Why you're probably in the diabetes danger zone

Telegraph

18-05-2025

Since I first began my medical career back in the 1970s, one health crisis has stood out starkly as the epidemic of our times: diabetes. It's estimated to affect 5.8 million people in Britain, causing 500 premature deaths every week and putting an intolerable strain on the NHS, at a cost of more than £10 billion a year to the taxpayer.
My decades of work at the cutting edge of research into this complex, debilitating disease revealed for the first time that it could be reversed – as well as the exact way to do it. The groundbreaking findings now form the basis of the NHS's new programme to help patients beat the condition.
And intervention is urgently needed. The latest figures show that over half a million more people in England were identified as being at risk of developing Type 2 diabetes in a year in 2023 than 2022 – an increase of almost a fifth. The heartbreaking stories I've encountered in patients over the years, involving amputations, blindness, nerve damage, excruciating pain and shortened life expectancy, are multiplying far too rapidly.
But the message I want to send, loud and clear, is that warding off diabetes and returning to full health, potentially permanently, isn't complicated. It's something everyone has the power to do safely, at home, in as little as eight weeks.
How do you know if you're in the diabetes 'danger zone'?
Many people in the diabetes 'danger zone' – the period in which blood sugar levels are elevated, but full-blown diabetes hasn't yet begun – will have no idea, as prediabetes tends to be symptomless. But there are people who are particularly at risk of developing the disease who should be especially vigilant.
If there's someone in your immediate family with diabetes, or you've experienced gestational diabetes during pregnancy, your risk of developing Type 2 diabetes is higher. Certain ethnic groups, including people of South Asian and Afro-Caribbean descent, are also more susceptible. Men are more likely than women to develop the condition, while women's risk increases around the menopause.
The causes of Type 2 diabetes aren't always what you think
Too often, it's assumed that the primary cause of Type 2 diabetes is obesity, but this isn't the case. The relationship between weight and the disease is more nuanced than that. In fact, almost three-quarters of people with a BMI of over 45 do not suffer from it.
Type 2 diabetes is characterised by too much sugar in the blood when the body is unable to produce enough of the hormone, insulin, which should control blood sugar levels, and cells throughout the body stop responding effectively to the insulin they do receive.
The series of research projects I led at Newcastle University showed that it is actually caused by one factor: too much fat in the liver and pancreas. We showed that excess sugar in the blood is converted to fat, which is stored around the body, including inside the vital organs. If you continue to eat too much and exercise too little, at some point you reach your own personal fat threshold, when fat in the liver and pancreas start to impede their ability to function properly.
When there is excess fat in the liver, it will produce too much glucose and also pass excess fat to the pancreas. This excess fat then attacks the pancreas's insulin-producing cells, leading them to malfunction. The result is Type 2 diabetes.
All of which means it's possible not to be visibly overweight, but to still be in the danger zone – because even someone with a 'healthy' BMI might have gone beyond their own body's fat threshold. A better measure of when you need to take action is if your waist size is high or has increased in adult life, which indicates that fat may be building up inside those vital organs. Other signs you're in the zone include suffering from fatigue, feeling thirsty all the time or are getting up to pee more than usual in the night.
People of all ages should be vigilant
Historically, Type 2 diabetes has been associated with older adults, but one of the most shocking developments I've witnessed in my work is the explosion in numbers of young people developing it.
In people under the age of 40, there was an increase in England of almost a quarter between 2022 and 2023, from 173,166 to 216,440. This is absolutely disastrous, because it's a much more vicious disease in younger people, who suffer complications sooner and die earlier than if they develop it later in life. Tragically, we're even starting to see young children with diabetes.
To monitor whether your blood sugar levels are higher than normal, home test kits are available. Or you could ask your GP for regular blood tests, which are particularly important if any family members have Type 2 diabetes. Prediabetes is a major wake-up call: approximately 25 per cent of people with prediabetes will develop Type 2 diabetes within three to five years, and up to 70 per cent will develop the disease at some point in their lifetime. With prediabetes, you are also at a much greater risk of heart attacks and strokes.
Follow my plan, though, and you can reduce your blood sugar levels to a normal range within seven days, although it takes up to two months to address the underlying factors.
Here's how to do it.
1. Short, sharp weight-loss
If you're in the diabetes danger zone, however much fat you have in your body is too much for your own constitution. There's no escaping the fact that to get this fat from inside your internal organs, you'll need to lose weight. How much depends on genetics, body shape and your personal fat threshold, but most adults in Britain would benefit from losing at least 10 per cent of their body weight.
In fact, to avoid diabetes, we should aim to stay as close as we can to the weight we were at the age of 21.
I favour a short, sharp calorie deficit, which had become unfashionable but most people find to be less of a psychological burden. The perceived wisdom used to be that losing a lot of weight quickly means you're certain to regain it all, and more, but our research shows this isn't true – and that the benefits of this approach are enormous.
When you go on a very strict diet, your body will tap into the fat in your liver as a source of energy because it's far easier to access and metabolise than the fat under your skin.
The NHS uses this approach: a slightly longer programme of 800 calorie-a-day diet of soups and shakes with an optional 100ml of skimmed or semi-skimmed milk. This is followed by a carefully phased re-introduction of food and ongoing maintenance, avoiding anything ultra-processed and eating smaller portions than previously.
Now, we have new data from a study run jointly with Glasgow University that shows after five years, the people who went through this rapid weight loss have required less than half the number of admissions to hospital than the usual treatment group. We also have new evidence from another study that if people keep off the weight for four years or more, their rate of heart disease halves.
This is all reinforced further by the results one year after the NHS rollout of the programme, showing that around a third of people on it are now free from diabetes, which is hugely positive.
2. Focus on food, not exercise
Losing a large amount of weight sounds daunting, but in my work with patients I've discovered a series of tips which make the process easier and more effective.
Firstly – and this often shocks people – don't embark on a new exercise regimen. Exercise has myriad health benefits, and studies have shown that it helps to lower blood sugar, but it is not an effective tool for weight-loss in adults.
Once the excess body fat has been lost, certainly the more active you are the better it is for your long-term health, and if you have a sedentary job, stand up regularly: it's been shown to significantly reduce blood sugar and insulin levels.
3. Find your body's optimum weight
Once you've lost the weight and are out of the diabetes danger zone, it's vital to work out how much food your body needs to keep you at that level, so you must weigh yourself every week and write it down. Writing down what you eat is an excellent way to keep track, too.
Maintenance might look different for different people – perhaps you might halve the amount of carbohydrates you put on your plate, or try intermittent fasting.
I welcome the arrival of weight-loss drugs such as Wegovy, but they don't encourage people to change their eating habits in the long-term. Sustained weight-loss is about learning a new skill; a different way of eating for the rest of your life. Unfortunately, there's no silver bullet. Find the foods that fill you up without putting on weight, such as fibrous vegetables and fish.
The people I've encountered who have been most successful have all enlisted the support of their friends and family right from the start to help them stay on track. I'd go so far as to say it's impossible to do it without this.
4. Restricting alcohol is another must
Alcohol contains almost as many calories as fat and most alcoholic drinks contain 200 calories or more, so avoid it during the short duration task of getting your weight down and keep an eye on it long term.
5. Stop snacking
We don't need to eat between meals and we often do it out of boredom rather than hunger. If you feel a craving, go for a walk or find something else to occupy you until the next mealtime. When it comes, don't eat in front of the television, because the distraction often causes us to eat more. When you're eating, enjoy it.
Life Without Diabetes: The definitive guide to understanding and reversing Type 2 diabetes by Professor Roy Taylor is out now