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Many people in India believe that if their fasting sugar or HbA1c is normal, they are 100% safe from diabetes.
The truth? By the time these numbers rise, the disease may have been silently progressing for 5–10 years.
As an endocrinologist, I’ll show you how to detect diabetes early — before your routine reports turn abnormal.
🧠 The Timeline of Diabetes Development
- Stage 0: Insulin resistance begins — fasting sugar normal, HbA1c normal.
- Stage 1: Post-meal sugar starts rising — fasting still normal.
- Stage 2: Both fasting & post-meal sugars abnormal → official diagnosis.
Early detection means catching Stage 0 or Stage 1 — before permanent damage begins.
🚨 Early Red Flags to Watch For
High-Risk Body & Medical Clues
- Belly fat (waist > 90 cm men, > 80 cm women)
- Family history of diabetes
- PCOS in women
- High BP, fatty liver, high triglycerides
Subtle Early Symptoms
- Fatigue after meals
- Cravings for sweets or carbs
- Brain fog / difficulty focusing
- Dark skin patches on neck or armpits (acanthosis nigricans)
- Tingling in feet despite “normal” reports
🔬 Advanced Tests to Catch Diabetes Early
| Test | Why It Helps | Ideal Range |
|---|---|---|
| Fasting Insulin | Detects hidden high insulin (hyperinsulinemia) before sugar rises | 3–7 mIU/L |
| HOMA-IR | Direct measure of insulin resistance | < 2 |
| Postprandial Glucose (2 hrs after meal or 75g glucose) | Catches early spikes missed in fasting | < 140 mg/dL |
| Continuous Glucose Monitoring (CGM) | Tracks 24h sugar patterns | No spikes > 140–150 |
| Oral Glucose Tolerance Test (OGTT) | Gold standard for early detection | 2hr < 140 mg/dL |
| Triglyceride / HDL Ratio | Blood marker of insulin resistance | < 2 |
| C-peptide | Checks pancreas insulin-making capacity | 1–3 ng/mL fasting |
❗ Why HbA1c Alone Can Miss Early Diabetes
- HbA1c is an average of 3 months’ sugar — short spikes may not affect it much.
- Conditions like anemia, kidney disease, and certain hemoglobin types can falsely lower HbA1c.
📋 Endocrinologist’s Early Detection Protocol
For anyone with risk factors — even with normal sugars:
- Test fasting glucose + fasting insulin + HOMA-IR
- Do an OGTT (fasting & 2-hour sugar after glucose)
- Consider a 14-day CGM for hidden spikes
- Check TG/HDL ratio and screen for fatty liver
🧠 Bottom Line
Normal fasting sugar does not mean you are safe.
Diabetes starts years before it shows up in reports — and only advanced tests + clinical signs can catch it in time.
💬 Tip: If you have belly fat, family history, or fatty liver — don’t wait for “high sugar” to take action.
A simple post-meal sugar test or fasting insulin can reveal hidden risks.