Diabetes Self-Management Blog

Most doctors and health writers blame Type 2 diabetes on bad genes, bad behavior, or both. Diabetes is all your fault—either you’re doing something wrong, or there’s something wrong with you.

But, as I explain in my new book Diabetes: Sugar-coated Crisis, rates of Type 2 diabetes are soaring all over the world. The number of people with diabetes has tripled in only 30 years. People’s genes have not changed in 30 years. Nor have we all become a gang of gluttons, eating ourselves sick. What has changed is the environment we live in. That’s where all the Type 2 diabetes (and the high blood pressure and heart disease) are coming from.

Our modern environment causes diabetes in at least three ways: stress, barriers to physical activity, and unhealthy food. High-calorie, low-nutrition food is available everywhere, and it’s cheap. Healthy food is less available and more expensive. High-sugar breakfast cereals and high-fat fast foods are marketed heavily to children, so kids learn unhealthy eating before they even get to school.

At the same time, physical activity is getting harder to do. We used to walk to work and do physical labor once we got there. We would entertain ourselves with games and sports. Now we drive to work or school, sit at a desk or stand at a counter all day, drive home, and watch TV. Most of us don’t even get the activity of walking to a bus. As one teacher told me, “Kids used to play basketball. Now they play video basketball.”

Just as bad as the food and exercise environments is the stress built into modern life. In small doses, stress is a lifesaver. When we are threatened, stress prepares us to run or fight by raising our blood glucose and blood pressure and increasing insulin resistance. None of us would have survived without stress. (An interesting article on the topic can be found here.)

But in modern society, we can’t run from or fight against threats. If you can’t pay the mortgage, or you’re threatened with losing your job, or your child is in the military, there’s nothing to run away from. You just worry, and you probably eat high-carbohydrate “comfort foods” to feel better. Over time, these kinds of stresses build your insulin resistance and give you lots of abdominal fat. You’re on the way to Type 2 diabetes. For more about the stress-diabetes connection, see my article at www.mendosa.com/stress.htm.

Stress is not evenly spread through society. Since stress is a response to threats we cannot control, the less control we have, the more stress we will have. Those with the least power have the most stress and the most Type 2 diabetes. Scientists cite Native American and African-American communities, where 20% to 70% of adults have diabetes, as proof of a genetic cause. But I would argue that these communities have the most Type 2 because they have the least power.

Of course, genes and behaviors are important. It is possible to eat a healthy diet, get regular exercise, and reduce stress even though the environment is against it. If you are able to do this, you will do much better at managing your diabetes. But those of us with more power—money, education, support, self-confidence—find it easier to go against the environment.

So if we want to prevent Type 2 diabetes or manage it once we have it, we need to empower ourselves by finding resources and support and building self-confidence. If we want to stop the diabetes epidemic, we need to change the unhealthy environments that cause it. This will be a job for governments, employers, schools, churches, health-care systems, communities, and all of us.

What are you doing about stress, lack of activity, and unhealthy food? How do you find the strength to live right in an unhealthy environment? Please post questions or comments to this blog.


  1. The REAL environmental cause of type 2 Diabetes may be that the industrial chemicals in our air and water have damaged our genes in ways that disrupt the glucose metabolic pathways.

    This is rarely discussed, though scientists who work with animals know that obesity is almost always the result of a genetic flaw, not behaviorial in origin.

    Most people, for example, don’t know that plastics contain substances used to make them fire-resistant which also behave like estrogens. These fire-proofing chemicals have been found in human fat and breast milk.

    The EPA has completely given up on the task of monitoring the safety of our environment and now mostly serves the whims of the Republican Party’s big corporate donors.

    Blaming the victim is always easier than looking for a cause, especially when the fixing the cause for the “obesity epidemic” might cost industry big bucks.

    Posted by lottadata |
  2. I am female, white, 47 yo, 5′9″ 142#s, a runner, and recently (Jan this year) dx’d with type 2. No one else in my family has diabetes.

    I have always been active. I have never been obese - pudgy at a couple periods in my life (no longer than a year).

    Go figure.

    Posted by mary A |
  3. One of the biggest contributors to Type II is the medical industrial complex. In order to get more money and more funding the parameters are being lowered every year as to what qualifies as Type II diabeties.
    Follow the money!!

    Posted by Azballgofar |
  4. Environmental chemicals definitely play a role in the genesis of Type 2, although nobody knows exactly how. Science Digest recently published an article on air pollution and diabetes here.

    I don’t know much about the food additives angle mentioned by lottadata, but it certainly makes sense.

    Re: the thin, physically active Mary A recently diagnosed with Type 2 - you may want to go back to your doctor and ask to be checked out for late-occurring Type 1. You may need to be on insulin. This mistake gets made all the time. I’ll be blogging about this in a couple of weeks.

    Re: following the money - as azballgofar suggests - absolutely! It’s not ALL about the money, but mostly.

    Posted by David Spero RN |
  5. On every site I’ve been on, when someone mentions being thin and athletic, it seems the response is always that it must not be Type 2. I’m confused. While it’s true I’m overweight, my mother is 100 lbs soaking wet and has always been extremely active, walking sometimes several miles a day. She was diagnosed with Type 2 about 10 years ago. Her mother, also thin and very active, was also diagnosed with Type 2. Am I missing something? Are all Type 2’s fat? If so, how does that explain the people in my family who are thin but have it? Ok - so I can blame myself I guess. Who can my mother blame?

    Posted by 33-yr-old Type 2 Female |
  6. Is there any scientific publication related to this issue please forward to me.

    Posted by fayyazoddin |
  7. Thank You So much, for all this information !
    I am studying Health and Social Care at college,
    and am doing Type 2 Diabetes for my public health issues assignment and this is EXACTLY what i needed to know :)

    Posted by Nicola Birchmore |
  8. Type 2 diabetes is truly a fatal disease. The sad part of this disease is that this is primarily hereditary. Thus, it would be hard for individuals to prevent this disease when they have family members who already suffered from it. The best way to prevent this disease from worsening is to maintain balance and healthy lifestyle.

    Posted by Scott Alexander |
  9. I have just been diagnosed with pre-type 2 diabetes. I am not overweight and I have maintained a very healthy diet for many years. I have not been very active for the last few years but I certainly don’t sit around all day by any means. My father had type 2 in his later years. Hereditary? Environmental? Stress? All three, I think.

    Posted by Annie |
  10. modern society put obstacles to man actualization of values .it gives you false needs . The comodities and consumerism of this society and brought new habits to humans regarding eating foods and exercises and the impact over our old genetic programming results in insulin resistance obesity metabolic syndrome diabetes. modern society with the fludge of avertisments brings perversion of what we desire and we live an atmosfere of spiritual misery.

    Posted by Francisco barretto |

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