetes herbal treatment. Visit rich herbs foundation w w w. richherbsfoundation. c o m. I did another blood test after the treatment, i am diabetes free. I have also lost over 35 pounds since treatment.

Elena Poensgen
Elena Poensgen10 months ago

Thank you

Elena Poensgen
Elena Poensgen10 months ago

Thank you

Philippa Powers
Philippa Powersabout a year ago


Wendi M.
Wendi M1 years ago


Jeanne Rogers
Jeanne Rogers1 years ago

Thank you for sharing.

Michelle M.
Michelle M1 years ago

And how to explain prediabetes and diabetes in active, skinny, athletic build people with no fatty liver? Is it all genetic in these cases?

Siyus Copetallus
Siyus Copetallus1 years ago

Thank you for sharing.

heather g.
heather g1 years ago

I have Type 2 diabetes. However, I only buy sugar for hummingbirds, I don't consume dairy products or any white flour products and apart from fish twice a week, eat only veggies. In the morning I have oatmeal. My doctor always compliments me on keeping my Diabetes in control, but having read this article, feel I'm about to expire tomorrow.

Jim Ven
Jim Ven2 years ago

thanks for the article.