“Fat and Lazy,” or Type 2 Diabetes—Which Came First?

One of my ongoing freelance projects is writing a monthly series for my local newspaper about the top 10 killers in our area. It pretty much follows national trends, and I’ve already done the top four: heart disease, lung cancer, stroke, and COPD (chronic obstructive pulmonary disease). Next up is number five: diabetes.


Last week, I went to interview one of the local endocrinologists, and the first thing I said to him was: “I’m a new patient. What’s the first thing you’re going to tell me?”

Doc immediately began a long litany involving diet and exercise. I listened (and listened, and listened) and finally halted his dissertation. “Do you realize,” I asked, “that you have yet to say anything about helping me get my blood glucose under control?”

But that’s what he was saying, he insisted.

He may have thought so, but it wasn’t what I was hearing.

“My A1C is 10.5%,” I said. “I’m tired and hungry all the time. Besides, diets haven’t worked for me in the past, so all you’re doing is setting me up for failure.”

Ah, wouldn’t it be nice if the conversation went more like: “My, your sugars are high: You must feel terrible! We’re going to get those down and you’ll feel much better.” And then maybe explain what helps lower blood glucose? And tell me that getting my blood glucose under control will alleviate the hunger and give me back some of that old zip?

I remember when I first began taking insulin and the lethargy went away. It was a miracle drug! Energy in a bottle! I couldn’t wait to give myself the next injection! “Heh,” said my boss, who had Type 2 diabetes and knew what was happening. “You just thought you were getting old, didn’t you?”

The whole scenario made me think about Type 2 diabetes, attitude and reality. For example, I thought of a “chicken or egg” case: Which came first: “fat and lazy” or Type 2 diabetes?

For instance, when glucose isn’t getting into your cells, your body thinks it needs more food. You’re hungry. The higher levels of glucose in your blood are sapping your energy as well. You’re tired. You’re eating too much in an attempt to quell your hunger. You’re too tired to exercise. You gain weight. It’s a vicious circle.

About that point is when you’re diagnosed with Type 2 diabetes—which you’ve already had for years.

As I write this, I’m on a cruise ship. I was sitting on the veranda earlier today, looking at the navy blue waters of the ocean. Just a flat blue. Then I looked down and the view became three-dimensional, with bubbles and water forming patterns together and pieces of seaweed under the water coming into view.

Had I not looked at the ocean from a different perspective, I would have missed seeing a deeper (so to speak) picture. Could it be that way with Type 2 diabetes? That people in the diabetes industry looked only at the surface for years, saw only “fat and lazy,” and never looked beneath the surface for contributing factors?

Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Diabetes Self-Management.
About Our Experts >>

  • Y2rooster

    I’m still so confused about my Diabetes! I was diagnosed 11/05. I had lost roughly 25 lbs.,stayed tired most of the time(even though I fought through it), and had pretty much every other symptom there is. This seemed to start 5 months before I was diagnosed. I have never been overweight and have always been pretty active. As a matter of fact, I’ve ben trying to gain weight for as long as I can remember. Now I can’t seem to gain a pound! I have not gained back any of my weight since. So, could “skinny” have come before Type 2????

  • Linda

    I actually resent the immediate assumption that weight and exercise are the cause of my diabetes. I have always been within the recommended BMI and have exercised regualary all my life. My parents are exercise nuts. My diabetes is entirely genetic. But anytime I read an article, these are the only items of recommendation.

  • mylove4him

    My husband was recently diagnosed with Type II. Since starting Metformin he indeed has more energy, feels more like ‘the old days’ and has lost 25lbs. The weight loss came from changing our eating habits and walking a few times a week. Before this diagnosis he barely made it through the day without a nap! It’s a terrible injustice to make assumptions about how a person became overweight or out of shape. In our experience, many healthcare professionals are wonderful at stating the ‘facts’ but are lacking in the area of educating the patient about their disease. If one doesn’t ask the right questions or has limited access to resources of information, they likely come away from the Doctor feeling worse about themselves than before they walked in. There is so much to re-learn after this diagnosis and sometimes we need more than just the facts.

  • Renee Thanig

    I was diagnosed with Type 2 diabetes in March of 1999. I was overweight but could not lose weight no matter what I did. I was and still am active bowling 3 times a week during Sept – April and playing softball weekly from April- Sept. I also ride bike, hike etc.
    When I was finally diagnosed because my feet were tingly all the time and I requested to be checked for diabetes along with whatever the doctor was looking for (he didn’t think it would be diabetes). I then met with a dietitian who helped me understand carb counting, portion size and I also added walking to my exercise program. I did lose about 75 pounds (have gained back about 20 and holding it steady now), however I don’t think I would have gotten so heavy if my body would have been working correctly for all the years before the diagnosis. So I guess what I am trying to say is that at least in cases like mine the diabetes probably was there before the fat as I was never lazy

  • Diana Baltodano RN.,C,C.D.E.

    Frequently when I have a new diagnosis T2DM patient, they will be filled with guilt thinking that if they had not allowed themselves to become fat, they would not now have diabetes. Their families tell them that, medical professionals and the diet industry all do.
    I tell them the effect of hyperinsulinemia on appetite and the storage of fat. But the pressure from society is still there.

    I remember when I was first diagnosed with T2DM, 9 years ago. My endocrinologist listened as I cried in her office for 30 minutes and beat myself up for the many years of obesity. She then told me it would be ok, that I have a condition that is hereditary, that weight loss will help to control it, but that I need not focus on losing 100 pounds. She told me to focus on lifestyle changes. I left feeling better about having diabetes, better about myself and empowered to make lifestyle changes. I did lose weight without dieting. I followed her advice. I will always remember how she made me feel.

  • bncriss

    Why do some folks always point that finger at something that has made their lives less than what it should be, but invaribly fail to look down that arm and see that there are three fingers pointing right back at the real cause.

    I have been diagnosed with type 2 since 1997 (Halloween Day). The first thing they told me was I had to lose weight and exercise more or I had a good chance of having my feet aputated later on down the road. I was told to just try and loose a pound or two a month. Just try eating one scoop of ice cream instead of 5. Eat just a palm size of meat instead of an arm length size.

    Was it easy, not at first, but now 10 years down the road, it actually is. Just like taking insulin, that first shot was real scary, and I begged my doctor for two years, but once I did it, I thought how redicules it was to have been so frightened over nothing. The shot is 10 times less painful than the prick to test your blood. Yes, I said 10 times LESS painful.

  • Diane


    I have been reading your blog for quite some time and really like to hear your opinion on things. You hit the nail on the head with this topic.

    For most of my life I have been a “noraml” weight person. I was exteremely active being a competitive swimmer ( I went to the state championships twice). I also did Diving, Gymnastics and Tap Danced. I continued with swimming throughout my adult life.

    It was when I became pregnant that I found out that I had Gestational Diabetes and ended up on insulin. the first sign was a lot of weight gain in the begining of my pregancy. After the insulin, I started loosing weight.

    After the baby was born, I was ok – no diabetes, until 8 years later. I kept on gaining weight, mind you I was still swimming. Doctors would say to me try doing some exercise not even asking if I was doing any. Well I ended up with type 2 diabetes and now I have a weight problem. So did the chicken come first or the

  • jk

    I loved the insight here. I’ve been officially diagnosed with Type II for about 6 months, went straight on Lantus and metphormin, but know I’ve had it for years. And yes, the fat and lazy thing is very accurate. Partly due to the fact that we, as a nation, are somewhat lazy… leading to being fat.

    If my doctor had put it to me like, “your sugars are crazy high, if you don’t get this under control you’ll be a full-blown diabetic in a few years” instead of “well, you should really get more exercise and try to lose some weight… and hey, here’s HOW to do that”, I may have been more inclined to save myself.

    JK in KC

  • Debbie

    My doctor sounds like yours. I so agree with you when you said having Type 2 diabetes means just fat and lazy.
    I have had my meds changed so many times i have lost count and now of them work yet my doctor doesn’t seem to be concerned with trying to control my sugar just about how much I weigh and to GET THE WEIGHT OFF. Do these doctors really think I just love being over weight? I would love to be the size I onced was yet no matter what I do I just gain weight.I was told everything I eat turns to sugar and my body stores the fat and sugar so why won’t the doctor get me the right meds to control the sugar and something to help me loose weight? If I was famous I bet I could get some kind of diet pill that worked.
    When it is so important not to be fat with diabetes I would think the doctors would try everything they could to help get and keep the weight off,but no–all I ever hear is loose weight and I am so tired of hearing about my fat.
    Hope you all have a better doctor then I do.

  • mow

    i was diagnosed 27 nov 2007 with type 2 diabetes i was clinically depressed for a day or two.im trying hard to accept ths new diagnoses as i had atrium and aorta valves replaced 2005.im on warfarin and also have chronic anaemia so i need lots info and emotional support.

  • bmbr

    Hi…newly diagnosed and been told by lot of ppl that i brought it on myself for being overweight. I did have panreatitis after a gallbladder op 3 years ago …cud that be a factor ? I mean not everyone who is overweight has dabetes right ??? or am i ?

  • Jan Chait

    bmbr, I wrote a blog that ran May 29, 2007. Try reading that earlier entry and see if it answers some of your questions.

  • bmbr

    thanks for the info…i am only 41…i have been overweight for a few years now…..so i prob didnt help myself….however i think now that the symptoms for diabetes have act been there for quite some time and i hadnt realised….i went to doc with extreme swelling of the ankles and he ran some bloods to rule out kidney disease ( act had many many kidney probs all thru my teenage yesars )and thats wen my high blood sugar showed up…so just a random test showed it…have been exhausted for years and running to toilet a lot for about a year so looks like it may have been there.

    thanks again for info

  • Mike in Phoenix

    Thank you all for your comments. It’s nice to know there are places on the internet to go and see what others have experienced, or are experiencing. I’m 49 years old, officially diagnosed with Pre-Diabetes, or Insulin Resistant, but I’m certain mine has turned to full-blown type II diabetes. I have an appointment to see the doctor on Tuesday, 7/1/2008, but I wondered if anyone had any advice for me. My situation is… I am 6′ tall and weigh 330lbs. I was first alarmed when I started having problems with my vision about 3 months ago and now I have ups and downs throughout the day, and they all seem to be related to before I eat, or after I eat, which leads me to believe these symptoms are glucose related.

    Right now I do nothing for diet except try not to each as much as I used to (and it does no good) and I cannot exercise because of severe back problems. I severely injured my back in 1981, again in 1999, and I haven’t been the same since. I think the most I can do is walk and swim. These hurt quite a bit too, but I can do them if I’m willing to suffer a bit for a day or two afterwords.

    Is there anyone else out there with a similar history, that has found success with medicine, diet, limited exercise, etc.? I look forward to someone, anyone, that can give me some degree of hope. Also, the doctor I am seeing is a Family Practice physician, a D.O. to be specific. Can I expect help from her or should I be seeing a specialist?

  • Dan

    Ok guys, here’s some logic for you, because I want you to educate those around you as well.

    Why would the incidence of diabetes II increase proportionally with the body mass index within a population?

    Look at the numbers. Fat first then diabetes.
    Educate your children on changing old habits, making smart food choices, learning portion control and incorporating daily exercise to change their future!

    Set a good example on changing your life; they need you to act because they want quality time with you healthy.

  • Sara

    I disagree with Dan, I think the pre-diabetes comes first. A lot of us here are women, and there seems to be a pattern. Healthy and active until something like the birth of a child. My second pregnancy I gained about 15 lbs. Soon after he was born, after I was done nursing I was sooo thirsty and famished all the time. I rode mt bikes, and i mean rode. Not the average jaunt. I some times raced, swam had a routine at the gym etc… I did not gain weight immediately but started having rediculous bouts with the toilet. I ate and within 1/2 i went. I would be driving home and have to pull over for fear I’d fall asleep at the wheel. My energy waned. My activity did decrease. But the fact that i was parched all the time, starving to death and frequently after eating fell asleep should have been an indicator. Over one Year I gained 110 lbs. Mind you I was tired, but my doc just said get exercise now your obese and could have complications. Well duh?
    That was 7 years ago, I literally track my food, I keep a program called fitness assistant on my desktop. I force my tired rear to the gym at least 4 days a week and I eat less than 1300 calories a day, majority being protein. I have lost all of 6 lbs in 6 months. So… Today I am pregnant, my doc says WOW. You are diabetic and have been for at least 3 months if not longer. My a1c was 6.1… but only because I bust my lazy rear and eat 1300 calories a day. It could have been worse. I thank god I know what is wrong with me now. My first dose of insulin brought me down to 80, which I had not tested at in 6 years( I check daily averaging 135ish)And I cried I felt soooo human again. I thoguht OOMG I can do 100 laps at the pool not 12 and I can ride the biuke for an hour not a half… Maybe my weak arms will lift more than 45lbs. I think pre-diabetes is not addressed properly. I dont think its fat and lazy… I think its genetic and a shame we are labelled. Stand up and demand the care you need. I think I am a perfect example, I did the right things, my blood work showed it, but nothing would give, my bidy could not respond properly.

  • Christine M

    I am so very happy to read these comments. I have eaten very well all of my life, except when I have been dieting. I remained on the lower side of healthy for my height other than when I was pregnant and gained lots of weight because of a kidney malfunction. I have always been highly energetic. When I approached fifty I gained a lot of weight even though my lifestyle and eating habits hadn’t changed. I found it quite difficult to lose the weight. I was then diagnosed with Type II diabetes and the medical profession assumed that I had poor eating habits. I couldn’t convince them that I had eaten fresh, organic fruit and vegetables all of my life with only an occasional treat.

    My brother is Type I diabetic and we have so many type I and Type II throughout the family (not all of the type II are overweight either) clearly there is some kind of pancreatic malfunction. And yes, I hate being branded as a person with poor eating habits who doesn’t exercise. I actually walk on the treadmill for 2 hours every day,which is very difficult when one is tired. I also study law and operate a successful business. No, I am not a lazy person. But I am often a very tired person.

    I agree with everyone who says pre-diabetes is not addressed properly. I did meet one doctor who was of the opinion that dieting as a young person could be a factor as glucose levels fluctuate. And it is clear that genes are a major contributor.

  • Christine M

    I also disagree with Dan. In fact, I think he’s unable to think laterally. He is clearly blinkered as are many of the medical profession. My mother, who is not a diabetic, but I am sure is a carrier, is amazed at how little I eat and how much I have to exercise. She is 88 and I eat the same products she eats. I have diabetes and she doesn’t?????? She was also amazed when I began to gain weight before being diagnosed because she didn’t think I was eating enough to survive. So Dan, I say to you try to think outside the square. The experts weren’t even aware of type 1.5 until recently.

    I noticed whenever I undertook heavy lifting of any kind instead of losing weight I gained it. Subsequently,some scientists found that diabetics carrying heavy backpacks up a hill actually increased their sugar levels because their bodies were under stress. I was pleased to learn that because it proved my theory right. Also I know from my own experience when I am working hard mentally in my profession my sugar levels rise and I gain weight. This is usually when I eat less than usual.

    So Dan, you are amazingly ill-informed.

    One of my doctors described it as a “bitch of a disease.” And I agree.

  • Linda

    My daughter (18) tells me that 90% of people with diabetes have chosen it because of their life style. I assume she gets her stats from 90% of diabetes is stage 2 as oppossed to stage 1…stats that I’ve seen. I don’t support or believe that 90% chose this. I can’t believe 1% would choose it. Just would like some stats or info from people that know what it really means.
    My father was type 2, and he was self inflicted by his life style…I also know thats probably not the norm. Would love to hear from those that have insight on the subject.
    I’m not trying to prove a point to my daughter…I want her to be able to open herself up to the world that really exists. Thanks if you can help.

  • Daniel 2

    The comment that Dan left earlier spoke to an important point; that Type 2 diabetes is becoming more prevelant in America because increasing weight is also becoming more prevelant. That in my opinion is an important correlation. It is obvious to me that the most likely the majority of adult these days that contract T2DM are because they are usually grossly overweight and out of shape.
    In the past, when America was healthier, lighter in the waistline and fitter, back when we worked physical jobs for a living, exercised more, moved around more out of necessity, and didn’t spend countless hours in the chair at work at the computer, or on the couch watching TV, and driving to work, the adults who got T2DM were the ones who were genetically predisposed to diabetes, and children with T2DB were almost unheard of. The numbers of type 2 have exploded as the country has gotten fatter and out of shape.
    Therefore, I believe that most, but not all people who have T2DM are just lazy and inactive.
    I feel for the individuals who can’t exercise, who have T2DM, and if your conditions and inability to exercise and eat right really aren’t your fault, then I feel for you. But reality tells me that most people who don’t exercise, are just making excuses. And I have heard all of them.
    I can list a few; I have bad knees, plantar fasciitis, I’m too tired, I work too much, I can’t afford a gym membership, it’s too cold, it’s too hot, on and on and on,
    I have heard all of them. The truth is that the average person generally hates exercise, it is just that they don’t want to admit it.
    Hey, I hate it too, I just don’t like being fat and unhealthy. I’m willing to endure the pain; and the good news is after awhile, you seem to get used to the exercise, no matter what it is.
    Everybody has a predisposition to get sick, like getting diabetes, or other diseases. Exercise reduces the chances of getting T2DM, and reduces the effects and severity of people who have it.
    And I am talking about heavy exercise, not just walking for 30 minutes 3 times a week. Exercise as much as you can, and build up to increasing time and intensity.
    The problem of posting that your condition is genetic, whether it is or is not, is that you prepetuate the idea that obesity, Type 2 Diabetes are genetic, and that if you get it, you are stuck with it for life, is that other overweight people believe that they have genetic T2DM when they don’t, and don’t do anything about it.
    For Mike in Phoenix who can’t exercise because of his bad back, invest in a recumbent bicycle!
    Look, there is always going to be unlucky people who are going to get T1DM and T2DM because of genetic reasons, whether fat or not; but most fat people with it have it because they are fat, and don’t assume that if you have it, it is genetic. Try some serious exercise and diet control if you want to find out, and you want to live longer and thinner. Give it all you got, don’t give up. Fight for your own life.
    Another point, there is no such thing as pre-diabetes. You either have diabetes or you don’t.
    And health doesn’t come in a pill.

  • Pat


    I am Pat an Aferican American who has recently been diag. with diabetes. My diagnosis is so new I don’t even know which type I have. I have all of the symptoms and my mom and several family members are diabetics. I go to the gym about three times a week. I ride the stationary bike about 40 min and I do sit-ups total work about 45 min to one hour. I am a little depressed about all of this, by the way I am overweight. I am a 50% service connected disabled vet. so running and all of that I cannot do. I go to the VA for care. I am waiting on more info and to put in classes.

  • kelly

    Hello there, i have been diagnosed with Type 2 for 4 years now, the doctor tells me my metabolism is so bad it compares to an 80 yeard old woman. I have a bad thyroid problem and POS on top of that. FOr the life of me i can not loose weight. I eat amazingly healthy i workout and still dont loose. I am on victoza, metformin and symlin. I been changing my meds for years hoping for the best and still nothing. any suggestions?

  • jim snell

    I would check liver glucose leakage during day and dawn effect at am wakeup.

    I could not lose an ounce on 1200 tight diet watching carbs and 2 miles a day walking. My weight climbed to 330 lbs.

    A1c was 13.3 during this time and am BG was 238.

    Once liver stopped using mnetformin in timesd approach, A1c dropped to initially 6.9 and then 6.4 and morning BG was 100 to 140 same as at midnight. Weight dropped from 330 to under 250. Diet and exercise indentical to before and after adjusting metformin.

    Using CGMS proved best how to take metformin.
    Liver leakage stops on metformin up to strength in blood on current taken pill. Single large dose waste of drups and ineffective – does not work and residual in body has no impact on liver leakage shutoff. See Salk, John Hopkins etc.

  • jim snell

    This is an excellent article and attacks the stupidity of certain “folks” trying to help type 2 diabetes.

    First off:

    a) medical conditions and leaky liver can override any benefits of diet and exercise. The human body’s regulation system depends on a storage based approach where glucose is stored all over – liver, fat cells, skeletal muscle cells.

    As long as there is room to store more glucose in liver, fat cells, skeletal muscle cells, insulin releases by pancreas will cause regulation of blood bg by shifting blood glucose to the storage sites. Once storage sites filled, insulin rises as pancreas attempts to force more storage.

    A leaky liver can keep all the storage sites filled up and the storage cells turning off the local pancreas insulin to block any more loading of glucose and resulting body destruction. IE Insulin resistance.

    The leaky liver is so powerfull refilling all the other storage sites to point exercise and diet limtation, carb control are ineffective.

    Once the leaky liver, and medical conditions overwhealming the storage sites has stopped, tight diet – cab control, sufficient hearty exercise are then critical to keeping the storage sites from being overfilled all the time and getting/keeping insulin resistance shutdown and enabling/maintaining good BG regulation.

    I have lived this directly and have data, numbers and diet and exercise regimene over a 4 year period backing this up.

    The argument about fat and or lazy comes from the same crowd standing in the wrong dead end tunnel with the lights turned off who keep wanting to shove more insulin at the problem while at same time their flat earth societies ignore all data and research on cell physiology and operation.

    Unfortunately, the hunter gatherer gut/gene set was optimized 10,00 years ago in times of shortages, famine ans scrawny game to grab and save every carb eaten. It was not optimized in a day of 24/7 feast of plenty on grains, corn and rice, sugars from high tech farming and manufacturing to bypass extra carbs over the side to prevent overloading local body stores causing rotting of the body by constant exposure to excess glucose in the blood stream.

    Nature allowed external events to control energy input to body that now the human MUST do the energy eaten limitation and management and medical science needs to be there correcting internal body screwups that cause overloading of the glucose. Current Doctors need the latest 23third century Star Trek tools-computers, monitoring and analysis tools to quickly fight and manage this epidemic. The current single shot lab tests, horse and buggy whip, best educated guesses, and order of the wand and magic of Merlin are not up to the job today witnessed by the rate of growth and expansion of type 2 cases that is described as an explosion around the world and gains of 200% and 300% just waiting to bankrupt us all and the world,

  • Sue

    Thank you.

  • Karin

    I’m a TYPE 1 (one) Diabetic and was diagnosed over 15 years at the age of 27. Type one is an autoimmune disease – Type 2 is a metabolic disorder THEY ARE completely 2 different diseases.

    Here is a link explaining what a metabolic disorder is: http://www.nlm.nih.gov/medlineplus/metabolicdisorders.html

    Chicken or the Egg, which came first? Fat then the diagnoses of type 2 diabetes?
    I think we are asking the wrong question. Do you eat processed, junk food? Have minimal fruits and veggies and lean meats in your diet? Do you consume diet soda, use artificial sweeteners? Well if you do and you have a history of Diabetes in your family it’s not if but when you will be diagnosed a type 2 diabetic. Some people gain weight by eating the good’ol American Diet some remain the same. Yes, the majority of type 2 diabetics are over weight but I know quite a few who are “normal” size.

    We hear throughout our lives to eat right but really what does that mean? Remember food companies are pushing products and label accordingly to the newest fad, “all natural”, “sugar-free” etc. They’re goal is to make money. So we’ve been had, lied too, twisted in all different directions all to come out fat, tired and sick. Honestly, I am grateful for my diagnoses of Type 1 diabetic because it has opened my eyes. After many visits to Dietitian and Nutritionist I finally came to this conclusion. Eat only what comes from the earth, If it can sit on a shelf for years and not spoil, don’t eat it. If the ingredients listed take up half the box and you can’t pronounce some of the words, don’t eat it. I truly believe if I had not been diagnosed with this disease my family would be very sick.

    In regards to your visit with the doctor, you have to be your own advocate. I know doctors can have terrible bedside manner, some not all but try to see things from their perspective. Day in a day out they see patients who basically say “just give me the pill”. Many Patients don’t want to hear what they have to do to fix it, they want the easy way out. Dr’s get complacent in their explanation of what it means to be a diabetic so you have to ask the questions and do the research. It’s your life don’t you think you’re worth it?

  • OG Mudbone

    If you can cure Type 2 with diet and proper exercise, you were being fat and lazy. Uncle had type 2 because he ate and slept like crap for 20 years while working in the oilfield, he got his stuff together, and poof no more type 2.