A man in his early fifties comes in for a routine check and feels in excellent health. No complaints, no reason for concern, he says. Yet his HbA1c shows that his average blood sugar has been on the high side for months. This is not an exception. Type 2 diabetes develops slowly, often for years without clear symptoms, and the vast majority of people with diabetes in the Netherlands have type 2.
My conviction up front: with blood sugar, looking early is almost always more pleasant than waiting. A value that rises slowly often goes unnoticed, and it is precisely that quiet phase that is the window in which you can still do a lot. This guide walks through all of it: what type 2 diabetes is, what insulin resistance means, which blood values matter, what the risk factors are and what you can concretely do yourself.
What is type 2 diabetes and how does it develop?
Type 2 diabetes is a condition in which your blood sugar is structurally too high because your body uses insulin less well. Insulin is the hormone that helps move sugar from your blood into your cells. When that works less well, more glucose stays behind in your blood. This process usually builds up over years, which explains why the diagnosis is often made late.
Type 2 differs from type 1. In type 1 the body makes almost no insulin itself anymore, usually through an autoimmune process. In type 2 there is often still insulin, but your cells respond to it less. Lifestyle, weight, heredity and age all play a role. The NHG (Dutch College of General Practitioners) type 2 diabetes guideline therefore describes type 2 as a condition in which both insulin resistance and insufficient insulin production play a part.
What is insulin resistance?
Insulin resistance means your cells respond less sensitively to insulin. Your pancreas then makes more insulin to keep your blood sugar normal anyway. For a while this works, so your glucose value can still be fine while something is already changing beneath the surface.
This is exactly why insulin resistance stays invisible for so long. Your fasting glucose can still be fine while your insulin is already raised. The Diabetes Fonds (Dutch Diabetes Foundation) describes insulin resistance as an early phase on the road to type 2 diabetes, and that is precisely where the opportunity lies: the earlier you see it, the more room there is to adjust. Read in our explainer on recognising insulin resistance which signals can fit and how to test it.
Which blood values say something about your blood sugar?
Three values together give a broader picture of your sugar metabolism: your fasting glucose, your HbA1c and your fasting insulin. Each measures something different. One shows a snapshot, another an average over weeks, and the third shows how hard your body works to keep things in balance.
| Blood value | What it measures | Where to have it checked |
|---|---|---|
| Fasting glucose | Your blood sugar as a snapshot, after at least 8 hours without food | Fasting glucose |
| HbA1c | Your average blood sugar over the past 2 to 3 months | HbA1c |
| Fasting insulin | How much insulin your body makes to keep your sugar normal | Fasting insulin |
To have these values measured together, you can choose a diabetes blood test or a broader complete metabolic panel. An abnormal value is not a diagnosis, but a starting point to look further together with your GP. Read also our explainer on the HbA1c value and on fasting glucose.
How to read these three values together
A single number rarely tells the whole story. A normal glucose with raised insulin can point to early insulin resistance. A slightly raised HbA1c next to a normal fasting glucose can mean your blood sugar mainly rises after meals. It is precisely these combinations that make the pattern readable, which is why measuring several values is often more informative than one isolated draw.
Prediabetes: the phase in between
Between healthy blood sugar and type 2 diabetes lies an in-between zone that doctors call prediabetes. Your glucose or HbA1c is then higher than normal, but not yet high enough for a diabetes diagnosis. The most important thing about this phase is that it can often still be influenced. Research shows that for some people lifestyle can make the difference between progressing to type 2 diabetes or not. The effect varies from person to person, so see it as an opportunity and not a guarantee. Read in our explainer on prediabetes and how to reverse it what you can concretely track.
What are the risk factors for type 2 diabetes?
The risk of type 2 diabetes depends on a combination of factors. Some you cannot change, such as age and family history. Others you can, such as weight, diet and movement. The more factors come together, the greater the chance that your blood sugar rises over time.
- Overweight, especially around the belly: belly fat is strongly linked to insulin resistance.
- Little movement: muscles use glucose, so sitting still works against you.
- Family with type 2 diabetes: heredity plays a clear role.
- Age over 45: the risk increases with the years.
- A previous raised blood sugar or gestational diabetes: this can be an early signal.
When several of these factors come together with raised blood pressure and unfavourable cholesterol values, doctors sometimes speak of metabolic syndrome. Besides diabetes, that cluster also raises the risk of cardiovascular disease, something the Hartstichting (Dutch Heart Foundation) has pointed out for years.
Can you prevent or delay type 2 diabetes?
In many people a raised blood sugar can be favourably influenced with lifestyle, and sometimes prediabetes partly reverses. Research shows that movement and diet together can make the difference. The effect varies from person to person, so treat this as direction and not a promise. The four levers below all act on the same dial: your insulin sensitivity.
| Lever | Why it works | Practical direction |
|---|---|---|
| Movement | Muscles take up glucose, even independent of weight loss | Combine daily movement with strength a few times a week |
| Diet | Fewer fast sugars and more fibre keep your blood sugar steadier | Fibre-rich carbohydrates, protein with every meal, less soft drink |
| Weight | Even a modest reduction in belly fat improves your insulin sensitivity | Aim for a gradual, sustainable reduction |
| Sleep and stress | Short sleep and chronic stress can unfavourably affect your blood sugar | Protect your night's rest and build in moments of calm |
The Voedingscentrum (Netherlands Nutrition Centre) gives practical guidelines for the dietary side that fit well here. Always discuss big changes with your GP, especially if you take medication.
Which numbers are commonly used as cut-offs?
After a result, many people mainly want to know: am I fine, or do I need to do something? The honest answer: that depends on context, and your GP looks at your whole situation rather than one cut-off. Still, it helps to know which reference values doctors often use, if only to place your own result better. The numbers below align with the way the NHG (Dutch College of General Practitioners) type 2 diabetes guideline looks at glucose and HbA1c. Treat them as orientation, not a diagnosis.
| Value | Often considered normal | Often seen as borderline |
|---|---|---|
| Fasting glucose | Below approx. 5.6 mmol/l | Approx. 5.6 to 6.9 mmol/l (towards prediabetes) |
| HbA1c | Below approx. 42 mmol/mol | Approx. 42 to 47 mmol/mol (towards prediabetes) |
A single value just above a cut-off does not automatically mean something is wrong. A cold, a short night or an unintentionally non-fasted draw can already influence a result. That is why an abnormal value is usually repeated before conclusions are drawn, and it is always considered together with your complaints and risk factors. That is precisely why a result with interpretation is worth more than a bare list of numbers.
The first steps after a raised result
Suppose your fasting glucose or your HbA1c falls just in the borderline range. What then? Panic is rarely needed, but waiting without a plan is not the intention either. Below is a level-headed order that fits many people, always in consultation with your GP.
- Have it confirmed. One measurement is a snapshot. A repeat measurement, sometimes supplemented with HbA1c, gives a firmer picture than one isolated number.
- Map your risk factors. Waist size, blood pressure, family history and your cholesterol values together determine how heavily one cut-off weighs.
- Choose one or two lifestyle dials. Not everything at once. More movement and fewer fast sugars are often the most achievable start, and they act directly on your insulin sensitivity.
- Plan a check-in. A repeat measurement after a few months shows whether you are moving in the right direction. The Diabetes Fonds (Dutch Diabetes Foundation) stresses that this borderline phase in particular can often still be influenced.
What I most want to pass on: use a cut-off as a starting signal, not a verdict. The phase between normal and diabetes is exactly the place where lifestyle can make the most difference, and that is more hopeful news than most people think.
A common mistake in this phase is measuring too often. Pricking your blood sugar again every week mainly produces noise, because small fluctuations are normal and say little on their own. HbA1c only changes over weeks, so a repeat measurement within a month rarely adds anything. A sensible cadence is usually a baseline, a focused lifestyle period of a few months, and then a check. If you want to sense your progress in between, your waist size or your fitness often says more than an extra prick. That way you keep measuring in service of your goal, and not the other way around.
When is having your blood sugar measured useful?
A blood sugar test is mainly informative if you have complaints or recognise several risk factors. Think of a lot of thirst, frequent urination, unexplained tiredness or a family history of diabetes. Some people choose to test periodically to stay informed, certainly around and after the age of forty-five.
If you have no complaints and no risk factors, isolated testing often yields little. A targeted choice fits better than simply having everything measured. In doubt? Your GP can help you decide whether a test is useful in your situation. Bear in mind too: you would rather receive a result with interpretation alongside it, not as a bare list of numbers.
Frequently asked questions
What is the difference between glucose and HbA1c?
Glucose is a snapshot of your blood sugar. HbA1c shows your average over the past two to three months. Together they give more context than each alone.
Can you have type 2 diabetes without symptoms?
Yes, that happens often. A raised blood sugar gives no clear symptoms for a long time, so it is sometimes found by chance.
Do you need to be fasted for a blood sugar test?
For fasting glucose and insulin yes, usually at least 8 hours without food. For HbA1c you do not need to be fasted. Follow the advice with your test.
Is prediabetes the same as diabetes?
No. With prediabetes your blood sugar is higher than normal, but not yet high enough for a diabetes diagnosis. It is often still a phase in which lifestyle can mean something. Discuss this with your GP.
My advice: do not wait until complaints force you. If you recognise several risk factors, look specifically at your blood sugar and discuss the result calmly with your GP. Every blood test result at Vitalcheck includes a professional assessment by a doctor registered in the Dutch BIG register. A blood value is not a diagnosis: always discuss complaints and treatment decisions with your GP.
Sources
- NHG guideline Diabetes mellitus type 2. Dutch College of General Practitioners. 2021.
- Diabetes Fonds (Dutch Diabetes Foundation). What is type 2 diabetes? Accessed 2026.
- RIVM. Diabetes mellitus: figures and context. Public Health and Care. Accessed 2026.
- Voedingscentrum (Netherlands Nutrition Centre). Nutrition with diabetes and healthy weight. Accessed 2026.
- Hartstichting (Dutch Heart Foundation). Diabetes and cardiovascular disease. Accessed 2026.
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