By Dr Vikas Das Mahesh, GP with a special interest in Diabetes
Courtyard Health Clinic, Musselburgh
One of the most common things I hear from patients who have recently been diagnosed with type 2 diabetes is:
“But I felt absolutely fine.”
And that is exactly the problem.
Type 2 diabetes often develops gradually. People may be working, raising families and getting on with everyday life while their blood glucose levels rise quietly in the background. Some people notice they are more tired than usual, thirstier, or passing urine more often. Others notice very little at all.
Current estimates suggest that almost 1.3 million people in the UK may be living with undiagnosed type 2 diabetes. In addition, around 6.3 million people are estimated to have non-diabetic hyperglycaemia (prediabetes). (1)
The encouraging news is that identifying raised blood glucose levels, or an increased risk of diabetes, at an early stage gives us a valuable opportunity to intervene before complications develop.
What Is Type 2 Diabetes?
Type 2 diabetes develops when the body’s insulin does not work effectively, a process known as insulin resistance, and/or when the pancreas can no longer produce enough insulin to maintain normal blood glucose levels.
Insulin is the hormone that allows glucose to move from the bloodstream into the body’s cells, where it is used for energy. When this process becomes less efficient, glucose builds up in the blood.
Over time, persistently high blood glucose levels can damage blood vessels and increase the risk of complications affecting:
• The heart and circulation
• Kidneys
• Eyes
• Nerves
• Feet
Type 2 diabetes develops through a complex interaction between genetics, age, ethnicity, body composition, metabolic health and lifestyle factors. While excess weight, particularly around the abdomen, is an important risk factor, diabetes can also develop in people who are not overweight.
What about Type 1 Diabetes?
Type 1 and type 2 diabetes are different conditions.
Type 1 diabetes is an autoimmune condition in which the immune system attacks the insulin-producing cells of the pancreas. People with type 1 diabetes require insulin treatment and the condition is not caused by lifestyle factors.
Symptoms of type 1 diabetes tend to develop quickly and are often remembered using the 4 Ts: (6)
• Toilet – needing to urinate more frequently
• Thirst – excessive thirst
• Tired – unusual fatigue
• Thinner – unexplained weight loss
Although often associated with children and young adults, type 1 diabetes can develop at any age. Anyone experiencing these symptoms should seek prompt medical assessment.
Who is at increased risk of Type 2 Diabetes?
There is no single cause of type 2 diabetes, but several factors can increase risk: (3)
• Living with overweight or obesity
• Carrying excess weight around the waist
• Increasing age
• Having a close family member with type 2 diabetes
• High blood pressure
• Physical inactivity
• Previous gestational diabetes
• Polycystic Ovary Syndrome (PCOS)
• Previously elevated blood glucose levels
• South Asian, Black African, African-Caribbean or Chinese ethnicity Age and ethnicity are particularly important. For people of White ethnicity, risk increases significantly from around age 40. For people from South Asian, Black African, African-Caribbean and Chinese backgrounds, increased risk begins at a younger age, often from around 25 years old.
This is why assessing overall cardiovascular and metabolic health is often more informative than focusing on weight alone.
What are the symptoms of Type 2 Diabetes?
Possible symptoms include: (5)
• Increased thirst
• Passing urine more frequently, particularly at night
• Persistent tiredness
• Unexplained weight loss
• Blurred vision
• Recurrent genital itching or thrush
• Slow-healing cuts and wounds
However, many people experience few or no symptoms, especially in the early stages. Symptoms can develop so gradually that they become part of everyday life and go unnoticed.
What Is Prediabetes?
Prediabetes describes blood glucose levels that are higher than normal but not yet in the diabetic range. In UK clinical practice, this is commonly referred to as non-diabetic hyperglycaemia.
An HbA1c result of 42-47 mmol/mol indicates an increased risk of developing type 2 diabetes.
Importantly, progression to diabetes is not inevitable.
Research has shown that lifestyle interventions, including increased physical activity, improved nutrition and weight management where appropriate, can significantly reduce the risk of developing type 2 diabetes in people at higher risk.
How do we test for Type 2 Diabetes?
One of the most commonly used tests is HbA1c, which reflects average blood glucose levels over the previous two to three months. (4)
In non-pregnant adults:
• Below 42 mmol/mol – below the usual high-risk range
• 42-47 mmol/mol – increased risk of developing type 2 diabetes
• 48 mmol/mol or above – within the diagnostic range for diabetes In people without symptoms, a diagnosis of diabetes usually requires confirmation with a second test. Depending on the clinical situation, fasting blood glucose testing or an oral glucose tolerance test may sometimes be more appropriate.
Why does early diagnosis matter?
Over time, diabetes can damage both small and large blood vessels, increasing the risk of:
• Cardiovascular disease
• Kidney disease
• Diabetic eye disease
• Peripheral neuropathy
• Foot complications
Early diagnosis allows treatment of blood glucose levels as well as associated risk factors such as blood pressure, cholesterol and smoking. It also creates an opportunity to prevent progression in people who are at high risk but do not yet have diabetes.
Can Type 2 Diabetes go into remission?
For some people, yes.
Type 2 diabetes remission means blood glucose levels remain below the diabetic range for a sustained period without diabetes medication. Evidence from the DiRECT trial demonstrated that significant weight loss can lead to remission in some individuals, particularly when diabetes has been diagnosed relatively recently. (9)
The important term is remission, not cure. Continued monitoring remains essential because blood glucose levels can rise again in the future.
Diabetes Screening and Assessment at Courtyard Health Clinic
At Courtyard Health Clinic in Musselburgh, patients have access to comprehensive diabetes and metabolic health assessments with Dr Vikas Das Mahesh, GP with a special interest in diabetes.
You may wish to arrange an assessment if you:
• Have symptoms suggestive of diabetes
• Have a family history of the condition
• Have previously been told your blood glucose is borderline
• Have had gestational diabetes or PCOS
• Are concerned about your weight or metabolic health
• Have had an abnormal HbA1c result elsewhere
• Simply want a clearer understanding of your future health risks
Our assessments may include:
• HbA1c testing
• Blood glucose testing where clinically appropriate
• Cholesterol and lipid profile
• Blood pressure assessment
• Weight and BMI measurement
• Waist circumference
• Review of family history and diabetes risk factors
• Assessment of wider cardiovascular and metabolic health
Most importantly, we take the time to explain what your results mean and how they relate to your overall health.
Our goal is not simply to identify diabetes, but to help patients understand their individual risk factors and make practical, evidence-based decisions that support long-term health and wellbeing.
Book an assessment
If you have symptoms of diabetes, have risk factors for developing type 2 diabetes, have previously been told your blood glucose is raised, or simply have not reviewed your metabolic health for some time, consider booking a consultation at Courtyard Health Clinic.
Early identification creates the greatest opportunity to prevent future health problems and improve long-term outcomes.
About the author
Dr Vikas Das Mahesh is a GP at Courtyard Health Clinic, Musselburgh, with a special interest in diabetes, metabolic health and cardiovascular risk reduction. He provides evidence-based assessment, diagnosis and management of diabetes and related metabolic conditions.
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References
1. Diabetes UK. How many people in the UK have diabetes? Current UK diabetes statistics.
2. Scottish Intercollegiate Guidelines Network (SIGN). SIGN 172: Prevention and Remission of Type 2 Diabetes (2025).
3. National Institute for Health and Care Excellence (NICE). PH38: Type 2 Diabetes: Prevention in People at High Risk.
4. NICE Clinical Knowledge Summaries. Diabetes – Type 2: Diagnosis in Adults.
5. Diabetes UK. Type 2 Diabetes: Symptoms and Risk Factors.
6. Diabetes UK. The 4 Ts of Type 1 Diabetes.
7. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. New England Journal of Medicine. 2002;346(6):393-403.
8. Lean MEJ, Leslie WS, Barnes AC, et al. Primary Care-Led Weight Management for Remission of Type 2 Diabetes (DiRECT): An Open-Label, Cluster-Randomised Trial. The Lancet. 2018;391:541-551.
9. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a Primary Care-Led Weight-Management Intervention for Remission of Type 2 Diabetes at 5 Years (DiRECT). The Lancet Diabetes & Endocrinology. 2024.
