Understanding Blood Sugar Control: the Progression to Diabetes

In a series about Understanding Blood Sugar Control, you have to include an article about diabetes. It’s not because this is the only result of erratic blood sugar levels (as a reminder, I talked about the possible impacts in this post). Rather, it’s because this is the diagnosis that is directly tied to one’s ability to control their blood glucose and the one which 29 million Americans had been given by the end of 2012.

In case you missed the groundwork, you can check out this post to understand from where the glucose in our blood comes (hint: all carbohydrates) and this one to learn how your body achieves blood glucose control.

Now let’s talk about the dysregulation that can happen with blood sugar control…

The standard blood glucose test is done after 8+ hours of fasting to ensure that the blood glucose measured isn’t from food that was recently eaten, but hasn’t yet made it into the cells. When fasting, the glucose in the blood is either from glycogen (typically), liver-created glucose, or food that was eaten a long time ago.

Wait… what?! How can glucose from the food we eat stay in the blood for a long time???

Although we don’t know exactly when it happens, with repeated spikes in blood glucose eventually the cells decide they have had enough and they stop responding to insulin.

Literally, the cells no longer open the door when insulin knocks. When the cells get “stubborn” (or more accurately in self-preservation mode), the first response is for the pancreas to produce more insulin. In doing so, the pancreas tries to kick down the cell’s door because glucose floating around in the blood is dangerous.

Technically, at this point a person should be diagnosed as being insulin resistant. However, they aren’t because the increased insulin works… for a while. And their blood glucose levels will be within normal range as the high levels of insulin force the cells to take in glucose.

So step 1 is that the serum insulin level is high, but the blood glucose level is within range.

If no change is made to the diet and the onslaught of glucose in the blood continues, the cells stop responding to the increased insulin levels. The glucose starts staying in your blood longer. And this is when you get diagnosed with prediabetes (or to use the more PC term, insulin resistance) or type 2 diabetes mellitus (aka, T2DM), depending on how high the glucose levels are.

In other words, step 2 is a diagnosis of insulin resistance or diabetes, which is based only on your blood sugar levels even though your insulin levels were likely indicating a problem long before that.

(Note: in addition to the 29 million Americans who were diagnosed with diabetes in 2012, an additional 86 million had been diagnosed with prediabetes.)

Again if no change is made and the blood sugar remains high, eventually the pancreas runs out of steam and no longer produces enough insulin to overcome the cells’ resistance. At this point, a person has to take glucose lowering medications and/or be injected with insulin in order to achieve an appropriate blood sugar level.

This is step 3: insulin-dependent type 2 diabetes.


It is worth noting, that a diagnosis of insulin resistance or type 2 diabetes doesn’t take into account the other impacts the high blood sugar levels are having in the body. As I explained previously, too much glucose floating around in the blood is dangerous in all sorts of ways.

In fact, some experts say that Alzheimer’s Disease is type 3 diabetes because it is caused by changes in the brain as a result of increased blood glucose and insulin. (Note: Although brain cells do not need insulin to absorb glucose, insulin is involved in the release of neurotransmitters.)

For the record, the problem isn’t the cell’s response. The problem is our diets. Because the fact is that once you’ve eaten a food, the body has to do something with it.

In the next entry in this series, we’ll talk about how to achieve blood sugar control.  Don’t miss out on this valuable “how to” information by signing up for my weekly newsletter. It also includes additional info and personal insights from me that you won’t get anywhere else.



Much of this information does not apply to type 1 diabetes mellitus (T1DM) which is an autoimmune disease in which the immune system attacks the pancreas. The result is that the pancreas loses its ability to produce sufficient amounts of insulin, so the “knock on the cell door” never happens. However, for people with type 1 diabetes who do not achieve sufficient blood sugar control, the outcomes will be the same as someone who has blood glucose spikes for other reasons.


— American Diabetes Association. Statistics about diabetes. In Diabetes Basics. Accessed on June 3, 2015.
— Gropper SS, Smith JL. Advanced Nutrition and Human Metabolism. 6th ed. Belmont, CA: Wadsworth Cengage Learning; 2013.
— Hall J. Guyton and Hall Textbook of Medical Physiology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011.
— Kroner Z. (2009). The relationship between Alzheimer’s disease and diabetes: type 3 diabetes? Alternative Medicine Review. 2009; 14(4): 373.
— Suzanne M, Wands JR. Alzheimer’s disease is type 3 diabetes — evidence reviewed. Journal of diabetes science and technology. 2008;  2(6): 1101-1113.

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