Diabetes
Type 2 diabetes: knowing before it’s diabetes
Type 2 diabetes does not arrive one morning. It develops over years, silently, and there is a long window beforehand in which the trajectory can still be changed.
The short version
- Many people with type 2 diabetes have no symptoms at all when they are diagnosed.
- Prediabetes means blood glucose is higher than normal but not yet diabetic. It is a warning, and it is often reversible.
- A short risk questionnaire and a blood test are all it takes to know where you stand.
- Modest weight loss and regular activity substantially reduce the chance of progressing to diabetes.
Most long-term conditions announce themselves. Type 2 diabetes generally does not. By the time symptoms appear, blood glucose has often been creeping up for years, and some of the complications may already have begun.
That is the argument for checking before anything feels wrong.
Who should be checked
Risk assessment is recommended for:
- Everyone from 40 onwards, every three years
- Aboriginal and Torres Strait Islander people from 18
- Anyone with a parent or sibling with type 2 diabetes
- Women who have had gestational diabetes or polycystic ovary syndrome
- Anyone with high blood pressure, high cholesterol or heart disease
- Anyone carrying weight around the middle, which matters more than overall weight
- People on long-term steroids or some antipsychotic medicines
The AUSDRISK questionnaire takes a couple of minutes and is the usual starting point. Your GP can go through it with you, and the score determines whether a blood test is worthwhile.
The tests
HbA1c reflects your average blood glucose over roughly the past three months. It requires no fasting, which makes it convenient, and it is the test used most often.
Fasting glucose is a single snapshot taken after an overnight fast.
An oral glucose tolerance test involves a sweet drink and blood tests over two hours. It is used in pregnancy and where earlier results are equivocal.
What prediabetes means
That your blood glucose is above normal but below the diabetic range. It is not a diagnosis of diabetes, and it is not inevitable that it becomes one.
It is best understood as the most useful warning you will get. Structured lifestyle change at this stage substantially reduces the chance of progressing — in several large studies, by a considerable margin. It is one of the few situations in medicine where the intervention is genuinely in your hands and genuinely works.
The numbers worth knowing: losing around five to ten per cent of your body weight, and doing about 150 minutes of moderate activity a week, is roughly what the trials that showed benefit actually asked of people. Not a transformation — a shift.
What helps
- Movement, including strength work. Muscle is where glucose gets used. Two sessions a week of resistance training alongside walking does more than walking alone.
- What you drink. Sugary drinks and alcohol are often the easiest single change with the largest effect.
- Fibre and whole foods. Slower-releasing carbohydrates rather than no carbohydrates.
- Sleep. Poor sleep and untreated sleep apnoea both worsen insulin resistance, and both are treatable.
- Smoking. Increases the risk and compounds every complication.
A referral to a dietitian is worth asking about. Under a chronic disease care plan those visits are Medicare-subsidised, and specific practical advice tends to outperform general good intentions.
Symptoms worth acting on now
If any of these are present, book an appointment rather than waiting for a routine check:
- Passing urine more often, particularly at night
- Thirst that is not satisfied
- Unexplained weight loss
- Tiredness that is out of character
- Blurred vision
- Cuts or infections that heal slowly
- Recurrent thrush
If you are diagnosed
Type 2 diabetes is managed rather than endured. A care plan sets out your targets, schedules the checks that matter — HbA1c, kidney function, eyes, feet, blood pressure and cholesterol — and brings in subsidised visits to a dietitian, podiatrist or diabetes educator.
The treatments available have changed considerably in recent years, and several now do more than lower glucose alone. What suits you is a conversation with your GP rather than something to read about online.
Questions we get asked
Can prediabetes be reversed?
Often, yes. Structured lifestyle change at the prediabetes stage substantially reduces the chance of progressing to type 2 diabetes. It is the most useful window there is.
Do I need to fast for the blood test?
Not for HbA1c, which is the test used most often. Fasting glucose does require an overnight fast. Your GP will tell you which is being ordered and what preparation it needs.
I have no symptoms. Is it still worth checking?
Yes — most people with type 2 diabetes have no symptoms when diagnosed. That is precisely why risk assessment is recommended from 40, and from 18 for Aboriginal and Torres Strait Islander people.
General information only. This article is general health information for people in the Port Stephens area. It is not advice about your individual situation and it does not replace a consultation with a doctor. If you are worried about a symptom, book an appointment or call us on (02) 4008 4400. In an emergency, call 000.
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