My father-in-law, Jim Nickels, was too busy running the family restaurant to go to the hospital. It was a small restaurant on the beach in Aptos, California, but he knew my mother-in-law couldn't it handle alone.

Type 2 diabetes is a two-hit disease.

Still, every day he felt and looked worse. He knew he had type 2 diabetes, and his doctor told him his blood sugar was out of control. It was October 25, 1969, when he stayed home and my mother-in-law went to the restaurant to receive deliveries before the restaurant opened at 11.

When she came back home, he was unconscious on the floor. She called the ambulance, but he died before they could get him to the hospital. Just one week earlier he had turned 54, but had been too sick to celebrate.

In those days many people besides my father-in-law died from sky-high blood sugar. That was before we had blood glucose meters to tell how we were doing. The only drugs we had to treat diabetes then were insulin injections and the first-generation sulfonylureas, which help the body pump out more insulin from the pancreas.

Nowadays, however, it is easy and can be practically painless to track your blood sugar levels with a home meter. And now we can treat the root cause of type 2 diabetes.

Diabetes comes from the body's inability to metabolize carbohydrates well. For people with type 1 diabetes the problem comes from something that causes the beta cells of the pancreas to stop producing insulin. Type 2 diabetes, which affects 90 to 95 percent of all people with the disease, is more complex. We can describe this type of diabetes as a two-hit disease.

Typically, the first hit is insulin resistance. This makes it more difficult for blood sugar to enter the body's cells. At this point the pancreas still produces insulin, but the body can't use it well enough. In fact, the pancreas pumps out more and more insulin to compensate for using it so poorly.

But after years of trying to make up for the resistance the body has to the insulin that it needs, the beta cells of the pancreas tend to wear out. This beta cell fatigue is the second hit, and only then do you have diabetes.

But what causes insulin resistance in the first place? It's partly in your genes and partly associated with environmental or lifestyle factors like being overweight and not getting enough exercise.

Unlike tests for diabetes itself, it's hard to measure insulin resistance. But, like my father-in-law, if you have type 2 diabetes you can safely assume that you had insulin resistance first. That could have been years before a doctor diagnosed diabetes. First, insulin resistance can take a long time to progress into diabetes. And even after diabetes develops, it typically takes 6½ to 10 years for a doctor to diagnose it.

This article originally appeared on HealthTalk Interactive, but is no longer online there.

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