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A Public Health Pamphlet

From the author of Sweet Lies

How Type 2
Diabetes
Develops

A simple guide to what happens in the body over time.

The Hidden Problem
1 in 20
adults in sub-Saharan Africa has diabetes
73%
of them are undiagnosed
60M
adults in the region are projected to be living with diabetes by 2050 — up from about 25 million today
Understanding the disease

Type 2 diabetes does not arrive in a single moment.

It develops slowly, through a chain of quiet changes inside the body — changes that can often be slowed, and in the early years, even put into remission. This pamphlet walks through those changes, one step at a time.

1
Step 1 of 9

Some people are more at risk

Type 2 diabetes can affect anyone. Family history, excess weight, low activity, and certain health conditions can all play a role. It can also develop in people who appear slim.

2
Step 2 of 9

Insulin can fail in two ways

Insulin is a hormone made by the pancreas that helps sugar move from the blood into the body's cells for energy. This can go wrong in two main ways. First, the body's cells may stop responding to insulin properly. Second, the pancreas may not make enough insulin for the body's needs. In many African patients, this second problem may begin early — sometimes before the cells become resistant to insulin.

3
Step 3 of 9

Sugar has trouble moving into the body's cells

Because insulin is not working properly, or the body has too little of it, sugar cannot enter the cells easily. The cells get less of the fuel they need, and sugar builds up in the blood instead.

4
Step 4 of 9

The liver adds to the problem

The liver stores sugar and releases some into the blood between meals and overnight. Normally, insulin helps tell the liver when to slow down. But when insulin is not working well or is in short supply, the liver may keep releasing sugar even when blood sugar is already too high.

5
Step 5 of 9

Sugar builds up in the blood

With sugar unable to enter the cells properly, and the liver releasing too much sugar on top of that, blood sugar levels rise higher than they should.

6
Step 6 of 9

The pancreas makes more insulin to try to help

When blood sugar rises, the pancreas tries to fix the problem by making more insulin. In many people, this extra effort helps keep blood sugar under control for a while.

7
Step 7 of 9

Over time, the pancreas cannot keep up

For some, this compensation lasts years; for others, the pancreas tires early. Over time, it may no longer be able to make enough insulin for the body's needs.

8
Step 8 of 9

Blood sugar stays too high

Now several problems are working against the body at once: the cells are not responding well to insulin, the liver is releasing too much sugar, and the pancreas can no longer make enough insulin to overcome this. Blood sugar stays too high over time.

9
Step 9 of 9

Type 2 diabetes develops

When blood sugar stays high over time because insulin is no longer working properly or the pancreas can no longer make enough of it, this is called type 2 diabetes.

These steps may happen in a different order and at a different speed in different people.

When to get checked

Speak to a health worker if you notice:

  • Passing urine more often, especially at night
  • Feeling unusually thirsty or hungry
  • Tiredness that does not ease with rest
When to get checked
  • Blurred vision
  • Cuts or wounds that heal slowly
  • Tingling or numbness in hands or feet

Many people have no symptoms at all. A simple blood sugar test is the only way to know for sure.

The Good News
💚

The story does not have to end there.

In the early years, type 2 diabetes can often be slowed and, in some people, put into remission through weight management, reducing sugary drinks and refined starches, healthy eating, and regular movement.

Protecting Yourself

Four simple things that help

  • Move more. Walk briskly for at least 30 minutes at least 5 days a week.
  • Eat whole foods. Choose whole grains, vegetables, and legumes such as beans over refined starches and sugary drinks. Keep sweeter fruits to small portions.
Protecting Yourself
  • Manage your weight. Even small, steady weight loss helps. Harmful fat can build up around organs, even in people who look slim.
  • Get checked regularly, especially if you are aged 40 or older, overweight, or have a family history of diabetes — but remember, diabetes can also affect people who do not fit these risk factors. Only a blood sugar test can tell.
Public Health · 2026
Dr. Ndirangu
Wanjuki
Author of Sweet Lies
sweetlies.life
© 2026 · Please share freely

How Type 2 Diabetes Develops — A Free Visual Guide

Author: Dr. Ndirangu Wanjuki, author of Sweet Lies: A Tale of Sugar, Deceit and Triumph. Published: 15 April 2026. Last reviewed: 19 April 2026. Audience: general readers in Kenya and across sub-Saharan Africa.

Summary

Type 2 diabetes does not arrive in a single moment. It develops slowly, through a chain of quiet changes inside the body — changes that can often be slowed, and in the early years even put into remission. Around 1 in 20 adults in sub-Saharan Africa currently has diabetes; about 73% of those cases are undiagnosed; and the number of adults living with diabetes in the region is projected to rise from roughly 25 million today to about 60 million by 2050.

The nine steps by which type 2 diabetes develops

  1. Some people are more at risk. Family history, excess weight, low activity, and certain health conditions all play a role. Type 2 diabetes can also develop in people who appear slim.
  2. Insulin can fail in two ways. Insulin is made by the pancreas and helps sugar move from the blood into cells. Either the cells stop responding to it (insulin resistance), or the pancreas stops making enough of it. In many African patients, insufficient insulin production may begin earlier than insulin resistance.
  3. Sugar has trouble entering the cells. Without working insulin, sugar cannot get into the cells, so it builds up in the bloodstream.
  4. The liver adds to the problem. The liver normally releases stored sugar between meals, guided by insulin. When insulin signalling fails, the liver keeps releasing sugar even when blood sugar is already high.
  5. Sugar builds up in the blood. The combined effect raises blood sugar above the normal range.
  6. The pancreas makes more insulin to compensate. For a while this extra effort keeps blood sugar under control.
  7. Over time the pancreas cannot keep up. Eventually it can no longer produce enough insulin for the body's needs.
  8. Blood sugar stays too high. Insulin resistance, excess liver glucose, and a tiring pancreas all push blood sugar up at once.
  9. Type 2 diabetes develops. Persistently high blood sugar, caused by failing insulin and/or insulin resistance, is what defines type 2 diabetes.

Warning signs to watch for

Many people have no symptoms at all. A simple blood sugar test is the only reliable way to know.

Prevention and remission

In the early years, type 2 diabetes can often be slowed and in some people put into remission. Four practical steps:

About

This guide is part of Sweet Lies, a literary work by Dr. Ndirangu Wanjuki exploring the human cost of sugar in modern African life. The book is available at sweetlies.life. The guide is free to read and share.