I want to start with a question nobody asked you at that appointment.
How long do you think this has been developing?
Because here’s what the research tells us: by the time someone receives a type 2 diabetes diagnosis, they’ve typically had significant insulin resistance for seven to ten years. Their pancreatic beta cells — the ones that produce insulin — have likely already lost close to half their functional capacity. The disease that got named that day didn’t start that day. It built slowly, over years, sending signals along the way that were either missed, minimized, or never connected into a pattern.
I say this not to assign blame to anyone, healthcare workers are working within real constraints, and this is a systemic failure, not an individual one. I say it because I want you to understand the full picture of what you’re dealing with. And because the answer to that question “how long this has been developing?” is also the answer to how much time you have to change the trajectory.
For the majority of people with type 2 diabetes who are still in the earlier stages, with insulin resistance as the primary driver and without significant complications, the biology is still responsive. The window is still open.
This masterclass is for both groups: those who just received a diagnosis and want to understand what it actually means, and those who were told their blood sugar is “a little high” or their A1c is “borderline.” If you’re in the second group, I want to say this directly: you are not fine, you are not pre-anything in the way that word implies safety. You are on a continuum. And the continuum is still reversible where you’re standing.
Part 1: Recognizing the Pattern
This is the opening of a longer article.
The full piece — the mechanisms, the labs to ask for, and what to do about it — is free to read on our newsletter.
Sources & Research
Every claim in this article is grounded in peer-reviewed research. DOI links open the original studies.
American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes — 2025. Diabetes Care. 2025;48(Suppl 1):S1–S352. doi:10.2337/dc25-SINT
Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023;148(20):1606–1635. doi:10.1161/CIR.0000000000001184
Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344–355. doi:10.1016/S2213-8587(19)30068-3
