Often silent for years. Prediabetes is the stage where it is still genuinely reversible.
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Type 2 diabetes develops when the body becomes resistant to insulin and the pancreas cannot keep up. It develops slowly, often over years, and many people have it for a considerable time before diagnosis.
The stage before it — prediabetes — is where the opportunity lies. At that point the process is frequently reversible, and reversible is a word that stops applying later.
Many people have no symptoms at all, which is why testing rather than waiting is the point.
HbA1c reflects your average blood sugar over roughly three months, so it cannot be skewed by what you ate yesterday or by a stressful morning. That is why it has largely replaced fasting glucose.
It measures haemoglobin, so anything that alters red cell lifespan distorts it.
In those situations a fasting glucose or glucose tolerance test is used instead, and it is worth saying if any apply to you.
Insulin resistance develops years before blood sugar itself becomes abnormal. Measuring insulin and C-peptide alongside HbA1c shows the process while it is still early — and early is where it is reversible.
Rapid weight loss, marked thirst, and diabetes appearing in someone slim or young may be type 1 rather than type 2 — which needs insulin urgently and is dangerous if treated as type 2.
And new diabetes over 50 with unexplained weight loss warrants looking further, because it can be an early sign of pancreatic disease.
HbA1c shows your average blood sugar over about three months, so it cannot be skewed by what you ate yesterday. Measuring insulin and C-peptide alongside reveals insulin resistance, which develops years before blood sugar itself becomes abnormal.
Where results show prediabetes, the consultation focuses on what actually reverses it. Where diabetes is confirmed, we cover treatment, monitoring, and referral into structured support.
Seek urgent care for very high blood sugar with vomiting, abdominal pain, rapid breathing, drowsiness or a fruity smell on the breath — that may be diabetic ketoacidosis, which is a medical emergency.
Also urgent: any foot ulcer, wound or area of discolouration that is not healing.
At the prediabetic stage the process is frequently reversible, and that word stops applying later.
The NHS Diabetes Prevention Programme is free, runs for nine months, and roughly halves progression to type 2 diabetes in people who complete it. If your HbA1c is 42 to 47, ask about it — it is the single highest-value thing available and it costs nothing.
Substantial weight loss can return blood sugar to non-diabetic levels without medication. That is not a fringe claim — it is established, and it is more achievable earlier in the condition.
Remission is not cure. Monitoring continues, because the tendency remains.
Free on the NHS and worth attending without fail: annual retinal screening, annual foot checks, and kidney monitoring.
Diabetic eye screening prevents avoidable blindness, and attendance is imperfect. It is the appointment least worth missing.
NHS diabetes care is free, structured, and genuinely comprehensive — annual review, retinal screening, foot checks, kidney monitoring, dietitian access, structured education programmes such as DESMOND, and all medication. Anyone with diabetes on medication also gets free NHS prescriptions for everything in England via a medical exemption certificate.
For a lifelong condition needing coordinated monitoring, the NHS is unambiguously the right home for this, and we would not try to replace it.
The single most important free thing is the NHS Diabetes Prevention Programme, for people with prediabetes — which substantially reduces progression to type 2 diabetes, and which people frequently do not take up.
The other under-known fact is that type 2 diabetes can go into remission, particularly within the first few years, through substantial weight loss. The NHS Type 2 Diabetes Path to Remission Programme provides that free in eligible areas.
Where a private consultation adds something is speed of diagnosis when symptoms suggest it, a proper conversation about what an HbA1c actually means, and reviewing whether weight-management treatment is appropriate alongside — though for many people the NHS route offers that too, with dietetic support attached.
What needs emergency assessment: vomiting with abdominal pain and rapid breathing, drowsiness or confusion, or a foot ulcer or infection — which needs same-day attention.
NICE NG28, Type 2 diabetes in adults: management, is the governing guideline. It sets HbA1c targets, recommends metformin as first-line, and — following its 2022 update — recommends SGLT2 inhibitors alongside metformin for people with cardiovascular disease or high cardiovascular risk.
NG28 recommends structured education at or around diagnosis, and covers annual review including kidney function, foot assessment and retinal screening.
NICE NG238 covers cardiovascular risk reduction in diabetes, including statin therapy.
NICE PH38 and the NHS Diabetes Prevention Programme underpin the recommendation for people with non-diabetic hyperglycaemia.
The DiRECT trial established that substantial weight loss can achieve remission of type 2 diabetes, which underpins the NHS Path to Remission Programme.
NICE NG19 covers diabetic foot problems, requiring same-day referral for suspected foot infection or ulceration.
Prediabetes — a warning, not a diagnosis.
Ask about the NHS Diabetes Prevention Programme, which is free and roughly halves progression in those who complete it. This is the stage where what you do makes the most difference.
It can go into remission, yes — with substantial, sustained weight loss.
It works better the earlier it is attempted, and remission means blood sugar back in the normal range without medication rather than the tendency having gone. Monitoring continues.
Not for HbA1c, which is the usual test and reflects three months rather than this morning.
Yes, and it is worth flagging. Iron deficiency can falsely raise HbA1c, and other conditions affecting red cells distort it in both directions.
Sickle cell trait and thalassaemia also affect it, in which case a different test is used.
You can — particularly if you are of South Asian, Black African or Caribbean heritage, where it develops at considerably lower body weight and often a decade earlier.
Being slim also raises the question of type 1, especially with rapid weight loss and marked thirst. That distinction matters urgently, because type 1 needs insulin.
Many people never do. Type 2 diabetes is progressive, so treatment often intensifies over years — but starting insulin is not a failure and not inevitable.
It is well established, inexpensive and effective, and it does not cause low blood sugar on its own.
Stomach upset is common initially and usually settles, and the slow-release form is better tolerated — worth asking about rather than stopping.
Long-term metformin depletes B12, which should be checked periodically and frequently is not.
Annual eye screening, annual foot checks, and kidney monitoring — all free, and all aimed at the complications rather than the number.
Eye screening is the one people skip and the one that prevents avoidable sight loss.
Sugary drinks are worth removing entirely — they raise blood sugar fast and add nothing.
Beyond that, total refined carbohydrate matters more than sugar specifically, and unnecessarily restrictive diets tend not to last.
August 23, 2026
Ongoing
Time to be seen
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Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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