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Live long enough, and you’ll get diabetes. That’s not a scare tactic — it’s a biological reality. We all carry genes passed down from ancestors who had to survive on almost nothing. Cavemen who endured harsh winters, soldiers who rationed their way through war and people who survived famine did so because their bodies were masters at conserving sugar, storing fat and surviving starvation.
That genetic resilience is our inheritance. In today’s world of abundance and metabolic confusion, those same survival traits are making us sick.
After twenty years of testing thousands of patients using a Nof1™ model — a study that looks to determine the best intervention for an individual patient — I’ve seen the same pattern again and again. It doesn’t matter whether someone is lean, active, or carrying excess visceral fat — everyone’s glucose and insulin are on a roller coaster. The only difference is when it begins to damage their health. Pregnant women often fail early glucose screenings. Fit men in their 30s drop from heart attacks. People who appear metabolically perfect still lose muscle mass and develop silent insulin resistance. Every single one of us declines — just in different decades and at different rates. Chronic disease is simply the end stage of this slow drift.
Even if your hemoglobin A1C is “normal,” it’s only an average, masking damaging spikes and dips. I know this firsthand — my own A1C has been below 5, yet a continuous glucose monitor (CGM) revealed dysfunction beneath the surface.
That kind of real-time data has changed the way I treat patients. One-size-fits-all medicine is obsolete. Population averages don’t apply to individuals. We can now detect subtle metabolic shifts early and intervene long before chronic disease sets in.
The old story says diabetes only strikes the overweight or the undisciplined. That’s dangerously wrong. Diabetes is everyone’s risk because of biological drift. Hormones shift. Muscles shrink. Glucose control weakens. Even the cleanest eaters aren’t safe. Modern food, even farm-to-table, is often nutrient-depleted, picked before peak ripeness and grown in soils stripped of minerals. Without active countermeasures, damage quietly accumulates.
One of the most overlooked strategies in preventing this decline is hormonal optimization. Testosterone, for instance, helps build and maintain muscle — the body’s most important site for clearing glucose from the bloodstream.
On Nov. 10, the FDA removed the “black box” warning from estrogen therapy, acknowledging that for most women, the heart, metabolic and brain benefits outweigh the risks. Estrogen helps control sugar by enhancing insulin sensitivity. When estrogen drops at menopause, belly fat increases and the liver produces more glucose — both raising diabetes risk. Progesterone works synergistically with estrogen to support metabolic health and sleep as well as prevent endometrial cancer.
Without optimal hormones, resistance training and adequate protein, muscle erodes. That erosion drives insulin resistance, frailty, fractures and even sarcopenia. Restoring physiologic testosterone, estradiol and progesterone reverses these trajectories.
Nearly every disease of aging — Alzheimer’s, heart disease, stroke and cancer — shares a common root: energy imbalance, glucose volatility and inflammation. These aren’t random misfortunes. They’re connected consequences.
To outsmart this drift, first regulate glucose to your optimal level, not the population average. Just like body temperature, glucose tolerance is personal. The goal is to know your own baseline and track when it shifts. Second, use new tools. GLP-1 receptor agonists such as Ozempic and Mounjaro, along with GIP analogs, help stabilize metabolism. These aren’t just weight-loss drugs — they reduce inflammation and cardiovascular risk. But the real power comes when real-time data meets personalized action. My patients receive context, accountability and plans built around their biology. Not one has progressed to diabetes, despite starting with abnormal labs.
Diabetes is not just a disease; it’s a warning sign that your system is off course. You can’t change your genes, but you can act on what they reveal. The tools are here. The truth is clear. The future of medicine is personal, predictive and proactive — staying ahead of a diagnosis, not waiting for one.
Florence Comite MD is a leader in precision medicine and founder of a longevity-focused health center. Dr. Comite has spent over two decades applying data-driven care to extend healthspan and prevent chronic disease. Her upcoming book, Invincible: Defy Your Genetic Destiny to Live Better, Longer, will be published by Little, Brown Spark in Spring 2026 and is available for preorder now.