Understanding insulin resistance, the underlying cause of type 2 diabetes

Diabetes and prediabetes cost an estimated $1.5 billion in Hawaii each year. The serious consequences include heart disease, stroke, amputation, end-stage kidney disease, blindness and death. Diabetes is growing at an epidemic rate in the United States. But most of care focuses on treating the symptoms of elevated blood sugar with medications and little attention to lifestyle. Type 2 diabetes is mostly a lifestyle disease with genetics only contributing a risk of 25-33 percent. So it makes sense to focus on lifestyle. But first, one needs to understand what is the underlying cause.

Normally, when we eat, our food breaks down into the sugars, which then get absorbed into the bloodstream. The elevation in blood sugar signals to the pancreas to release insulin, which is required to move the sugars from the blood into the cells to provide energy. Insulin is like a key that opens the door to let the sugar into the cells.


Insulin resistance occurs when that key doesn’t work well. The reason is that fat is blocking the “keyhole.” Fat is built up in the lining of your cells from excess calories and excess fat. Fat may also get stored in the liver, muscles. These are places were fat is not meant to be. Fat also may go into the pancreas, increasing insulin resistance and reducing the amount of insulin released. As a result the sugar get stuck in the bloodstream. So how do you remove that fat? Most people know that losing weight, which will reduce the amount of fat in these cells helps to improve your blood sugar. But eating fatty foods also blocks your insulin from working well in the moment.

Most people with diabetes only focus on their intake of carbohydrates. However, when you eat low-fat, high-fiber whole foods, these enter your bloodstream slowly and give your body more time to react. The fiber also feeds your good bacteria (probiotics), which help to suppress inflammation as well as a host of other functions in the body. These foods are most optimal for restoring good insulin function, which will keep your blood sugars in an even range, the way it is meant to do.

What about low-carb, high-fat diets like the ketogenic diet, which have become popular? In the short term, your blood sugars may improve as your need for insulin is decreased. However, you are not addressing the issue of fat in the wrong places and the underlying reason for the insulin resistance. A diet high in animal fats increases inflammation and will not result in a preponderance of the most beneficial bacteria. A positive balance of good bacteria is emerging as an excellent predictor of health.

What about cost of going more plant-based? Studies show that a family of four can save at least $1,200 annually by eating more legumes, whole grains, fruits, vegetables and nuts.

We have a long growing season here in Hawaii where home-based gardens will allow even more of the diet to be sourced at home. As you transitional your diet, your need for medications may decrease, saving you more money. Do not make changes to your dosage without contacting your medical provider.

Plant-based eating is gaining more and more adherents as evidence grows for its benefits in preventing and reversing many chronic diseases as well as being the best way to take care of our planet. In fact, there is a long history of eating this way by pre-contact Hawaiians. The main foods eaten were plants. At that time, the chronic diseases of today were absent.

The good news is that most of the traditional foods and even many local-style dishes can be adapted to fit a plant-based diet. Many dishes incorporate vegetables, tofu is frequently eaten and chili is a mainstay in many households. So, with a little tweaking, the animal foods can be minimized or eliminated.


Help is available. Diabetes education is a benefit of almost all insurance plans.

Vivienne Aronowitz is a dietitian and diabetes educator with over three decades of experience.