Here’s What Really Causes Type 2 Diabetes

• Updated on: 2022-05-13
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Type 2 diabetes is one of the most common chronic health conditions in the U.S. (a whopping 10.5% of the population has it)1—yet it is woefully misunderstood by most people. There are all kinds of misconceptions about what causes type 2 diabetes . Because of this, you might think you did something wrong if you get a type 2 diabetes diagnosis. But the truth is, the condition is the result of a combination of factors, some of which can be outside of your control. Ultimately, type 2 diabetes occurs when your body doesn’t use insulin properly. The good news is that there are lots of ways to change that. Keep reading to learn what really causes type 2 diabetes—and what you can do to prevent it.
What is type 2 diabetes? | Type 2 diabetes causes | Risk factors for type 2 diabetes | Diabetes misconceptions | Type 2 diabetes in children | Diabetes diagnosis |  Treatments for type 2 diabetes | When to see a doctor
What is type 2 diabetes?
In a nutshell, type 2 diabetes is a chronic disease that occurs when your pancreas doesn’t produce enough insulin (or doesn’t use it efficiently), which results in too much glucose (or sugar) circulating in your blood, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Over time, high blood sugar levels can cause problems with your immune, nervous, and circulatory systems. Worth noting: If your body has started having problems producing insulin and using glucose, but your blood sugar hasn’t yet risen to a concerning level, then you may be diagnosed with prediabetes .
So what’s the difference between type 1 and type 2 diabetes? Type 1 diabetes also occurs when there is too much glucose in the blood, but it’s an autoimmune condition , meaning the body attacks the insulin-producing cells in the pancreas.
What causes type 2 diabetes?
Experts don’t know exactly what causes type 2 diabetes, but there are several factors at play—some are within your control (think: getting enough exercise) while others are outside of your control (like genetics). Here are some possible causes:
Insulin resistance
The main culprit of type 2 diabetes, insulin resistance is when your body doesn’t use insulin efficiently, which leads to high blood sugar. Glucose is what your body uses for energy. But it has a lock on it, meaning it can’t get into your cells on its own; it needs insulin to do that (think of insulin as a key that opens the lock so glucose can enter).
Insulin resistance is when your key (insulin) doesn’t work as well as it should. Sometimes it unlocks, and sometimes you have to go through a series of acrobatic hand movements to get the lock to open. Since glucose isn’t getting into your cells consistently, it means there is extra circulating in your blood, increasing your blood glucose, or blood sugar, which may lead to type 2 diabetes.
There’s another thing that happens with insulin resistance. Your body can’t make enough insulin to compensate for the extra glucose. As a result, more glucose ends up circulating in your blood, which can damage your cells and lead to complications that affect your eyes, kidneys, and nerves, according to a 2019 study published in the journal Nature.2
Excess body fat
So what causes insulin resistance in the first place? The answer is complicated, and it doesn’t just happen overnight. But one of the main factors is excess body fat, which can cause inflammation throughout your body. That inflammation may then trigger a chain reaction that ultimately leads to insulin resistance and eventually type 2 diabetes, according to a 2015 study published in the journal Lipids in Health and Disease.3
It’s important to note that not all people with type 2 diabetes are considered clinically overweight, and not all people who carry excess weight have type 2 diabetes.
Your genes and how you grew up
Inheriting certain genes can increase your risk of developing type 2 diabetes. If you have one parent with type 2 diabetes, your risk increases by 40%, according to a 2015 study published in the journal Genes. If both parents have it, that risk jumps to 70%. And compared to the general population, you have a three-fold increased risk if you have a parent or sibling with type 2 diabetes.4
Another factor? Your family’s approach to eating and exercise when you were young can influence your habits as an adult. For example, if you had a single working parent and ate more fast food than home-cooked meals, as an adult you might still find yourself reaching for convenience items over fresh foods more regularly, which could potentially contribute to excess body fat and insulin resistance over time.
Your race and ethnicity
According to the American Diabetes Association , those who are of Indigenous, Black, Hispanic, and Asian or Pacific Islander descent are at greater risk for developing type 2 diabetes than white people. One reason may be that individuals from these backgrounds tend to have a higher risk of having excess body fat, and therefore higher circulating insulin levels and instances of insulin resistance, according to an article in Pediatric Diabetes.5 However, there are a number of complex factors that influence someone’s weight—and the social determinants of health and systemic racism can certainly play a role. Marginalized people may not have the same access to health resources (like fresh fruits and vegetables and exercise-friendly neighborhoods) as white people, which can potentially contribute to body fat gain that can lead to diabetes, per a 2017 study published in the Journal of the American Medical Association.
Your medical history
Certain aspects of your medical history can also increase your chances of developing type 2 diabetes. “People are sometimes surprised to hear that if they had diabetes in pregnancy—called gestational diabetes—they are at a much higher risk of developing type 2 diabetes in the future,” Mary Vouyiouklis Kellis, MD , an endocrinologist at the Cleveland Clinic , tells SELF. Specifically, if you have a history of gestational diabetes or delivered a baby that weighed greater than 8.8 pounds, you are at greater risk for developing type 2 diabetes. If you’ve ever been diagnosed with fatty liver disease or prediabetes, your risk is also higher, according to the Centers for Disease Control and Prevention (CDC).
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Are there other risk factors for type 2 diabetes?
There are a few other things that can increase your risk for type 2 diabetes, though remember these things alone do not guarantee you’ll develop it.
The location of body fat
Research shows that carrying extra weight around your belly, in particular, can increase your risk for type 2 diabetes, as opposed to carrying it in your thighs or hips, according to an older study published in the International Journal of Clinical Practice.7 The reason is complex, but it has to do with how belly fat triggers changes in the body that increase insulin resistance risk.
Not getting enough exercise
According to a 2017 study published in Nature Reviews in Endocrinology, exercise may be protective against insulin resistance, because it helps the body use insulin better.8 Aim for at least 150 minutes of moderate-intensity physical activity a week to lower your risk, recommends the CDC .
Smoking
People who smoke are 30% to 40% more likely to have type 2 diabetes than those who don’t, according to the CDC . And the more cigarettes you smoke, the higher your risk. This may be because there is a connection between smoking and an increase in abdominal fat. In addition, smoking is known to contribute to insulin resistance.
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What are some misconceptions about what causes type 2 diabetes?
Much of what people think they know about type 2 diabetes is wrong. That can lead to stigma and blame surrounding a diabetes diagnosis—which is really not helpful or fair. Let’s clear up two major type 2 diabetes misconceptions right now:
Myth 1: Eating sugar will give you type 2 diabetes.
This is a common misconception but it doesn’t offer the complete picture, Dr. Vouyiouklis Kellis says. Many people can eat sugar throughout their lives without it causing type 2 diabetes. It’s when your body stops being able to produce or use insulin effectively that blood sugars start to rise. Of course, eating an excess of sugar can potentially lead to weight gain, which can increase your chances of developing insulin resistance and diabetes, but that’s not a foregone conclusion, which leads us to the second myth.
Myth 2: All people with type 2 diabetes are overweight.
Not true: You can be considered in a “healthy” weight range and have type 2 diabetes. For example, those of Asian descent in the United States are 30% to 50% more likely to develop type 2 diabetes at a lower body mass index compared to those of caucasian descent, according to a 2015 article published in the journal Diabetes Care.9 This may be because they have more visceral belly fat, which is found deep in the belly surrounding vital organs.
Again, if you carry more fat in your abdomen, you have a higher chance of developing type 2 diabetes, even if your BMI is in a “healthy” range. The bottom line: You can’t tell a person’s diabetes risk just by looking at them.
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What causes type 2 diabetes in children?
An estimated 5,758 young people ages 10 to 19 are diagnosed with type 2 diabetes each year in the United States, according to the CDC.1 In fact, the number of children with type 2 diabetes has doubled since 2001, according to a 2021 JAMA study.7 The causes of type 2 diabetes are the same in kids as they are in adults, and insulin resistance is the biggest one, per the CDC .
Similar to adults, carrying excess weight, particularly in the stomach area, contributes to the development of insulin resistance, as does a lack of regular exercise. Other risk factors that are true for adults are also the same for kids, including genetic and environmental factors, such as having a family member with type 2 or having a particular racial or ethnic background.
A couple of risk factors that are unique to kids include being born to a mom with gestational diabetes and going through puberty, which makes it harder for the body to use insulin. Because of that, kids with type 2 are typically diagnosed in their early teen years.
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How is type 2 diabetes diagnosed?
Many people find out they have type 2 diabetes when they get routine blood work. This is because type 2 diabetes is largely asymptomatic (you don’t notice any symptoms). Still, doctors diagnose about 1.5 million new diabetes cases a year, the CDC reports. The greatest percentage of those diagnosed are ages 45 and older.
To determine if you have type 2 diabetes, your doctor may order a few different blood tests, per the American Diabetes Association :
An A1C test or HBA1C: This measures your blood sugar levels over the course of about three months. If your A1C level is equal to or higher than 6.5%, most doctors will diagnose you with type 2 diabetes.
A fasting plasma glucose test: This blood test measures your blood sugar levels after eight hours of not eating or drinking. If your fasting blood test is more than 126 mg/dL on two different days, your doctor will likely diagnose you with diabetes.
An oral glucose tolerance test: This test involves having your blood drawn before drinking a very sweet beverage, and then having your blood taken again two hours after drinking it to see how your body processes the sugar. If your blood sugar is 200 mg/dL or higher after the second blood draw, you will be diagnosed with type 2 diabetes.
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What are treatments for type 2 diabetes?
Treatment for type 2 diabetes starts with making lifestyle changes like exercising regularly and eating more fruits and vegetables, which can reduce insulin resistance. Your health care provider may also advise you to lose weight, if possible. “Even a 7% to 10% weight loss can make a big difference,” Dr. Vouyiouklis Kellis says.
If you’re not sure where to start with eating balanced meals, check out the Mediterranean diet, which emphasizes lots of fruits and vegetables and certain fats like olive oil and fish. Figuring out what kind of exercise you enjoy can help you get into a good workout routine. Aim for a combination of aerobic exercises (like walking and biking) and resistance training (such as weightlifting).
If lifestyle changes don’t get your blood sugar levels back on track, your doctor may prescribe medications that help your body use insulin more effectively. If your body can no longer produce enough insulin, you may need to inject a synthetic form of insulin .
Finally, there’s another super effective (yet less-talked-about) lifestyle factor that can aid in your diabetes management journey: social support. Research shows that people with strong support systems are more likely to engage in better self-care behaviors and keep up their healthy lifestyle habits.6
Here are a few places that offer support and mentorship resources:
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When should you see a doctor if you’re concerned about type 2 diabetes?
If you have several of the risk factors mentioned above or experience any signs of type 2 diabetes , it might be time to schedule an appointment with your doctor. They can help you determine how to best minimize your risks for diabetes and test you for it, if necessary. While many things are out of your control, Dr. Vouyiouklis Kellis advises focusing on those that are in your hands. “Work on the modifiable risk factors—those that you can actually change, like being more active,” she says.