Diabetes: What Your GP Might Not Be Telling You

Nearly one in ten adults in the UK currently has diabetes. Add those living with pre-diabetes and you are looking at closer to one in three people affected in some way by disordered blood sugar. These are not abstract statistics. They are people sitting in waiting rooms, managing fatigue, wondering why they feel the way they do.

And yet, for most of them, diabetes care is still largely reactive.

The problem with conventional care

A typical diabetes review in general practice is brief. An HbA1c result, a medication check, perhaps a blood pressure reading, and then a follow-up in three months. What often gets missed is the fuller picture: what someone is eating, how they are sleeping, what their stress levels are doing to their cortisol and insulin, and whether there are environmental or metabolic factors driving their poor control.

Diabetes is not simply a disease of blood sugar. It is a disease of metabolic dysregulation. And treating it well requires more than chasing a number.

Controlled diabetes is not the same as uncontrolled diabetes

This distinction matters enormously. The serious complications associated with diabetes, including blindness, kidney failure, amputation and cardiovascular disease, are largely complications of chronically uncontrolled blood sugar. They are not inevitable consequences of the diagnosis itself.

The landmark UKPDS study demonstrated that for every 1% reduction in HbA1c, there is a 35% reduction in diabetic complications. That is a transformative finding. It means that good metabolic control is not just clinically desirable. It is life-changing.

People living with well-controlled diabetes can and do live long, healthy lives.

The types of diabetes matter more than most people realise

There is a tendency in general practice to treat all diabetes as broadly the same condition. It is not. Type 1, Type 2, LADA (latent autoimmune diabetes in adults), and MODY (maturity-onset diabetes of the young) each have distinct mechanisms, different trajectories, and critically different optimal management approaches.

LADA in particular is frequently misdiagnosed as Type 2. People are started on tablets when what they actually need is a much more tailored approach. Getting the diagnosis right from the outset matters.

What good diabetes care actually looks like

In a specialist setting, a thorough assessment goes beyond HbA1c. It looks at fasting insulin, post-prandial glucose, lipid fractions, liver markers, inflammatory markers, and in many cases thyroid function and nutritional status. It considers diet, movement, sleep, and stress, not as lifestyle add-ons, but as core clinical variables.

That is the kind of care that moves the dial.

If you have been told your diabetes is “fine” based on a single number, or if you are managing a diagnosis but still feel far from well, it may be worth asking more questions.

The Key Points

• Diabetes affects close to one in three people in the UK in some form, yet care remains largely reactive rather than proactive.
• Standard GP reviews often miss the fuller picture, including diet, sleep, stress, and the metabolic factors driving poor control.
• The serious complications of diabetes are largely consequences of chronically uncontrolled blood sugar, not of the diagnosis itself, and good control makes a transformative difference.
• Different types of diabetes have distinct mechanisms and require different approaches, and misdiagnosis, particularly of LADA as Type 2, is more common than most people realise.
• Good specialist care goes well beyond a single HbA1c figure and treats diet, movement, sleep, and stress as core clinical variables.
• If you have been told your diabetes is fine based on one number but still feel far from well, it is worth asking more questions.

Author: Dr Imran Mughal, Private Specialist GP
Website: www.imclinic.co.uk
Book a consultation: https://notes.thanksdoc.co.uk/book/clinic/im-clinic