I'm hoping someone who knows about this in detail chimes in, but it's kinda interesting in a watching the world burn kind of way charting the biological progression of Type II. As I understand it: 1) Fatty McLard enjoys a lifestyle of little activity and a diet high in sugar and fat resulting in a caloric surplus  2) Fatty McLard externally balloons up until energy balance is met...this requires gaining weight until BMI is off the 90s issued charts and the scale read out begins with at least a 3.  3) Over time, internally at a cellular level, due to the constant supply of sugar, the pancrease is always having to secrete insulin into the blood to push glucose/triglycerides (fat) into organs-muscle/fat cells....eventually these cells become insulin resistant..so the insulin+nutrient isn't pushed(pulled?) into the cell its supposed to go into  4) Over time, as far as the pancreas can tell, the blood is saturated with insulin so it's ability to produce more is impacted to the point where external supply is required. So, it really makes me laugh when fats go on about blood sugar being low...because for the amount of sugar they are consuming they must have absolutely tonnes of it circulating/packed into cells as glycogen...they're in a permanent state of carb loading. But knowing that it's essientially a matter of chemical management that you can control without the need for pills if caught early enough, if I was given such a diagnosis I'd be less "I'll just take a pill" and more "Right, lets get on a 300cal deficit keto diet while doing hours of LISS to use as much fat for fuel while improving insulin sensitivity"