In short: Type 2 diabetes often develops slowly and many people have no symptoms for years. The most common warning signs are passing urine more often (especially at night), feeling very thirsty, tiredness, unexplained weight loss, repeated thrush or itching around the genitals, slow-healing cuts and blurred vision. A simple HbA1c blood test confirms the diagnosis, and early treatment reduces the risk of long-term complications.

This guide, written by a Ready Health prescribing pharmacist, explains the early signs of type 2 diabetes, who is most at risk, how it is diagnosed in the UK and how it is managed in line with NICE guideline NG28.

What is type 2 diabetes?

Type 2 diabetes is a long-term condition in which the body either does not make enough insulin or cannot use it properly (insulin resistance). Glucose then builds up in the blood. Over time, raised blood glucose can damage blood vessels and nerves, increasing the risk of heart attack, stroke, kidney disease, sight problems and foot complications.

It is different from type 1 diabetes, an autoimmune condition where the body stops producing insulin and which usually starts more suddenly.

What are the early warning signs of type 2 diabetes?

Symptoms are often mild and easy to put down to a busy life. Look out for:

needing to pass urine more often than usual, particularly at night
feeling thirsty a lot of the time
feeling unusually tired or lacking energy
losing weight without trying
itching around the penis or vagina, or repeated episodes of thrush
cuts or wounds that take longer to heal
blurred vision
tingling or numbness in the hands or feet (usually a later sign)

Many people have none of these symptoms and are only diagnosed through a routine blood test. That is why testing matters if you have risk factors, even if you feel well.

Who is most at risk of type 2 diabetes?

You are more likely to develop type 2 diabetes if you:

are over 40, or over 25 if you are of South Asian, Chinese, Black African or African-Caribbean background
have a parent, brother or sister with diabetes
are living with overweight or obesity, especially carrying weight around the waist
are physically inactive
have high blood pressure
had diabetes in pregnancy (gestational diabetes)
have previously been told you have prediabetes (non-diabetic hyperglycaemia)
have polycystic ovary syndrome (PCOS)

Diabetes UK has a free online "Know Your Risk" tool, and adults in England aged 40 to 74 without certain existing conditions are invited for an NHS Health Check every five years.

How is type 2 diabetes diagnosed?

In the UK, diabetes is usually diagnosed with an HbA1c blood test, which reflects your average blood glucose over the previous two to three months. It does not need fasting.

HbA1c result	What it usually means
Below 42 mmol/mol	Normal range
42 to 47 mmol/mol	Raised risk (non-diabetic hyperglycaemia, often called prediabetes)
48 mmol/mol or above	Consistent with type 2 diabetes (usually confirmed with a repeat test if you have no symptoms)

HbA1c is not suitable for everyone, for example in pregnancy, in children, if symptoms have come on quickly, or with some blood conditions. A fasting glucose test may be used instead. A clinician interprets results alongside your symptoms and history.

How is type 2 diabetes managed under NICE NG28?

NICE guideline NG28 (updated in February 2026) sets out how adults with type 2 diabetes should be supported in England. Key points include:

Structured education and lifestyle support – healthy eating, regular physical activity and support with weight loss. For some people, significant weight loss can bring blood glucose back into the normal range (remission).
Individualised targets – NICE now emphasises protecting the heart and kidneys, not just hitting an HbA1c number. Targets are agreed with you.
Initial medicines – for most adults, NICE now recommends modified-release metformin alongside an SGLT-2 inhibitor as initial treatment, with adjustments for people living with frailty or reduced kidney function. A prescriber decides which treatment is suitable for you.
Managing cardiovascular risk – blood pressure, cholesterol and stopping smoking are all part of care.
Regular checks – including HbA1c, kidney function, eye screening and annual foot checks.

If you are found to have prediabetes, the NHS Diabetes Prevention Programme offers free support to help lower your risk.

Frequently asked questions

Can you have type 2 diabetes without symptoms?

Yes. Many people have no noticeable symptoms, which is why diabetes is often picked up on a routine blood test. If you have risk factors, ask about an HbA1c test.

Can type 2 diabetes be reversed?

Some people achieve remission, meaning their blood glucose returns below the diabetes range without diabetes medicines, usually after substantial weight loss. Remission is not guaranteed and needs ongoing monitoring.

Do I need to fast for a diabetes blood test?

Not for HbA1c. Fasting is only needed if a fasting glucose test has been requested.

When should I seek urgent help?

Seek urgent medical advice (NHS 111 or your GP) if you have extreme thirst, are passing large amounts of urine, are vomiting, feel very drowsy or confused, or are losing weight rapidly.

Key takeaways

Type 2 diabetes is often silent; symptoms include thirst, frequent urination, tiredness, weight loss and slow-healing cuts.
Risk rises with age, family history, weight, ethnicity and high blood pressure.
An HbA1c of 48 mmol/mol or above is consistent with diabetes; 42 to 47 indicates raised risk.
NICE NG28 (2026) focuses on lifestyle support, heart and kidney protection and individualised treatment.
Early diagnosis gives you the best chance of preventing complications.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

Worried about your blood sugar or want to understand your risk? Ready Health in Standish, Wigan offers private blood tests including HbA1c, with a clinician to explain your results. Book a blood test consultation.