Written by Diana Licalzi, MS, RD, CDCES

Fact #1: Not All Carbohydrates Are Created

Many people believe that all carbohydrates negatively impact diabetes management. However, research shows this understanding is incomplete. Carbohydrates fall into two main categories: complex and simple.

Refined simple carbohydrates found in white bread, white pasta, many breakfast cereals, pastries, crackers, foods with added sugar, etc., significantly compromise diabetes health. These products oftentimes contain not only simple carbohydrates but also added oils, sodium, and saturated fats—a combination that worsens insulin resistance.

In contrast, complex carbohydrates present in whole grains, starchy and non-starchy vegetables, fruit, and legumes (such as quinoa, brown rice, asparagus, butternut squash, and chickpeas) offer substantial benefits. These foods contain fiber, antioxidants, vitamins, minerals, and water—nutrients that enhance insulin sensitivity.

Unfortunately, media messaging often vilifies all carbohydrates without making this crucial distinction. This leads many people with diabetes toward high-fat, high-protein diets that may actually exacerbate insulin resistance rather than improve it.

Fact #2: Sedentary Lifestyle Significantly Increases Type 2 Diabetes Risk

Physical inactivity represents one of the most firmly established risk factors for developing type 2 diabetes. When we consume more energy than we expend, our bodies store the excess as fat, contributing to weight gain and insulin resistance.

Extensive research confirms this connection. A comprehensive meta-analysis examining 18 studies with over 700,000 participants found that people who spent the most time sitting around (like watching TV or at a desk) had a 112% increased risk of developing diabetes comaped to those who spent the least time sitting.[1] 

Our bodies use glucose for energy during physical activity. Regular movement helps maintain proper glucose metabolism and insulin sensitivity, while prolonged sitting disrupts these processes.

Fact #3:  Insulin Resistance Stems From Fat Storage Within Muscles and Liver Cells 

The root cause of insulin resistance—a hallmark of type 2 diabetes—lies not just in overall body fat but specifically in where this fat accumulates. When excess fat deposits within muscle and liver cells (intramyocellular and intrahepatic lipids), it interferes with normal insulin signaling.

Research published in the New England Journal of Medicine demonstrates that these intracellular fat deposits disrupt the insulin receptor pathways and glucose transport mechanisms. This disruption prevents cells from responding properly to insulin signals, leading to elevated blood glucose levels despite the pancreas producing insulin.[2]

Understanding this mechanism explains why certain dietary patterns and physical activity levels directly influence insulin sensitivity. 

Fact #4: Chronic Stress Contributes to Type 2 Diabetes Development

The relationship between psychological stress and diabetes extends beyond making poor food choices during stressful periods. Chronic stress triggers physiological responses that directly impact glucose metabolism.

When stressed, our bodies release hormones like cortisol and adrenaline, which increase blood glucose levels to prepare for perceived threats. In prehistoric times, this "fight or flight" response provided energy for immediate physical action. However, in today's world, where stressors rarely require physical exertion, these elevated glucose levels remain unused.

Research shows that prolonged stress activation leads to chronically elevated blood glucose, increased insulin resistance, and altered fat distribution—particularly visceral fat accumulation around organs.[3] These factors collectively increase the risk of developing type 2 diabetes.

Stress management techniques like meditation, adequate sleep, and social connections represent underappreciated yet powerful tools for diabetes prevention and management.

One Big Myth: Type 2 Diabetes Is Always a Chronic Progressive Disease

Perhaps the most harmful misconception about type 2 diabetes is that it inevitably worsens over time, requiring increasingly intensive medication regimens. This perspective, while common, contradicts growing scientific evidence.

Multiple studies published in respected journals like Cell Metabolism and The Lancet document cases of diabetes remission—where individuals maintain normal blood glucose levels without medication. [4,5] A landmark study published in The Lancet demonstrated that appropriate dietary intervention led to remission in nearly half of participants with type 2 diabetes.[5]

These findings suggest that for many people, type 2 diabetes can be reversed through targeted lifestyle modifications, particularly during the early stages of the condition. This potential for remission offers hope and empowers individuals to take active roles in their health management beyond medication adherence. To read more about this topic, check out our blog, Can Type 2 Diabetes Be Reversed? Here's What The Science Says.

To Recap

Understanding these evidence-based facts about diabetes provides a foundation for making informed decisions about prevention and management strategies. By recognizing the differences between carbohydrate types, acknowledging the importance of physical activity, understanding the cellular mechanisms of insulin resistance, addressing chronic stress, and rejecting the notion that diabetes must inevitably progress, you can develop more effective approaches to metabolic health.

References

1. Wilmot EG, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–905.
2. Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med. 2014;371(12):1131-1141.
3. Kelly SJ, Ismail M. Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes. Annu Rev Public Health. 2015;36:441-462.
4. Taylor R, et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery. Cell Metab. 2018;28(4):547-556.
5. Lean ME, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551.