Diabetes: A 21st Century Health Crisis goes beyond glucose numbers to explore the science, prevention, management, lifestyle strategies, and evolving treatments surrounding diabetes. How did your own experience living with type 2 diabetes influence the way you approached the book?

My experience living with type 2 diabetes profoundly shaped how I approached this book. When I was diagnosed in 2003, I quickly realized that receiving a diagnosis and truly understanding the disease are two very different things. Patients are often given glucose readings, lab results, medications, and dietary recommendations, but many never receive a clear explanation of what is happening inside their bodies or why the disease developed.

That experience motivated me to become a serious student of diabetes. I wanted to understand not only how to control blood glucose but also the underlying physiology of insulin resistance, pancreatic beta-cell dysfunction, hormonal regulation, inflammation, obesity, nutrition, physical activity, and the many organs and biological pathways now known to contribute to type 2 diabetes.

As my research progressed, I came to appreciate how dramatically diabetes science has evolved. Type 2 diabetes is no longer adequately explained as a simple problem of insufficient insulin or elevated blood sugar. It is a complex metabolic disorder involving multiple organs, hormones, genetic and environmental factors, and lifestyle behaviors. That broader understanding became one of the book’s foundations.

Living with the disease also shaped how I wrote it. I deliberately tried to view the subject from two perspectives: What does the science tell us, and what does a person living with diabetes need to know? Those are not always the same question. Scientific accuracy is essential, but information has limited value to patients if it is presented in language they cannot understand or apply to everyday decisions.

For that reason, I tried to bridge the gap between medical science and practical application. I wanted healthcare professionals to recognize the scientific foundation of the discussion while enabling those without medical training to understand concepts such as insulin resistance, the Egregious Eleven, hormonal regulation, diabetes complications, nutrition, exercise, medications, and remission.

Perhaps most importantly, living with diabetes taught me that knowledge can transform the emotional experience of the disease. A diagnosis can initially evoke fear and uncertainty, but understanding creates opportunity. Once people understand what is happening in their bodies and why their daily choices matter, they can become active participants in their health rather than passive recipients of treatment.

That is ultimately the perspective I brought to the book: A type 2 diabetes diagnosis is not the end of the story. Knowledge gives us the opportunity to write the chapters that follow.

One of the book’s goals is to help readers understand diabetes as more than a blood-sugar problem. What are some of the biggest misconceptions people still hold about diabetes?

Perhaps the most persistent misconception is that diabetes is simply a disease of high blood sugar. Elevated glucose is certainly one of its defining characteristics, but it is better understood as the visible manifestation of a much more complex metabolic disorder.

Modern diabetes research has shown that multiple organs, hormones, and biological pathways contribute to the development and progression of type 2 diabetes. These include insulin resistance in skeletal muscle, excessive hepatic (liver) glucose production, declining pancreatic beta-cell function, abnormal glucagon secretion, altered incretin (gut) hormones, kidney glucose regulation, adipose (fat) tissue dysfunction, changes in the brain and the gastrointestinal (microbiome) system, inflammation, and other mechanisms. Models such as the Ominous Octet and, more recently, the Egregious Eleven have broadened our understanding beyond the traditional pancreas-centered view of diabetes.

Another major misconception is that type 2 diabetes begins when blood glucose rises. In reality, insulin resistance can develop 10 to 15 years before conventional diagnostic criteria identify diabetes. During those early years, the pancreas may compensate by producing more insulin (hyperinsulinemia), keeping glucose levels relatively normal even as metabolic dysfunction progresses.

That is why I believe insulin resistance deserves far more public attention. Blood sugar is often the last chapter of the story—not the first. Recognizing metabolic dysfunction earlier creates a window of opportunity to intervene before diabetes becomes firmly established.

Another misconception is that people develop type 2 diabetes simply because they ate too much sugar or lacked self-discipline. Lifestyle certainly matters, but diabetes results from a complex interplay of genetics, age, body composition, environment, nutrition, physical inactivity, sleep, stress, hormonal and metabolic factors, and individual susceptibility. Reducing this complex disease to personal failure is scientifically inaccurate and can create stigma that discourages people from seeking help.

There is also a misconception that diabetes inevitably leads to severe complications. Diabetes is unquestionably serious, and poorly controlled disease can damage the cardiovascular system, kidneys, eyes, nerves, and other organs. But those outcomes are not inevitable. Earlier diagnosis, improved glucose management, blood pressure and lipid control, healthier lifestyles, patient education, modern medications, and regular screening can substantially alter the disease’s trajectory.

Finally, many people still assume that once type 2 diabetes develops, nothing can fundamentally improve except the glucose level. We now know that some individuals can achieve remission, particularly when intervention occurs early and substantial metabolic improvement is achieved. Remission is not the same as a permanent cure, but its possibility fundamentally changes the conversation.

I, therefore, want readers to move beyond thinking, “Diabetes means my sugar is too high. The better question is, “What is happening across my metabolic system, and what can I do about it?” Replacing blame and oversimplification with understanding is one of the most powerful steps we can take to improve diabetes care.

Of all the diabetes treatment developments you researched, which do you believe have had the greatest impact on patients?

Several advances have transformed diabetes care, but I believe one of the most important changes is conceptual: we have shifted from treating a glucose number to treating the whole patient.

For decades, the primary goal of diabetes therapy was to lower blood glucose. That remains essential, but we now understand that successful diabetes management must also address cardiovascular disease, kidney disease, obesity, blood pressure, lipids, and other factors that ultimately determine metabolic health, longevity, and quality of life.

The development of newer medication classes has played an important role in that transformation. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic, Wegovy, and Rybelsus, have attracted significant attention because they can improve glucose control while also promoting substantial weight loss in many patients. Some agents have also demonstrated cardiovascular benefits. The emergence of medications targeting multiple incretin pathways has further expanded this therapeutic approach.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have transformed modern medicine, evolving from standard blood sugar medications into a cornerstone therapy for cardiovascular and renal protection. Their importance extends well beyond glucose lowering. These medications have demonstrated significant cardiovascular and renal benefits in appropriate patients, fundamentally changing how clinicians approach organ protection in diabetes.

Continuous glucose monitoring has also been transformative. Historically, glucose testing provided patients with isolated snapshots. A continuous glucose monitor can reveal patterns throughout the day and night and show how meals, exercise, medications, sleep, illness, and other factors affect glucose levels. That information can turn glucose monitoring from a simple measurement into an educational tool.

For people who require insulin, advances in insulin formulations, pumps, continuous glucose monitoring, and automated insulin-delivery systems have also eased the burden of managing the disease. Yet I would hesitate to identify any single drug or device as the greatest advance. To me, the most consequential development has been the recognition that diabetes requires a multi-target approach.

Medication, technology, nutrition, physical activity, weight management, adequate sleep, stress management, smoking cessation, education, and appropriate monitoring should not be seen as competing strategies. They are complementary tools.

Modern medicine has given us extraordinary therapies, but no medication can reproduce every benefit of a healthy lifestyle. Conversely, lifestyle should not be used as an argument against medication when medication is medically indicated. The best diabetes care brings the two together.

The question is therefore no longer simply, “How do we lower this patient’s glucose?” It is increasingly, “How do we help this person live longer, protect the heart and kidneys, prevent complications, maintain independence, and enjoy a better quality of life?” I believe that this shift in thinking may ultimately prove as important as any individual therapeutic breakthrough.

How can patients become more active and informed participants in discussions with their healthcare professionals?

The first step is to recognize that good diabetes care should be a partnership. Healthcare professionals bring medical knowledge and clinical experience, but patients bring something equally important: intimate knowledge of their lives, habits, symptoms, priorities, concerns, and ability to adhere to a treatment plan.

Patients should therefore never be afraid to ask questions.

They should understand their key numbers—not just whether a result is “good” or “bad,” but what it means. That includes HbA1c, fasting glucose, blood pressure, cholesterol and triglycerides, kidney function measurements, weight, and other relevant metabolic indicators. When a laboratory value changes, patients should ask why it may have changed and what can reasonably be done about it.

The same principle applies to medications. Patients should know why a medication has been prescribed, what benefit is expected, what important adverse effects to watch for, and whether it offers benefits beyond lowering glucose. If a treatment is difficult to tolerate, too expensive, or unrealistic in someone’s daily life, that information needs to be communicated. A theoretically excellent treatment accomplishes little if the patient cannot adhere to it.

Preparation before an appointment can make these conversations far more productive. I encourage patients to keep a short list of questions, bring relevant glucose information when appropriate, keep an accurate medication list, and note meaningful changes in diet, exercise, sleep, weight, symptoms, or overall health. A spouse, family member, or caregiver can also participate when helpful.

Patients should also become informed consumers of health information. The internet provides extraordinary access to medical knowledge, but it also offers unprecedented access to misinformation. Claims of miracle cures, guaranteed reversals, secret treatments, or therapies supposedly hidden by the medical establishment should immediately raise questions. Patients should ask: What is the evidence? Where did this information come from? Has it been supported by credible research?

Information found online can certainly be shared with a physician or other healthcare professional. In fact, I encourage it. The goal should not be for patients to diagnose or prescribe for themselves, but to use reliable information to ask better questions and participate more intelligently in decisions about their health.

Finally, I believe patients should understand that most diabetes management happens outside the physician’s office. A healthcare professional may see a patient several times a year, while the patient lives with the disease every day. Nutrition, physical activity, medication adherence, sleep, stress management, glucose monitoring, and hundreds of seemingly small decisions accumulate over time. That is why patient education is so important. Knowledge does not replace the healthcare professional; it strengthens the partnership. The most successful patient is not necessarily the one who knows the most medical terminology. It is the one who understands enough about the disease to ask informed questions, participate in decisions, and consistently apply that knowledge. Ultimately, I want readers to understand that they are not simply passengers on their healthcare journey. The healthcare professional may help provide the map, but the patient still has a hand on the steering wheel.

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