Type 2 Diabetes – FAQ and glossary of terms

When I was first diagnosed with type 2 diabetes, I knew very little about it, I was scared and confused, and learning about the disease, as well as some of the conditions that often accompany it, definitely helped put things in perspective. Ultimately, it was understanding the danger I was in that motivated me to change. This stopped being about weight loss for me, it was life and death stuff.

DISCLAIMER

I gathered this FAQ initially as part of my own self-education. This is gleaned from various sources over many years and should not be considered medical advice, nor should it be relied upon for accuracy. As I have said elsewhere, I am not a doctor and have no relevant medical training. Always consult your own practitioner before embarking on any serious changes in your lifestyle and especially your medication.

Under NO circumstances should you ever adjust your medication without first consulting your medical team.

What is diabetes?

The bad news – type 2 diabetes is a nasty, insidious, progressive disease that strangles you from the inside. It typically starts by attacking your circulatory system, clogging up your blood vessels and causing hypertension or high blood pressure. It then impacts your kidneys, nervous system, optic nerves and other key systems, and can lead to blindness, amputations and early death.

Diabetics are generally considered to have double the risk of mortality compared to those without. This, of course, is an average – obviously, the further the disease progresses, the higher your risks. For every 1% increase in HbA1c, (e.g. from 6% to 7% or from 42mmol/mol to 53mmol/mol) the risk of death from cardiovascular causes (heart attack/stroke) and kidney disease climbs significantly.

There are also strong correlations to be found between type 2 diabetes and pancreatic cancer, which remains one of the most deadly and untreatable cancers in the world.

The good news we are often told is that type 2 diabetes – unlike type 1 – is in large part a “lifestyle disease”!

“It is caused mainly by lifestyle choices – you eat too much sugar/refined carbohydrates/ultra-processed foods! Stop being such a greedy guts and get more exercise!”

But it’s not quite as simple as that, is it?

Redefining Type 2 Diabetes: Beyond the “Lifestyle” Label

The common characterization of Type 2 diabetes as a “lifestyle disease” tries to place the entire burden of the condition on individual choices, overlooking the profound environmental and systemic shifts that have occurred over the last few decades.

Evidence is on the rise that the growth of type 2 diabetes is closely tied to a food landscape that has been intentionally engineered for “craveability.”

Major food conglomerates deliberately adopted strategies from the tobacco industry, employing former tobacco scientists to apply hyper-palatability models to processed foods. These products are designed to bypass natural satiety signals, making it significantly harder for individuals to rely on willpower alone in an environment filled with addictive, low-cost options.

Furthermore, the physical reality of daily life has undergone a radical transformation. Our societal infrastructure has shifted toward increasingly sedentary working conditions and urban designs that often prioritize convenience over movement.

When addictive food engineering meets a mandatory decrease in daily physical activity, the resulting metabolic strain is a logical outcome of the environment rather than a simple failure of personal discipline.

Let’s reframe the conversation toward supportive solutions and systemic change rather than individual judgment. For further reading on these topics, I suggest the following:

Sedentary Work and Health: National Institutes of Health (NIH): The Impact of Occupational Shifting on Physical Activity

Food Engineering and Tobacco Influence: The Washington Post: How Big Tobacco’s Tactics Helped Create the Modern Food Industry

The Science of Hyper-Palatable Foods: University of Kansas: Research on the Tobacco Industry’s Role in Hyper-Palatable Foods

Other factors

There is a genetic predisposition to consider as well.

Unlike some conditions caused by a single faulty gene, Type 2 Diabetes is polygenic. This means it involves hundreds of small variations across many different genes.

• Heritability: Research suggests that the heritability of T2D – the proportion of risk explained by genetics—is between 20% and 80%. However, your family history can almost double your risk.
• Family History: If one parent has T2D, your risk is roughly 40%. if both parents have it, that risk can jump to 70% or higher.
• Beta-Cell Function: Many of the genes linked to T2D specifically affect how the pancreas produces insulin or how the body senses rising blood sugar levels

Type 2 Diabetes is just a “fatties disease” – isn’t it?

No, that’s not true. Not all type 2 diabetics are “fat” in the conventional sense. Around 10-15% of those diagnosed with T2D have a normal BMI.

It is more accurate to say that we all have a “fat threshold”, which is the limit of fat storage our body can handle before fat begins to accumulate in the liver and pancreas, leading to Type 2 diabetes. This explains why people of all sizes can develop the condition.

The Pancreas and the “Twin Cycle”

Why is the pancreas so important in Type 2 Diabetes? The pancreas has two critical roles, but in Type 2 Diabetes, it gets “clogged” by visceral fat.

• The Insulin Pump: The pancreas contains Beta cells that pump out insulin to manage your blood sugar.
• The Fat Clog: In Type 2 Diabetes, fat doesn’t just sit under your skin; it builds up inside and around the pancreas. Even a tiny amount of excess fat (as little as one gram) inside the pancreas can “stall” the Beta cells, stopping them from working correctly.
• The “Sleep” Mode: These cells aren’t necessarily dead; they are just “dormant” or overwhelmed.

How does the Fast Diabetes Reset help? This is where your 36-hour fasts and Ketosis come in.

1. Clearing the Clog: When you fast for 36 hours, your body looks for the most “dangerous” fat to burn first. This is usually the visceral fat inside the pancreas and liver.
2. The “Wake Up” Call: As that fat clears, the Beta cells can “wake up” and start producing insulin normally again. This is the biological mechanism behind Remission.
3. Reducing the Load: By eating your low-carb menu (Keto Hana, Heck sausages, etc.), you are giving the pancreas a “holiday.” Because there is no sugar to manage, the pancreas doesn’t have to work overtime, allowing it to heal.

Why the pancreas is “The Most Important Organ” in T2D

In Type 1 Diabetes, the pancreas has failed permanently. In Type 2, the pancreas is usually just exhausted and smothered in fat. By adding this to your site, you move the conversation from “managing symptoms” (kidneys/blood pressure) to “fixing the root cause” (pancreatic fat). This aligns perfectly with the Newcastle University (DiRECT) study you mentioned earlier, which proved that losing fat from the pancreas is the key to reversing the disease.

Pancreatic cancer and type 2 diabetes – not to worry you but…

Diabetes is fundamentally caused by problems with pancreas function, and my dad had died from pancreatic cancer (PC) when he was just 53. So it was no surprise that I I started doing some research into any possible link between PC and T2D, and yes, there does seem to be a definite correlation. It’s a slightly scary picture:

Those stats are from the following “interesting” article.

Living with diabetes for a long time “is a known risk factor for pancreatic cancer,”

V. Wendy Setiawan, Ph.D., of the University of Southern California

So, yeah, this suddenly got really, really real for me. Since my dad died when I was 15 I’ve had nightmares about going the same way. Pancreatic cancer is the deadliest cancer on the planet with survival rates of just 25% beyond a year from diagnosis, and only 5% surviving more than 5 years. It’s very difficult to detect early which is one of the reasons it’s so difficult to treat.

The good news is that given my family history of PC my GP took this very seriously, and the good news is I have none of the early symptoms of PC which include jaundice, abdominal pain and sudden / unaccountable weight loss. An ultrasound also found no signs of the disease.

I mention this not to scare you but to advise you, if you have a family history of pancreatic cancer, to seek advice from your medical team.

Do I need medication to treat Type 2 Diabetes?

After a diagnosis of Type 2 Diabetes you will often be offered medication. I am not a medical professional, so I cannot advise you here. But I asked my endocrinologist this question. Do I need medication to treat my type 2 diabetes.

His answer was “no, you do not. But you will need to make changes to manage it”.

Is Type 2 diabetes curable? The good news

I also asked my endocrinologist this question: “Can it be cured/reversed”?. Clinicians are of course always reluctant to talk about “cures”. Once you have been diagnosed with Type 2 Diabetes, you will ALWAYS know that you have a propensity to the ill effects of the condition.

But the best news is, that in most cases, Type 2 Diabetes can be reversed, and without medication, purely by changes to your lifestyle.

I am not a fan of medication. Don’t get me wrong, I am NOT an antivaxxer type – I am vaxxed to the max! But I have had a number of friends in the medical profession who told me that GPs (equivalent of the USA’s “primary care practitioner” or PCP) are often under pressure to simply “medicate and move on”.

I understand in the USA this may be more pronounced due to the more commercial nature of private medical care. And while in the UK, medication is relatively inexpensive (typically less than £11 per month, equivalent to $14.56 or €12.60 at the time of writing), in the USA, for example, prices vary widely depending on your insurance coverage, region and individual store.

There is an argument that it is in the pharmaceutical industry’s interest to sell “treatments” rather than cures, which makes me a little suspicious of the model, and so I am always keen to understand if there are other sensible alternative approaches.

In the case of Type 2 Diabetes, there certainly are.

The good news is that Type 2 Diabetes is quite well understood, with long term studies demonstrating the efficacy of three specific approaches. I won’t call them “treatments” since they are not. They are nothing more than lifestyle accommodations.

Weight loss

The Diabetes Remission Clinical Trial (DiRECT) focused on whether significant weight loss could actually “turn off” Type 2 Disease. The short answer. Yes it can.

After 1-year of the study, 46% of participants achieved remission (HbA1c below 48 mmol/mol (6.5%)) without any medication. Remission was directly tied to the amount of weight lost. In the group that lost 15kg (33 lbs) or more, a staggering 86% achieved remission.

I mentioned this elsewhere, and I will say it again here. If you are recently diagnosed with type 2 diabetes, and have an HbA1c below 58 mmol/mol (7.5%), then you may well be able to reverse your type 2 diabetes by doing nothing more than losing weight. How you lose weight – in that case – is almost irrelevant.

If, however you have already gone above 58 mmol/mol (7.5%), already started to notice any other symptoms such as hypertension or nerve tingling (especially in the feet), or blurred vision, then I strongly suggest you stay for the rest of the story, because if you do not aggressively target your type 2 diabetes you risk permanent harm to your nerves and to your cardiovascular system.

Dietary change – the low carb verdict

Evidence from a 2021 review in Frontiers in Nutrition shows that low-carb diets (LCDs) can lower HbA1c before significant weight loss occurs. By limiting the primary trigger of blood sugar spikes (carbohydrates), you reduce “glycemic variability”—the dangerous highs and lows that damage blood vessels—independent of your waistline.

A 2024 study from the University of Alabama found that low-carb diets improved beta-cell function (the cells in the pancreas that make insulin). By giving these overworked cells a “rest” from constant glucose processing, they were able to recover and respond more effectively to meals, a benefit not seen as strongly in low-fat/high-carb weight loss diets.

The Diabetes Prevention Program (DPP) research has shown that “Diet Quality” (measured by the Healthy Eating Index) has an independent effect on diabetes risk.

If you lose weight by eating processed food, you miss out on fiber. Whole food diets, especially those containing high protein and fresh vegetables, produce Short-Chain Fatty Acids (SCFAs) in the gut. These SCFAs travel to the brain and liver to improve metabolic signaling and reduce hunger, providing a “hormonal” advantage that a UPF diet lacks.

Research published in The Journal of Clinical Investigation shows that nutritional ketosis – eating a ketogenic diet – can drop insulin levels by 50% or more within weeks. This “insulin holiday” allows the body’s cells to regain sensitivity to insulin much faster than they would on a high-carb, calorie-restricted diet. One of the most cited benefits in clinical trials (like those from Virta Health) is that ketones act as a natural appetite suppressant. This makes the calorie deficit required for weight loss feel “effortless” because it blunts the hunger hormone, ghrelin.

Micronutrients & Inflammation: Highly processed diets are high in trans fats and sodium, which cause oxidative stress. Even if you are thin, high oxidative stress keeps your body in a state of “low-grade inflammation,” which can keep HbA1c elevated even if your weight is “ideal.”

Meta-analyses (such as Choy et al., 2023) show that low-carb diets often lead to a more significant drop in triglycerides and a greater rise in HDL (good) cholesterol than low-fat diets, even when the total weight lost is the same.

A word of warning about medication: If you are currently on insulin or medications like Sulphonylureas or SGLT2 inhibitors, dropping to <130g of carbs can cause dangerously low blood sugar (hypoglycemia) or other complications. You must seek medical advice and work with your primary clinician to “taper” medications if you intend to lower your carb intake. DO NOT try a low carb diet while reliant on these medications.

Intermittent fasting

It’s important to understand that fasting isn’t just a way to skip calories; while this is certainly a mechanism that aids in weight loss, fasting also triggers a biological state called autophagy and a “metabolic switch.”

A study published in JAMA Network Open (2023) compared time-restricted eating (TRE or fasting) to standard calorie counting. While weight loss was similar, the fasting group showed unique improvements in insulin sensitivity. This is attributed to the extended “low-insulin window,” which allows the body to clear fat specifically from the liver more efficiently.

The “Twin Cycle Hypothesis” suggests that diabetes is driven by fat clogging the liver and pancreas. Research indicates that fasting protocols may accelerate the mobilization of this “internal” fat specifically, compared to a diet where you eat small amounts of sugar/carbs throughout the day ie, a typical ultra processed foods diet.

Fasting for 16+ hours triggers cellular cleanup processes. While hard to measure in standard GP blood tests, this “housekeeping” is believed to reduce systemic inflammation, which is a major driver of diabetes complications like kidney disease and neuropathy.

What about exercise?

While exercise alone cannot reverse type 2 diabetes, the “magic” of exercise happens regardless of weight loss and diet.

When you move your muscles, they pull sugar out of your bloodstream without needing insulin. This is known as insulin-independent glucose transport.

Studies show that as little as 7 days of vigorous exercise can improve blood sugar control by 45%—even if you don’t lose a single pound.

The Catch: This effect is short-lived. It begins to fade within 48 to 96 hours of your last workout. This is why consistency is more important than intensity for diabetes management.

What qualifies as “vigorous” exercise? Trust me when I tell you that it depends on where you are starting from! If you have never exercised a day in your life, then a brisk walk will be vigorous exercise! If you regularly play soccer then you may need to think about HIIT (High Intensity Interval Training). But I suspect if you regularly play soccer, you are less likely to be here with Type 2 Diabetes! 🙂

For me, I mostly swam, walked and did some walk/run interval training. I’m an experienced swimmer but my weight precluded me from doing much running. I have previously injured myself from running so have to be very cautious.

But for me I would describe these exercise sessions as moderate-intensity rather than “vigorous”.

If you have a sports watch or even an app on your phone that can measure your heart rate it can be good to use this to track your heart rate during exercise

The important thing is the consistency of regular exercise is all that is required to help control your blood sugar.

The quadruple whammy effect

Weight loss, driven by a ketogenic diet and intermittent fasting, combined with the compounding effects of moderate intensity exercise, is a literal quadruple whammy, rapidly removing glucose from your system (changing the fuel), while giving your body the best chance to repair the pipes – ie to heal from nerve damage thanks to autophagy.

It really is that simple.

Simple isn’t easy

While that sounds simple – and I have certainly demonstrated that with my own success – that doesn’t necessarily mean it’s easy.

Cutting out sugar/refined carbs/ultra-processed foods is often challenging, as they can be our “comfort foods”. They were for me, and for many years they were the reason that my best attempts at losing weight always resulted in me eventually plateauing, failing, and giving up, before eventually returning to my old habits and my old weight.

But regardless of how hard you might consider it to be – I can only speak from personal experience and say that once you start to experience the complications arising from type 2 diabetes – nerve damage, eyesight issues, and hypertension, for example – you might be amazed at how easy it becomes to make radical changes to your lifestyle.

HbA1c (glycated haemoglobin)

The primary test used to diagnose Type 2 Diabetes. Also referred to as glycosylated haemoglobin, haemoglobin A1C, or simply A1C. Glycated haemoglobin is something that’s made when the glucose (sugar) in your body sticks to your red blood cells. Your body can’t use the sugar properly, so more of it sticks to your blood cells and builds up in your blood. Red blood cells are active for around 2-3 months, which means the test effectively provides a “snapshot” or estimate of your previous 3 months’ blood sugar levels.

Very simply, a high HbA1c means you not only have too much sugar in your blood but have done consistently for the previous period. This means you’re more likely to develop some of those diabetes complications we talk about elsewhere on this page.

It is therefore a much more reliable indicator of your blood sugar levels than the simpler blood sugar “pin prick” tests, which only show your blood sugar levels “now”. Such tests are dependent on many factors and can change from hour to hour as well as day to day.

An optimal HbA1c level is 30-35 mmol/mol (4.9-5%). Outside of the optimal, the “normal” or “healthy” range is anything from 20-42 mmol/mol (4-6%). Anything above 48 mmol/mol (6.5%) is diabetic territory and generally considered a bad place to be!

An HbA1c level between 42 mmol/mol (6%) and 48mmol/mol (6.5%) is referred to in the UK as “prediabetes” and while this is considered the first sign of trouble for someone who has never had diabetes, it’s actually the target for recovering diabetics to aim for.

Getting to 48 mmol/mol (6.5%) or below and maintaining it without medication for 6 months is considered “clinical diabetic remission”.

Interestingly, even though 42 mmol/mol (6%) and below is considered “healthy” or “normal” it is not the target for most diabetics, since there are potential risks in going from too high a blood sugar to under 42 mmol/mol (6%) rapidly – especially if you are taking medication to treat your diabetes.

Note that in my case, I never accepted diabetes medication, and so was not concerned when I blew past my target of 48 mmol/mol (6.5%) and hit 42 mmol/mol (6%) straight away after my first three months.

Daily blood sugar tests/finger prick tests – pros and cons

You won’t see any mention in my data of finger-prick test results, which I know type 1 diabetics swear by – as they can be life saving. But I also know type 2 diabetics sometimes use them, and even non-diabetics engaged in ketogenic diets wanting to track their blood sugar.

These types of tests are be essential if you take insulin to treat your Diabetes, since over-medicating with insulin brings literal risk of death.

However, these kinds of tests can also be highly misleading, since they only show your blood sugar at a precise moment in time. Blood sugar fluctuates throughout the day based on all kinds of factors, including, but not necessarily limited to, time of day, how well rested you are, general health, what you’ve eaten, and how recently. They can even swing based on you having a recent cold shower!

Since I never took any medication for my Type 2 Diabetes, I was never even recommended to use such tests.

I was ultimately driven by outcomes, and the primary outcomes I was targeting were weight loss and a lower HbA1c. These instant, limited view “snapshots” were not useful in illustrating my progress towards those goals.

If you choose to use them and find them valuable for whatever reason, good for you!

On that note I will add a slightly tongue-in cheek alternative to checking your blood sugar…

Ketosis – the sweet smell of success

When you fast and / or follow a ketogenic diet, your body switches from burning glucose as its main fuel source to burning fat.

The Fat-Bank Audit

Think of your body like a high-interest savings account. When you eat carbs, you’re making constant deposits into your Fat Storage Bank. But when you fast or go keto, you stop the deposits and start making massive ATM withdrawals from your waistline.

Chemical money laundering

To make those withdrawals usable, your liver has to “launder” that stored fat into a currency called ketones. One specific byproduct of this transaction is acetone – basically the chemical “receipt” of your fat-burning success.

Since your body can’t spend the acetone, it tosses the receipts out through your breath and urine.

Some ketogenic diet fans invest in what are called “keto strips” – small strips of paper covered in a chemical receptor sensitive to acetone.

However, there is a fairly distinct smell to acetone in your urine – some describe it as smelling a bit like nail polish remover. Learning to recognize the smell of ketones in your breath or urine actually provides an alternative method of “tracking” blood sugar. While not necessarily reliable, as we have discussed, nether are pin prick tests, and as an alternative it is completely free and doesn’t require drawing blood or aiming to pee on a paper strip!

Fortunately, I haven’t really suffered with ketosis breath, or at least not that anyone has pointed out to me! 😬 But I have learned to recognize very easily the smell of acteone in my urine.

Eau de Adipose

So, the smell of ketosis could more aptly be called the “fragrance of fat loss”, or perhaps the French might call it “eau de adipose”! 😜

But ultimately, for me, it’s the sweet smell of success. It tells me that I am doing the right things, and keeping my blood sugar as low as possible.

When my pee stops smelling I know that I’ve somehow snuck in too much sugar and I’m now making glucose deposits rather than fat withdrawals.

Taking the piss

This has become a bit of a light hearted mantra for me – every time I pee I discreetly sniff just to see that I’m on track. When I get that telltale scent I smile to myself and think “ah! The sweet smell of success!” 👃🏼😁

Just a word of caution: it may be wise to avoid sharing this particular bathroom ritual with your friends or coworkers if you value their continued company and respect!

And on a slightly more sobmre note: This ‘sweet’ scent on the breath or urine is a sign of healthy nutritional ketosis for most Type 2s Diabetics. However, if it’s accompanied by extreme thirst, confusion, or vomiting, that’s an entirely different story – see a doctor immediately.

Hypertension

A very common symptom or co-morbidity of type 2 diabetes. High blood sugar causes inflammation and oxidative stress in the blood vessels, impacting your Endothelial System (aka the Vascular System).

The “endothelium” is the thin, inner lining of your blood vessels. Elevated blood sugar acts like shards of glass in the bloodstream, causing microscopic damage and inflammation to the lining. The Result: healthy blood vessels are flexible and can dilate (expand). Damaged vessels become stiff and narrow (atherosclerosis). Because the “pipes” are now stiffer and narrower, the heart has to pump much harder to move blood through them – this is the primary driver of hypertension.

I highly recommend ANY type 2 diabetes sufferer, whether diagnosed with hypertension or not, to invest in a home blood pressure cuff. Ensure it is medically approved in your geographical region.

They are typically very easy to use, and may have either an analog or digital display. The digital versions are generally easier to read and will provide heart rate as well as blood pressure readings.

Your blood pressure is recorded as two separte numbers:

• Systolic blood pressure is the first (top/upper) number. It measures the pressure your blood is pushing against your artery walls when the heart beats. Think of it as your active pressure.
• Diastolic blood pressure is the second (bottom/lower) number. It measures the pressure your blood is pushing against your artery walls while the heart muscle rests between beats. Think of it as your baseline or resting pressure.

Either a high systolic or diastolic reading can be used to diagnose high blood pressure.

Symptoms of hypertension

Hypertension often results in fatigue, and can contribute to other conditions such as erectile dysfunction in men, and generally requires medication to manage it until the diabetes is fully controlled.

Hypertension is widely referred to as “the silent killer”. Since the symptoms can be subtle, and easily attributed to other factors (stress, poor diet, physical effort etc), they can easily be missed entirely.

Failure to treat high blood pressure can lead to a stroke or cardiac event and even be fatal.

Reducing high blood pressure

Ultimately, reversing your type 2 diabetes will typically see your blood pressure return to normal levels, and eventually you should expect to be able to eliminate all hypertension medication. But remember that this may take time.

Think of it like this: Type 2 Diabetes is primarily an issue of fuel. The wrong type of fuel damages the pipes or plumbing. Too much fuel also causes harm to the plumbing, as increased weight adds strain to the system. This extra strain also causes the pipes to thicken and, as a result, become less flexible.

Changing the fuel is relatively straightforward. Unfortunately, it’s not quite as simple as a car, where you could drain the old fuel completely and refill with a nice new premium version! In normal operations, you would typically not empty the fuel tank completely before refilling, so some of the previous “old” fuel remains each time.

As mentioned in the HbA1c section above, it takes at least 3-4 months to see the old fuel completely replaced, even with a highly aggressive protocol like mine.

However, the damage to the “plumbing” is not automatically fixed just because you changed the fuel. The “pipes” (vascular system) will take more time, and it is a more complex system. While Type 2 Diabetes is primarily a metabolic issue (insulin/pancreas), hypertension is a multi-system issue involving your kidneys, your nervous system, and your heart.

Fixing the fuel issue resolves the insulin resistance, but if there is underlying salt sensitivity or if your kidneys have adapted to a higher blood pressure “set point,” they may still be signaling the body to keep pressure high. And as mentioned thicker, hardened arteries are less flexible and will take some time to return to their former state.

Don’t be surprised if your blood pressure becomes an additional challenge during your journey. See the next section for more details.

Orthostatic hypotension and cough syncope

For those with diabetes related hypertension, as you initially lose weight (typically around 10% of your starting body weight) the medication that you started on may prove to be too much for your system.

You will note that most medications have an “adult” and “child” dosage. If you are a pet owner, you will also have noted that most medications are based on your pet’s body weight. This is because medications have an “effective dosage” range based on how they are distributed through the body. A larger body requires a larger dosage. Too high a dose could be dangerous / toxic, while too small a dose will be ineffective.

As you lose weight, your body shrinks and the dosage of current medications can prove to be too much.

In those with hypertension, the first symptom will often be light-headedness, typically when standing or after effort. This is called orthostatic hypotension. Note “hypo” instead of “hyper” meaning under rather than in excess of. Orthostatic hypotension occurs when your body is unable to maintain your blood pressure when moving from a recumbent (seated/lying) position to standing. You may experience this first thing in the morning or just when you have been seated for a while.

This occurs beause of that damage to your “plumbing” we mentioned. Because your arteries have now become thicker and harder they are less flexible, and an essential adaptation of the vascular system is to tighten the arteries in your legs as you stand up to “force” the blood back up to your brain. Since those with hypertension lose that flexibility their ability to do this is compromised, resulting in a significant drop in blood pressure between being seated and standing. A drop in systolic blood pressure of more than 20 points, or a drop in diastolic pressure of more than 10 points, is considered sufficient for a diagnosis of orthostatic hypotension.

In mild cases, the result is lightheadedness. In the worst case, a sudden drop in blood pressure may cause you to faint. If you are already mostly standing when this happens, you can of course cause more serious injuries from an uncontrolled fall.

If you begin to experience these kinds of symptoms, you should take your time before standing up. Do so in stages. In the worst case

Coughing is another potential risk as your blood pressure medications become “too strong” for your system. Coughing actually places significant stress on your cardiovascular system, lowering your blood pressure and also leading to lightheadedness.

Persistent and/or severe coughing can result in a condition called “cough syncope”, where you lose consciousness. I personally experienced this and was lucky not to cause serious injury.

So do watch out for lightheadedness when standing, or even while coughing. Be especially vigilant when you have lost between 10-15% of your starting body weight (as measured from your type 2 diabetes diagnosis).

Insulin Resistance and the Kidneys

High levels of insulin can cause the kidneys to retain more sodium and water, which increases blood volume and further raises blood pressure.

Diabetic Neuropathy – nervous system damage

Once the circulatory system is compromised by diabetes, the reduced blood flow and high glucose then damage the nervous system, leading to diabetic neuropathy (numbness and tingling). The nerves furthest away from the heart and brain are the ones that are impacted first, leading diabetic neuropathy to be referred to as having a “stocking and gloves” or “socks and gloves” pattern. Ie, attacking feet and hands first. If left unchecked, diabetic neuropathy can cause all kinds of complications. A serious potential complication of diabetic neuropathy is a diabetic foot ulcer described below.

Diabetic Foot Ulcer (DFU)

A serious complication where neuropathy (lack of feeling) and poor circulation combine to allow minor foot injuries to become deep, infected sores. Without the warning sign of pain, these can go unnoticed until they require intensive medical intervention or, in severe cases, amputation. Daily foot checks are highly recommended for diabetics for this reason. After a type 2 diabetes diagnosis, you should be scheduled for regular 6-monthly check-ups with your GP where they will test your feet for loss of sensation.

Diabetic Retinopathy – retinal nerve damage

Similar to the impact of raised blood sugar on the nerves of your hands and feet, diabetes also damages the blood vessels in the light-sensitive tissue at the back of the eye, called the retina. At first, diabetic retinopathy might cause no symptoms or only mild vision problems, such as slightly blurry vision, less light sensitivity, for example. But this can lead to blindness, especially if diabetes is not managed.

Visceral Fat

The ‘hidden’ fat stored deep inside the belly, wrapped around the liver and pancreas. Unlike the fat under your skin, visceral fat is metabolically active and secretes chemicals that drive insulin resistance.

While diet and weight loss will of course reduce visceral fat, exercise and activity has been shown to have a particularly good effect here. By mobilising all of your major muscle groups, as in swimming, group aerobic sessions, dance aerobics etc, you can significantly reduce your visceral body fat.

Glycemic Load (GL)

A measure that takes into account how much a food will raise a person’s blood glucose level after eating it. Unlike Glycemic Index, it accounts for portion size, making it a more practical tool for daily eating.

Avoiding high GL foods is essential for rapid type 2 diabetes reversal.

The process by which the liver creates its own glucose from non-carbohydrate sources (like fat and protein). This is the body’s natural safety mechanism that prevents blood sugar from dropping too low during extended fasts.

While most of us might think “fasting” is little more than a strange religious practice, or a fad diet craze, it is important to understand that it is an essential part of our metabolism. We evolved over millions of years to survive periods of fairly extreme famine – lasting days and potentially even weeks – and so our bodies have become extremely efficient at storing body fat.

Because we don’t practise fasting regularly, however, our bodies become less practised and less efficient when it comes to burning that fat as fuel.

We all fast quite naturally overnight – it’s literally the reason we call our morning meal “break-fast” – and this will typically be between 10 and 14 hours between our last meal/snack of the night and our first meal the next day. By gradually increasing this fasting period, say to 16 hours, 18 hours or even longer, we train our body to become more efficient at burning fat.

The more efficient we become at burning body fat, it stands to reason, the faster we can lose weight.

See our fasting FAQ for more details.

Final Question – now I know how to do it why do I need to subscribe?

“Hey – great FAQ, but you just told me exactly what I need to know! So why would I need to subscribe?”

The simple answer is – you don’t!

If you, like me, are a self-starting data-driven individual you can probably figure out the rest of it for yourself.

So what would you get by subscribing?

This is one FAQ, distilled from the core material in my site. That material was developed over the course of 270 posts, across 8 years, during which time I documented my original forays into intermittent fasting, my experiments, successes and failures. Fasting is not something to enter into lightly and without proper guidance. Nor is a ketogenic diet.

I had a number of previous successes with ketogenic diets, during years of triathlon training, all of which informed my current and rather more detailed step-by-step plan, focused on the realities of “what happens when the rubber (literally) meets the road”. This includes things like exercising while in ketosis, adjusting for aging bodies, and so on.

My current real-time documentation of this specific success story started in December 2025 and discusses the initial teething troubles I had when getting back into fasting after a break, along with my simplified ketogenic diet, how I dealt with the holiday season, injuries, illnesses, setbacks, personal and professional issues, and so on.

While many “health gurus” will sell you on how easy things are, I cover all of the challenges I faced, often in nitty-gritty detail, and provide feedback on what worked for me as I overcame them.

In addition, subscribers will have access to a private peer support forum, where, of course, you can support each other and share stories, but also will be moderated by me, so I can also provide real-time advice and guidance. Sure, there are plenty of support forums out there for Type 2 Diabetics, but many of them are clearly resigned to a life of chronic acceptance of their condition. Many are sharing “advice” about fasting and the ketogenic diet that is simply not going to help you along your journey.

For me, as a busy executive, living alone, I had to cook from scratch and find shortcuts to making weekly meal plans that worked and were repeatable (as well as being tasty! I can’t promise my taste will be the same as yours, but I’ll ensure that as you experiment, you keep the right principles in mind.

So sure, you can of course figure it out for yourself, just like I did. Will you do it quicker with an experienced guide who has taken the journey before you and knows the paths intimately? And will likely entertain as well as inform and support you? As well as the mutual support of people on the same journey?

Would it be worth parting with a little bit of your hard-earned cash in order to have such a guide?

Only you can decide! 😊