Type 2 Diabetes: Early Signs, the HbA1c Test and Acting Early
Reviewed by Dr. Farhan Rashid Abbasi, Pharmacist, Medicine Online. For general information only; it does not replace advice from your own doctor.
World Diabetes Day is on 14 November, and its 2026 theme is early action on diabetes: earlier diagnosis, better access to care and reducing stigma. That message matters in Pakistan, which has one of the highest rates of diabetes in the world, and where many people live with high blood sugar for years before they find out. Type 2 diabetes often causes no clear symptoms at first, so the damage to eyes, kidneys, nerves and the heart can begin quietly. Finding it early, or catching prediabetes before it turns into diabetes, makes a real difference.
Early signs of type 2 diabetes
Many people have no symptoms. When signs do appear, they often develop slowly and are easy to blame on age, heat or stress:
- Feeling thirsty all the time and drinking much more than usual
- Passing urine often, including getting up at night
- Tiredness and low energy
- Blurred vision
- Cuts and wounds that heal slowly
- Frequent infections, such as urine infections, thrush or skin and gum infections
- Tingling, burning or numbness in the feet or hands
- Unexplained weight loss
- Dark, velvety patches of skin on the neck or armpits, a sign of insulin resistance
Who should get tested
Because symptoms come late, testing is the only reliable way to know. Ask your doctor for a sugar test if any of these apply:
- You are 35 or older. South Asians develop type 2 diabetes at younger ages and lower body weights than many other groups, so earlier testing is sensible.
- You are overweight, or carry weight around the waist. For South Asians, a waist measurement of about 90 cm (35.5 in) or more in men, or 80 cm (31.5 in) or more in women, signals higher risk.
- A parent, brother or sister has diabetes.
- You have high blood pressure or high cholesterol. See our guides to blood pressure and cholesterol.
- You had diabetes during pregnancy, or a baby weighing over 4 kg.
- You have polycystic ovary syndrome (PCOS).
- You are physically inactive most days.
If your results are normal, repeat the test at least every three years, or sooner if your doctor advises.
Understanding your test results
There are three common tests. A doctor usually confirms diabetes with a repeat test unless symptoms are clear.
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| HbA1c (average sugar over about 3 months) | Below 5.7% | 5.7% to 6.4% | 6.5% or higher |
| Fasting blood sugar (no food for at least 8 hours) | Below 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher |
| 2 hours after a glucose drink (OGTT) | Below 140 mg/dL | 140 to 199 mg/dL | 200 mg/dL or higher |
The HbA1c test is convenient because you do not need to fast, and it shows your average over the past few months rather than a single moment. Some conditions, such as anaemia or certain blood disorders, can make HbA1c less accurate, so your doctor may use another test. If you have been told you are anaemic, read our iron deficiency guide.
A home glucometer is useful for monitoring once you are diagnosed, but a lab test is needed for diagnosis. Our guide to choosing and using a glucometer explains how to get accurate readings.
Prediabetes: the best time to act
Prediabetes means your sugar is higher than normal but not yet in the diabetes range. It is a warning, not a diagnosis, and it can often be reversed. Studies have shown that losing around 5 to 7 percent of body weight and being active for about 150 minutes a week can substantially cut the chance of developing type 2 diabetes.
Practical steps you can start today
- Move more. A brisk 30-minute walk on five days a week is a good target. After-dinner walks help bring down sugar after meals.
- Cut sugary drinks. Soft drinks, packaged juices and sweet tea add a lot of sugar quickly. Water, lassi without sugar and plain tea are better choices.
- Watch portions of rice, roti and sweets. Fill half your plate with vegetables and salad, a quarter with protein such as dal, chicken, fish or eggs, and a quarter with roti or rice.
- Choose whole grains such as atta with bran, brown rice and daliya over white flour and white rice.
- Sleep well and manage stress, both of which affect blood sugar.
- Stop smoking, which raises the risk of diabetes and its complications.
If you are diagnosed
A diagnosis is the start of control, not the end of a normal life. Your doctor will set targets for sugar, blood pressure and cholesterol, and may start medicine alongside lifestyle changes. Our guide to type 2 diabetes medicines in Pakistan explains the main options. Ask for yearly checks of your eyes, kidneys and feet, and look after your feet every day.
Find glucometers, strips and diabetes care products in our glucometers and strips and diabetes collections. Prescription medicines are dispensed only against a valid prescription.
Read this article in Urdu: ذیابیطس کی ابتدائی علامات
Frequently asked questions
What are the first signs of diabetes?
Increased thirst, passing urine often, tiredness, blurred vision and slow-healing wounds are the most common early signs, but many people have none.
What HbA1c level means diabetes?
An HbA1c of 6.5% or higher, confirmed by a repeat test, usually means diabetes. A level of 5.7% to 6.4% indicates prediabetes.
Do I need to fast for an HbA1c test?
No. HbA1c can be done at any time of day without fasting.
Can prediabetes be reversed?
Often, yes. Modest weight loss, regular physical activity and healthier eating can bring blood sugar back to normal for many people.
At what age should I get tested for diabetes?
Most adults should be tested from 35, and earlier if they are overweight or have other risk factors such as a family history, high blood pressure or diabetes in pregnancy.
