How to Stay Ahead of a Type 2 Diabetes Diagnosis


By Hope Warshaw, MMSc, RD, DCES, BC-ADM 

Hope Warshaw is a Registered Dietitian (RD) and Diabetes Care and Education Specialist who has been involved in diabetes care, education, and support for over 40 years. 
Hope applies her credentials as a consultant, book author, freelance writer, and media spokesperson within her business, Hope Warshaw Associates, LLC, a consultancy based in Asheville, North Carolina. 


Experts now have a more-complete picture of how and why some people with overweight or obesity can develop Type 2 diabetes.

In people genetically set up to develop Type 2 diabetes (due to family history), weight gain—either rapid or those few pounds gained each year—can set in motion a cascade of hormonal and metabolic changes. 

Over time (sometimes decades), the pancreatic beta cells (that produce and secrete insulin) go into overdrive and madly overproduce insulin to keep blood-glucose levels in a normal range.

This can lead to a diminished ability of these pancreatic beta cells to keep up with the demand for insulin. 

If the person is not aware of their situation—which most of the time they are not—their blood-glucose levels will continue to rise. Eventually, these levels cross the line and Type 2 diabetes is diagnosed. 

Consider this a continuum of higher-and-higher blood-glucose levels that—if no healthy lifestyle actions are taken (read “Know your diabetes risk in 4 easy steps” below)—progresses and continues to cause further dwindling of endogenous insulin production (made by the pancreatic beta cells). 

Interestingly, these changes often occur even before there is a rise in blood glucose. 

Damage done even before diabetes diagnosis

Particularly disconcerting about this scenario is that most people are completely unaware that this is occurring in their body. 

It innocuously happens with few signs and symptoms—and typically occurs slowly over many years. 

You can also add to this that healthcare providers aren’t necessarily skilled at talking about weight and how to successfully address it. 

Know your diabetes risk in 4 easy steps

Step 1. Take the diabetes risk test. If you have risk factors for Type 2 diabetes—including a strong family history—take this test. If you are 35 years of age or older, get screened (read "Screening for Type 2 diabetes" below). Continue to follow up with healthcare providers and perform fasting and post-prandial blood glucose and/or A1C during your annual physical.

Step 2. Get a diagnosis. Get a sense of where your body is on this continuum by talking with your primary healthcare provider. Is your blood-glucose level still in the healthy range? Do you have Type 2 diabetes (read “Diagnosing Type 2 diabetes” below)? 

Step 3. Make small, slow, and steady lifestyle changes. These include making healthier food choices— particularly eating more dietary fiber to feed your gut microbiome. It also includes tweaking your eating habits and becoming more physically active (at least 20-30 minutes per day).  The end goal with these actions is to make permanent lifestyle changes, achieve weight loss, and learn how to keep lost pounds off. 

Step 4. Get reliable help and support. It can be daunting having to know what to eat and how to jump-start physical activity—and keeping it all going to achieve your goals. Seek and find reliable help and support. 

How do I know if I’m in remission?

A group of international experts (mainly from the United States and Europe) recently defined remission of Type 2 diabetes.2 

The experts stated that remission is an A1C of 6.5% or lower that is measured at least 3 months after discontinuing blood-glucose-lowering medication. 

Screening for Type 2 diabetes 

The American Diabetes Association recommends that all adults have their blood-glucose levels measured starting at the age of 45 (see "Diagnosing Type 2 diabetes").3  

Informal screening with the ADA/CDC Diabetes Risk Test should be considered in all adults without signs or symptoms of high blood-glucose levels.

According to the United States Preventive Services Task Force (USPSTF), for all people, screening for prediabetes and Type 2 diabetes should begin at age 35 years.4

Diagnosing Type 2 Diabetes3  




Diabetes (type 1, 2)

Fasting glucose

<100 mg/dL

>100 – 125 mg/dL

>126 mg/dL

Random glucose


> 140 to <199

> 200 (with classic symptoms)

2-hr result from an Oral Glucose Tolerance Test


> 140 to <199

> 200

A1c (average glucose level over past 2-3 months)


>5.7 – 6.4%


Hope Warshaw was compensated for the development and promotion of this blog from Pendulum Therapeutics, the manufacturer of Pendulum Glucose Control
Before you consider any of these gut-microbiome dietary solutions, talk to your healthcare provider. 

The FDA has not approved or evaluated these statements. Pendulum products are not intended to diagnose, treat, cure, or prevent any diseases.

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