How is pathophysiology of T2DM?

Genes cause impaired insulin/ resistance lead to IGT and thus T2DM. We may see increased glucagon and decreased insulin be pancreas (apoptosis, lipotoxicity, amyloidosis), increased hepatic glucose output, muscle insulin resistance and decreased glucose uptake leading to hyperglycemia, decreased incretin effect, increased renal reabsorption (SGLT2 upregulation due to hepatocyte nuclear factor-1 alpha stimulation), lipolysis all can lead to hyperglycemia (Omnious Octet) we see inflammation of islets and decrease in beta cell mass and secretion, inflammation is caused by dyslipidemia, hyperglycemia and circulating adipokines.