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Type II is caused by chronic ingestion of excess carbohydrates, which leads to insulin resistance in those who are genetically susceptible to it. The mechanism

Type II is caused by chronic ingestion of excess carbohydrates, which leads to insulin resistance in those who are genetically susceptible to it. The mechanism is that the carbohydrates are broken down into glucose in your blood, which must be removed because high blood glucose for an extended period causes severe disease. Higher insulin levels drives glucose into your muscles until they can't take any more, your other cells until they can't take any more, your liver until it can't take any more, and then stored as body fat until your fat cells can't take any more. When everything is full, higher and higher levels of insulin are needed to stuff more and more glucose wherever it can be stuffed. That's Type II diabetes.

pyaamb 5y ago
seems that type 2 might also have an autoimmune connection (paper linked in article) https://www.healthline.com/health/type-2-diabetes/is-type-2-diabetes-an-autoimmune-diease#what-it-means-for-treatment https://www.healthline.com/health/type-2-diabetes/is-type-2-...
- cperciva 5y ago
  That's very weak. Obesity is linked to inflammation but that's about as far as the evidence goes so far.
Diab97216 5y ago
This is in fact a commonly told story about how diabetes comes about. It matches with some of the science. But it's also clearly incomplete, as there are numerous cultures around the world that live on lots and lots of carbohydrates without developing diabetes, such as much of Asia eating mostly white rice, and hunter gatherer tribes that live off honey, and others.
- CorrectHorseBat 5y ago
  Diabetes is a big issue in Asian countries eating a lot of white rice, not sure why you think it's not.
- mataug 5y ago
  Incomplete is correct, asian cultures eat a lot of carbs but until recently a lot of the carbs weren't refined. Rice was eaten with the husk, and it was a luxury so people didn't consume as much of it as they do now. People also didn't have the luxury of 3 meals a day. So the point is that its easy to over indulge with our modern conveniences and thus developing type 2 diabetes is a lot easier today.
- sedivy94 5y ago
  Oversimplification. Brown rice and fructose, for example, are metabolized very differently from one another. I do agree that pinpointing a lower-level MOA other than just “insulin” will be a valuable discovery. But that MOA, whatever it is, isn’t the root of the problem. Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, income inequality, and mass production of processed foods?
  - xmodem 5y ago
    > Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, I don't see why the hell not. We already have these in the form of treatments for alcohol/nicotine/opiate dependence.
  - vidarh 5y ago
    > Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, income inequality, and mass production of processed foods? Is it the most effective treatment? Then yes. That does not preclude also trying to avoid the problem in the first place. But fixing behavioural patterns is one of the things we are worst at. Fixing diabetes won't fix all of the other issues of a bad diet, so it's not like the incentive to improve peoples diets will go out the window, though it might reduce the individual incentives for some people. But that's true for all kinds of things - we can't withhold treatment options because some people will take the availability of treatment as a reason not to be cautious.
tryptophan 5y ago
You're kind of oversimplifying a lot of things and making strong (potentially unfounded) assumptions. "chronic ingestion of excess carbohydrates" can't be the cause because plenty of people do that and do not get diabetes, therefore it is just a contributing factor. We do not know exactly what goes wrong and where to lead to this condition. For a more comprehensive source, try reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503727/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503727/
- sedivy94 5y ago
  Excess carbs ≠ excess calories. You’re conflating the two. How do you achieve one but not the other? Eat carbs and nothing else - which is surprisingly common. My father is quite thin, yet drank soda religiously my entire life, and is now struggling with metabolic disease.
  - 0x5345414e 5y ago
    This paper has some interesting details on potential causes of lean diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434081/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434081/
    - sedivy94 5y ago
      Thank you! Will read.
- throwawaycities 5y ago
  While true not everyone who consumes carbs/refined sugars will get T2D, there isn’t a single case of T2D where the patient didn’t over consume carbs/refined sugars. Similarly, there isn’t a patient that has reversed their T2D that didn’t make changes to their diet that reduced or entirely eliminated carbs/refined sugars to control their blood sugars levels/insulin spikes. It is a truth that all cases of T2D are preventable through diet/lifestyle, it is that simple. Though there maybe some other issues at play, it’s probably best to avoid the nasty disease altogether based on the available information and allow the research to continue so maybe one day people can eat all the sugar they want without risk of T2D, but then they would still be at risk for every other metabolic disease including obesity, fatty liver disease, and heart disease.
RHSeeger 5y ago
Given the fact that there are thin / normal weight people with type 2 diabetes, I think saying "ingestion of excess carbohydrates" is the primary cause is a bit misleading. You'd have to define "excess carbohydrates" as "enough to cause type 2 diabetes in that person", which leads to it almost being a tautology. There's still a large number of gaps in our understanding of the condition and it's causes.
- brandonmenc 5y ago
  "skinny fat" exists, and there may be a wide range of tolerances. Perhaps some people only need to ingest an excess for a very short time while others can do it longer or indefinitely.
WesolyKubeczek 5y ago
Well, it’s all good and nice and shit, but doesn’t explain how there are thin type IIs, and doesn’t explain how there exist lean mofos who guzzle down sugary coke and eat ultraprocessed junk food all the time and don’t get diabetic at all.
- deleted 5y ago
  [deleted]
samsa 5y ago
This is incorrect, or at least very misleading. Excess carbohydrate consumption exacerbates insulin resistance but the cause is an excess of intramyocellular lipids.
- 0x5345414e 5y ago
  This is the more correct answer. If anyone wants to dive into mechanisms of insulin resistance, this paper is a good overview: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170977/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170977/
karim79 5y ago
+1 I came here to type something similar. I've also observed that it has been described as "carbohydrate intolerance" which seems to make a lot of sense.

pyaamb 5y ago

seems that type 2 might also have an autoimmune connection (paper linked in article) https://www.healthline.com/health/type-2-diabetes/is-type-2-diabetes-an-autoimmune-diease#what-it-means-for-treatment https://www.healthline.com/health/type-2-diabetes/is-type-2-...

cperciva 5y ago
That's very weak. Obesity is linked to inflammation but that's about as far as the evidence goes so far.

Diab97216 5y ago

This is in fact a commonly told story about how diabetes comes about. It matches with some of the science. But it's also clearly incomplete, as there are numerous cultures around the world that live on lots and lots of carbohydrates without developing diabetes, such as much of Asia eating mostly white rice, and hunter gatherer tribes that live off honey, and others.

CorrectHorseBat 5y ago
Diabetes is a big issue in Asian countries eating a lot of white rice, not sure why you think it's not.
mataug 5y ago
Incomplete is correct, asian cultures eat a lot of carbs but until recently a lot of the carbs weren't refined. Rice was eaten with the husk, and it was a luxury so people didn't consume as much of it as they do now. People also didn't have the luxury of 3 meals a day. So the point is that its easy to over indulge with our modern conveniences and thus developing type 2 diabetes is a lot easier today.
sedivy94 5y ago
Oversimplification. Brown rice and fructose, for example, are metabolized very differently from one another. I do agree that pinpointing a lower-level MOA other than just “insulin” will be a valuable discovery. But that MOA, whatever it is, isn’t the root of the problem. Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, income inequality, and mass production of processed foods?
- xmodem 5y ago
  > Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, I don't see why the hell not. We already have these in the form of treatments for alcohol/nicotine/opiate dependence.
- vidarh 5y ago
  > Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, income inequality, and mass production of processed foods? Is it the most effective treatment? Then yes. That does not preclude also trying to avoid the problem in the first place. But fixing behavioural patterns is one of the things we are worst at. Fixing diabetes won't fix all of the other issues of a bad diet, so it's not like the incentive to improve peoples diets will go out the window, though it might reduce the individual incentives for some people. But that's true for all kinds of things - we can't withhold treatment options because some people will take the availability of treatment as a reason not to be cautious.

tryptophan 5y ago

You're kind of oversimplifying a lot of things and making strong (potentially unfounded) assumptions. "chronic ingestion of excess carbohydrates" can't be the cause because plenty of people do that and do not get diabetes, therefore it is just a contributing factor. We do not know exactly what goes wrong and where to lead to this condition. For a more comprehensive source, try reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503727/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503727/

sedivy94 5y ago
Excess carbs ≠ excess calories. You’re conflating the two. How do you achieve one but not the other? Eat carbs and nothing else - which is surprisingly common. My father is quite thin, yet drank soda religiously my entire life, and is now struggling with metabolic disease.
- 0x5345414e 5y ago
  This paper has some interesting details on potential causes of lean diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434081/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434081/
  - sedivy94 5y ago
    Thank you! Will read.
throwawaycities 5y ago
While true not everyone who consumes carbs/refined sugars will get T2D, there isn’t a single case of T2D where the patient didn’t over consume carbs/refined sugars. Similarly, there isn’t a patient that has reversed their T2D that didn’t make changes to their diet that reduced or entirely eliminated carbs/refined sugars to control their blood sugars levels/insulin spikes. It is a truth that all cases of T2D are preventable through diet/lifestyle, it is that simple. Though there maybe some other issues at play, it’s probably best to avoid the nasty disease altogether based on the available information and allow the research to continue so maybe one day people can eat all the sugar they want without risk of T2D, but then they would still be at risk for every other metabolic disease including obesity, fatty liver disease, and heart disease.

RHSeeger 5y ago

Given the fact that there are thin / normal weight people with type 2 diabetes, I think saying "ingestion of excess carbohydrates" is the primary cause is a bit misleading. You'd have to define "excess carbohydrates" as "enough to cause type 2 diabetes in that person", which leads to it almost being a tautology. There's still a large number of gaps in our understanding of the condition and it's causes.

brandonmenc 5y ago
"skinny fat" exists, and there may be a wide range of tolerances. Perhaps some people only need to ingest an excess for a very short time while others can do it longer or indefinitely.

WesolyKubeczek 5y ago

Well, it’s all good and nice and shit, but doesn’t explain how there are thin type IIs, and doesn’t explain how there exist lean mofos who guzzle down sugary coke and eat ultraprocessed junk food all the time and don’t get diabetic at all.

deleted 5y ago
[deleted]

samsa 5y ago

This is incorrect, or at least very misleading. Excess carbohydrate consumption exacerbates insulin resistance but the cause is an excess of intramyocellular lipids.

0x5345414e 5y ago
This is the more correct answer. If anyone wants to dive into mechanisms of insulin resistance, this paper is a good overview: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170977/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170977/

karim79 5y ago

+1 I came here to type something similar. I've also observed that it has been described as "carbohydrate intolerance" which seems to make a lot of sense.