Type 2 diabetes and pre-diabetes

Type 2 diabetes is a common long-term condition that affects how the body regulates blood glucose. It develops gradually and is often identified through routine blood tests before symptoms become obvious.

Pre-diabetes describes blood glucose levels that are higher than normal but not yet in the diabetic range. It is an important early warning stage, as lifestyle changes at this point can significantly reduce the risk of progression to type 2 diabetes.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

Book an appointment

What is type 2 diabetes?

Type 2 diabetes occurs when the body becomes less responsive to insulin and is unable to regulate blood glucose effectively. Over time, persistently raised glucose levels can affect blood vessels, nerves and organs.

Unlike type 1 diabetes, type 2 diabetes:

Develops gradually
Is strongly influenced by genetic and lifestyle factors
Is often managed initially without insulin
Is usually monitored and coordinated in primary care

What is pre-diabetes?

Pre-diabetes is not a disease, but it is a risk state.

It means that blood glucose levels are above the normal range but below the threshold used to diagnose diabetes. Many people with pre-diabetes feel completely well.

From a GP perspective, pre-diabetes:

Signals increased future diabetes risk
Is an opportunity for early intervention
Does not mean diabetes is inevitable

How type 2 diabetes and pre-diabetes are diagnosed

Diagnosis is based on blood tests, interpreted alongside clinical context.

The most commonly used test is HbA1c, which reflects average blood glucose over the previous 2–3 months.

Typical HbA1c ranges:

Normal: below 42 mmol/mol
Pre-diabetes: 42–47 mmol/mol
Type 2 diabetes: 48 mmol/mol or above

In some situations, fasting glucose or repeat testing may be used to confirm results.

How type 2 diabetes and pre-diabetes are diagnosed

Diagnosis is based on blood tests, interpreted alongside clinical context.

The most commonly used test is HbA1c, which reflects average blood glucose over the previous 2–3 months.

Typical HbA1c ranges:

Normal: below 42 mmol/mol
Pre-diabetes: 42–47 mmol/mol
Type 2 diabetes: 48 mmol/mol or above

In some situations, fasting glucose or repeat testing may be used to confirm results.

Learn more about the HbA1c blood test.

Symptoms to be aware of

Many people with early type 2 diabetes or pre-diabetes have no symptoms.

When symptoms do occur, they may include:

Increased thirst
Frequent urination
Fatigue
Blurred vision
Recurrent infections
Unexplained weight change

Symptoms often develop gradually and may be attributed to other causes.

Why early diagnosis matters

Persistently raised blood glucose can increase the risk of:

Heart disease and stroke
Kidney disease
Nerve damage
Eye problems

Early identification allows steps to be taken to reduce long-term risk, even before medication is needed.

When to seek urgent medical help

Seek urgent medical advice if you experience:

Very high blood glucose readings
Vomiting or dehydration
Confusion or drowsiness
Sudden visual changes
Signs of infection that are not settling

Urgent assessment is important in these situations.

How GPs manage pre-diabetes

Management focuses on reducing progression risk rather than medicalising the condition.

Common GP-led approaches include:

Explaining results clearly and calmly
Discussing weight, diet and activity in a non-judgemental way
Encouraging gradual, sustainable changes
Reviewing cardiovascular risk factors
Arranging follow-up blood tests

Medication is not routinely required for pre-diabetes in primary care.

How GPs manage type 2 diabetes

Management is individualised and usually stepwise.

It may include:

Education about the condition
Lifestyle modification
Oral medications when appropriate
Regular blood monitoring
Blood pressure and cholesterol management
Structured reviews

Many people manage type 2 diabetes successfully for years without insulin.

Monitoring and ongoing reviews

People with type 2 diabetes are usually offered regular reviews to monitor:

HbA1c levels
Blood pressure
Cholesterol
Kidney function
Weight
Cardiovascular risk

These reviews aim to reduce long-term complications rather than react to symptoms alone.

When further investigation or referral may be needed

Referral to specialist care may be considered if:

Blood glucose remains difficult to control
Complications are suspected
Diagnosis is unclear
There is concern about type 1 diabetes or atypical forms

Most people with type 2 diabetes are managed primarily in general practice.

Evidence based diet tips for pre-diabetes and type 2 diabetes

There is no single “perfect” diet for everyone. The most effective approach is the one you can sustain long term, that supports weight and waist reduction where appropriate, and keeps blood glucose stable.

Prioritise fibre at most meals: aim for vegetables, pulses (lentils, chickpeas, beans), and wholegrains. Fibre slows glucose absorption and supports fullness.
Choose higher protein breakfasts and lunches: eggs, Greek yoghurt, tofu, fish, chicken, or legumes can reduce mid-morning cravings and improve satiety.
Swap refined carbs for slower-release options: where you can, choose wholegrain bread, oats, brown basmati rice, or new potatoes with skin. Portion size still matters.
Reduce sugary drinks and high-sugar snacks: this is one of the highest impact changes. Prefer water, diet drinks, tea or coffee without added sugar.
Build meals using the “plate method”: half non-starchy veg, a quarter protein, a quarter higher fibre carbs. Add a small amount of healthy fats such as olive oil, nuts or seeds.
Limit ultra-processed foods where possible: frequent pastries, crisps, confectionery and takeaways can make glucose control harder and increase calorie intake without satiety.
Alcohol in moderation: alcohol can affect sleep, appetite and glucose control. If you drink, have alcohol-free days and avoid drinking on an empty stomach.
Consider meal timing: regular meals and avoiding late-night high-carb snacks can help some people. There is no need for extreme fasting unless clinically appropriate and safe for you.

What matters most: gradual, sustainable changes. Even modest weight loss can improve insulin resistance and reduce diabetes risk in people with pre-diabetes.

If you use glucose-lowering medication, have kidney disease, are pregnant, or have a history of eating disorders, seek personalised advice before making major dietary changes.

AccessGP work with blood tests to help you

When to speak to a GP

You should seek GP review if:

Blood test results are unclear or concerning
Symptoms develop or worsen
You feel unsure about management plans
Lifestyle changes feel overwhelming
You have concerns about long-term risks

Support is appropriate at any stage, not only after complications develop.

How various conditions are managed by GPs at AccessGP

GP insight

Type 2 diabetes and pre-diabetes are often discovered before symptoms appear. From a GP perspective, this is an opportunity rather than a failure. Early explanation, reassurance and gradual change can significantly improve long-term health outcomes.