Today, we at AuthorsReading.com are speaking with Gustavo J. Gomez about his groundbreaking book, DIABETES: A 21st Century Health Crisis—Understand It, Prevent It, Manage It. Widely regarded as a major contribution to modern metabolic science, the book reshapes how we think about one of the world’s most pervasive health challenges.
For anyone who has felt trapped in the exhausting cycle of restrictions, conflicting advice, and constant frustration that often accompanies diabetes management, Gomez offers a welcome change in perspective. Rather than focusing solely on numbers, charts, and medications, he helps readers understand the underlying reasons their bodies respond the way they do—and how everyday choices can meaningfully influence long?term health.
What follows is the full transcript of our interview.
Good morning, Gustavo. Please provide our readers a short summary of your book and what motivated you to write "DIABETES: A 21st Century Health Crisis." Was it a result of managing the condition yourself since your diagnosis in 2003?
DIABETES: A 21st Century Health Crisis—Understand It, Prevent It, Manage It is a comprehensive, evidence-based examination of one of the most significant public health challenges of our time. The book synthesizes current scientific research, clinical practice, and practical lifestyle strategies to help readers better understand diabetes, prevent its progression, and manage it more effectively. My goal was to translate complex medical science into language patients can understand while providing healthcare professionals with a thoroughly researched, evidence-based resource.
My motivation for writing the book was both professional and personal. After my 2003 diagnosis of type 2 diabetes, I realized that many patients receive fragmented information about the disease. They often learn about medications, diet, or exercise separately, but rarely gain a complete understanding of how diabetes develops and how its many components are interconnected. That experience inspired me to spend years studying the scientific literature and consulting leading medical sources to create a resource that presents diabetes as a complex metabolic disorder rather than simply a blood sugar problem.
You emphasize shifting from a "gluco-centric" approach to a "patient-centric" roadmap. Why is this distinction so vital for modern metabolic science?
The distinction is vital because blood glucose is only one visible aspect of diabetes. A gluco-centric approach focuses primarily on lowering glucose or hemoglobin A1c, sometimes treating those numbers as the primary measure of success. Glucose control remains essential, but it does not fully address the many biological processes that cause diabetes or determine its complications.
A patient-centric approach considers the whole person. It takes into account insulin resistance, pancreatic function, body weight, blood pressure, cholesterol, kidney health, cardiovascular risk, liver health, inflammation, medication tolerance, age, culture, psychological well-being, and the patient’s ability to adhere to a treatment plan. My book explains that type 2 diabetes can involve dysfunction across multiple organs and metabolic pathways—not only the pancreas.
A major theme in the book is that insulin resistance often develops 10- to 15-years before a formal diagnosis. How can patients use this specific window of time to reverse metabolic damage?
That 10- to 15-year period may be one of the most important window of opportunity in preventive medicine. During the early stages of insulin resistance, the pancreas often produces extra insulin (hyperinsulinemia) to keep blood glucose within the normal range. As a result, fasting glucose and hemoglobin A1c may still appear acceptable (normal) even though metabolic dysfunction has already begun. Over time, the pancreas may no longer be able to compensate, and blood glucose rises (hyperglycemia) into the prediabetes and diabetes ranges.
Patients can use this window by identifying insulin resistance before conventional glucose tests become abnormal. Once insulin resistance is recognized, the goal is to reduce the body’s demand for excessive insulin. This begins with assessing risk factors such as excess abdominal weight, physical inactivity, family history, abnormal triglycerides, fatty liver disease, and high blood pressure. Fasting insulin, C-peptide, the triglyceride-to-HDL ratio, HOMA-IR, or specialized insulin-resistance panels such as the Cardio IQ® Insulin Resistance Panel with Score from Quest Diagnostics. Once insulin resistance is recognized, the goal is to reduce the body’s demand for excessive insulin. I would describe this period not as a guarantee of reversal, but as a valuable window of opportunity in which progression may be slowed, prevented, or sometimes reversed before substantial pancreatic beta-cell function is lost
Can you walk us through the "Egregious Eleven" model and how it expands our understanding of diabetes beyond the traditional focus on the pancreas?
For many years, type 2 diabetes was viewed primarily as a pancreatic problem. The traditional view was that the pancreas either didn't produce enough insulin or that the body's cells didn't respond to it properly. While that remains part of the story, modern research has shown that diabetes is far more complex.
Scientific understanding has evolved from the Triumvirate, which focused on three major defects, to the Ominous Octet, which identified eight interacting pathways, and now to the Egregious Eleven, a model that recognizes eleven interconnected physiological defects contributing to type 2 diabetes. In addition to the pancreas, the model includes the liver, skeletal muscle, fat tissue, the kidneys, the brain, the gastrointestinal tract, the stomach and small intestine (through reduced amylin activity), the gut microbiome, and the immune system (through chronic inflammation). These organs and systems work together to influence insulin resistance, glucose regulation, and the progression of diabetes. This broader understanding has transformed how we approach treatment. Rather than focusing solely on lowering blood sugar, clinicians now have the opportunity to target multiple underlying mechanisms simultaneously.
. Why is it more accurate to describe diabetes as a multi-hormonal disorder rather than just a blood sugar issue?
Many people think of diabetes simply as "high blood sugar," but high blood sugar is actually a symptom, not the disease itself. The underlying problem involves a complex network of hormones that regulate how the body produces, stores, and uses energy. When these hormones become unbalanced, blood glucose rises—but the hormonal dysfunction usually begins much earlier.
Insulin is the central hormone because it enables glucose to enter cells, where it can be used for energy. However, it does not work alone. Other hormones—including glucagon, GLP-1, GIP, amylin, cortisol, epinephrine, and growth hormone—continuously interact to regulate glucose production, appetite, digestion, insulin secretion, and energy metabolism. When one or more of these systems become dysregulated, the result can be insulin resistance, impaired insulin secretion, excessive liver (hepatic) glucose production, and progressive metabolic dysfunction. This broader understanding helps explain why modern diabetes treatment has advanced so dramatically.
The hormones that regulate metabolism function like members of an orchestra. When each one performs its role in harmony, metabolism remains healthy. But when several begin to play out of tune, the result is the metabolic imbalance we recognize as type 2 diabetes.
. The book reviews the "Modern Pharmacopeia," including glucagon-like peptide-1(GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors. How are these medications revolutionizing cardiorenal protection?
The past decade has brought some of the most significant advances in diabetes treatment since insulin's discovery. Traditionally, most diabetes medications were designed primarily to lower blood glucose. While glucose control remains important, newer medications have broadened our goals by helping protect the heart and kidneys (cardiorenal) and, in many cases, supporting meaningful weight loss. This reflects a major shift from simply treating blood sugar to improving long-term health outcomes.
You advocate for the potential of diabetes remission. What is the biggest misconception patients have about the permanence of type 2 diabetes?
The biggest misconception is that a type 2 diabetes diagnosis automatically means the disease will progress relentlessly for the rest of a person's life. While diabetes is certainly a serious chronic disease, research over the past decade has shown that, for many individuals, type 2 diabetes can enter remission—especially when identified and treated early. One of the central messages of my book is that insulin resistance often develops 10 to 15 years before diabetes is diagnosed. Early intervention offers the best chance to slow progression and, in some individuals, to achieve remission. "A diagnosis of type 2 diabetes is not the end of the story."
It is important to distinguish between remission and cure. A cure implies that the disease has been permanently eliminated. Remission means that blood glucose levels return to the normal or near-normal range without the need for glucose-lowering medications for a sustained period. However, the underlying tendency toward insulin resistance may persist, so healthy lifestyle habits must continue. If those habits are abandoned, diabetes can return.
How does Intermittent Fasting (IF) specifically help "reset" cellular insulin receptors compared to traditional daily calorie restriction? (I think this is a very important question for readers of your book)
Unlike continuous calorie restriction—which can lower basal metabolic rate and keep insulin levels constantly fluctuating—Intermittent Fasting (IF) allows extended periods when circulating basal insulin drops significantly. This reduction relieves constant receptor stimulation, allows insulin receptors to regain sensitivity, shifts fuel utilization toward burning stored fat, and triggers autophagy to clear damaged cellular components.
You describe the gut microbiome as a "second genome." What role does it play in determining an individual’s response to antidiabetic drugs like metformin?
The gut microbiome functions as a "second genome," producing metabolic byproducts that directly influence host metabolism, immune signaling, and intestinal barrier integrity. For antidiabetic drugs such as metformin, individual variation in gut microbial composition determines drug tolerance and response. Metformin alters microbial diversity and promotes the production of short-chain fatty acids (SCFAs) that enhance GLP-1 secretion and glucose regulation.
Hyperbaric Oxygen Therapy (HBOT) is presented as a cutting-edge treatment. What are the most promising results you found regarding its ability to treat diabetic neuropathy and foot ulcers?
HBOT delivers high-concentration oxygen under pressurized conditions, stimulating angiogenesis (new blood vessel formation), dampening systemic inflammation, mobilizing stem cells, and boosting cellular repair. In clinical research, it has shown remarkable success as an adjunct therapy to accelerate healing of chronic diabetic foot ulcers, reduce amputation rates, and stimulate autophagy, thereby promoting nerve regeneration and relieving symptoms of diabetic peripheral neuropathy.
Statistics show that roughly 43% of adults with diabetes remain undiagnosed. What early biomarkers, such as fasting insulin, should people be tracking to catch the disease early?
With roughly 43% of adults living with undiagnosed diabetes, relying solely on standard fasting glucose (FG) or Hemoglobin A1c tests can miss early metabolic decline. Monitoring early biomarkers such as fasting intact insulin and C-peptide—through specialized testing panels like Quest's Cardio-IQ® Insulin Resistance Panel—can help detect hyperinsulinemia and insulin resistance up to a decade before blood glucose levels spike.
How does the Diabetes Plate Method serve as a practical tool for patients who find traditional carbohydrate counting too complex?
For patients who feel overwhelmed by complex carbohydrate counting and food weighing, the Diabetes Plate Method provides a simple, visual way to portion meals. By filling half the plate with non-starchy vegetables, one-quarter with lean protein, and one-quarter with high-quality carbohydrates, patients can automatically manage portion sizes, calorie intake, and glycemic load without tedious tracking.
You dedicated a chapter to the "Power of Habit." Why do you believe small, consistent behavioral choices are more effective than raw willpower in mastering metabolism?
Willpower is a finite, easily depleted mental resource that often fails under stress or fatigue. In contrast, building small, automated daily habits (cue-response-reward cycles) leverages the law of compounding choices, allowing consistent health choices—such as meal timing, physical activity, and sleep hygiene—to become second nature, sustaining long-term metabolic control effortlessly.
What are the two or three most impactful takeaways you want every reader—whether a medical professional or a patient—to gain from this book?
• Insulin resistance is a reversible warning, not a permanent fate: Identifying rising insulin levels early gives patients a 10- to 15-year head start to prevent diabetes before it begins.
• Comprehensive care requires a multi-target approach: Effective management combines modern multi-hormonal therapies, lifestyle interventions, and patient-centered education rather than relying solely on blood sugar numbers.
• Daily habits compound into metabolic health: Small, consistent daily disciplines are the most powerful tool for achieving long-term wellness and disease remission.
In your research, you mention the debate on whether type 2 diabetes is "self-inflicted." What is your personal perspective on balancing patient responsibility with genetic and environmental factors?
While modern sedentary lifestyles and processed, high-glycemic diets are major drivers of the Type 2 diabetes epidemic, labeling the condition as "self-inflicted" introduces harmful stigma and shame that hinder patient care. Type 2 diabetes stems from a complex interplay of polygenic genetics, environmental factors, and individual behaviors. The focus should shift from blame to personal empowerment and proactive health ownership.
Please provide us with a bit more about what you are working on now. Provide links to your website and anything else you would like to discuss.
If readers remember only one message after finishing the book, DIABETES: A 21st Century Health Crisis—Understand It, Prevent It, Manage It, I hope it is this:
Health is not something we find. It is something we build—one decision, one habit, and one day at a time.
Throughout this interview, we've talked about insulin resistance, hormones, medications, nutrition, physical activity, sleep, stress management, and the remarkable advances that have transformed diabetes care. Each of these topics is important, but together they point to a much larger truth: our daily choices profoundly influence our long-term health.
More than two thousand years ago, Hippocrates is credited with saying, "Let food be thy medicine and medicine be thy food." While medicine has advanced beyond anything Hippocrates could have imagined, I believe the principle behind those words remains remarkably relevant. Good nutrition, regular physical activity, restorative sleep, effective stress management, avoiding tobacco, and meaningful social connections are not simply healthy habits—they are the biological foundations upon which lasting health is built.
At the moment, I’m working on a new book tentatively titled “Mastering Health: The Habits That Build a Long, Strong Life—A Comprehensive Guide to Lifelong Wellness Through Daily Discipline.” This project has a target date of late 2027.
• Official Website: www.gustavojgomez.com
• Amazon Author Page: www.amazon.com/author/gustavojgomez
• Instagram: @drgjgomezauthor
• Contact: gustavo@gustavojgomez.com
