In one 2024 screening, almost 4 in 10 people had prediabetes and most had no idea. Here's what the numbers mean, which tests to ask for, and why this stage is so hopeful.
If I could get one message across to every adult in Singapore, it would be this: Type 2 Diabetes rarely arrives out of nowhere. For most people there is a long, quiet stage beforehand, often lasting years, when blood sugar is creeping up but nothing feels wrong.
That stage is called prediabetes. It's incredibly common here, it's usually invisible, and it's also the point at which you have the most power to change the story.
Prediabetes means your blood glucose is higher than normal, but not high enough to be diagnosed as diabetes. Underneath, it usually reflects insulin resistance: your cells have become less responsive to insulin, so your pancreas has to work harder to keep blood sugar in check. For a while, it manages. Eventually, for many people, it can't keep up.
More common than most people think.
Prediabetes isn't a diagnosis to fear. It's an early warning, and early warnings are a gift.
Because it usually doesn't feel like anything. Some people notice subtle signs, but none of them are reliable on their own:
The only way to know is to test.
In 2022, at 38, I was diagnosed with breast cancer. Six months after my operation, a routine blood test ordered by my oncologist showed that I also had Type 2 Diabetes. That experience is a big part of why I do this work today. I want more people to understand their numbers and catch rising blood sugar at the prediabetes stage, when change is easier.
Here are the four tests I'd ask about, with the cut-offs used in Singapore's clinical guidance where they exist.2
| Test | What it shows | Prediabetes range |
|---|---|---|
| Fasting plasma glucose | Your blood sugar after an overnight fast | 6.1–6.9 mmol/L (impaired fasting glucose) |
| Oral glucose tolerance test (OGTT) | How well your body clears a standard sugar drink after 2 hours | 7.8–11.0 mmol/L (impaired glucose tolerance) |
| HbA1c | Your average blood sugar over roughly the past 2 to 3 months | Often included in health screening reports, but Singapore's guidance does not currently use it to diagnose prediabetes |
| Fasting insulin | How much insulin your body needs to keep your blood sugar normal after an overnight fast | No agreed cut-off, and lab ranges vary. A higher result can signal insulin resistance even when your glucose looks normal. Not on standard panels, so you need to request it |
You may also see different thresholds online. For example, the American Diabetes Association considers an HbA1c of 5.7–6.4% to indicate prediabetes.4 If your HbA1c is in that range, it's worth a conversation with your doctor, even if your report doesn't flag it.
Of the four tests, this is the one I consider most important, and it's also the one you're least likely to get. Fasting insulin isn't commonly done and is definitely not part of a standard health screening panel. You'll need to ask your doctor for it specifically, and it may cost a little extra.
Here's why it matters. As insulin resistance builds, your pancreas makes more and more insulin to keep your blood sugar in the normal range. For years, this works. Your fasting glucose and HbA1c can look perfectly fine while your insulin is quietly climbing. Glucose tests only pick up the problem once your pancreas can no longer keep up. Fasting insulin shows you the strain much earlier, while there's still plenty of time to turn things around.
A UK study that followed more than 6,500 adults found that, in people who went on to develop Type 2 Diabetes, insulin sensitivity fell steeply over the five years before diagnosis. Their fasting glucose only rose sharply in the last three years.7
There's no single agreed "normal" range for fasting insulin, and Singapore's guidance doesn't use it to diagnose prediabetes, so go through your result with your doctor. They can also combine it with your fasting glucose to calculate HOMA-IR, a simple estimate of insulin resistance.
If your doctor won't order a fasting insulin test for you, contact me. I'll arrange for you to get it done at a clinic I partner with.
According to Singapore's clinical guidance, lifestyle intervention reduces the risk of developing Type 2 Diabetes by 31 to 37% over 2 to 6 years. The recommended targets are practical: at least 150 minutes a week of moderate activity such as brisk walking, and losing 5 to 10% of body weight (or reaching a BMI under 23) if you're carrying extra weight.2
Here's where I'd start:
Eat vegetables and protein before your rice or noodles. In one study, this simple change lowered post-meal glucose by up to 37%.5
Sweetened kopi, teh, juices and bubble tea add up quickly. Moving to siew dai and then kosong is one of the easiest wins.
A 10-minute walk after your biggest meal helps your muscles soak up glucose. Adding strength training twice a week gives that glucose more places to go.
Short sleep and chronic stress both push blood sugar up. They're not "soft" factors. They show up in your numbers.
A standard health screen gives you a snapshot. A CGM shows you the whole movie: which meals, habits and situations push your glucose up, so you can focus your effort where it matters most for you.
Rosalind had gained 7kg and couldn't understand why, even though she was eating clean and exercising, and her doctor couldn't find an issue. Wearing a CGM revealed hidden carbs that were quietly spiking her blood sugar. With a few simple changes, she lost all 7kg and more.
Prediabetes is common, silent and serious, but it is not a life sentence. If you haven't had your blood sugar checked recently, book a screening. If you've been told your numbers are "a bit high", take it as your invitation to act now, while the changes are smaller and the results come faster.
And if you have been diagnosed with diabetes already, please don't lose hope. I was told reversing mine was highly unlikely. No diagnosis is final.
I'm May, a breast cancer survivor who reversed my Type 2 Diabetes with the help of a CGM. I now coach people in Singapore to understand their blood sugar and build habits that last.
Work with meJoin a CGM workshopThis article is for education only and is not medical advice. Please speak with your doctor before making major changes to your diet, exercise or medication, especially if you have a pre-existing medical condition.
