What insulin resistance is
Insulin is the hormone that moves sugar from your blood into your cells for energy. With insulin resistance, cells respond less well, so the pancreas makes more insulin to keep blood sugar in range. For a while that works. Over time, blood sugar can rise into the prediabetes range and, eventually, type 2 diabetes.
High insulin levels also encourage fat storage, particularly around the abdomen, which is one reason blood sugar and weight are so closely linked. Insulin resistance is a common thread behind hormonal weight gain.
Common contributors
These factors often reinforce one another: poor sleep raises cortisol and appetite, extra abdominal fat worsens insulin resistance, and higher insulin makes fat harder to lose.
- Excess abdominal (visceral) fat
- Physical inactivity and loss of muscle mass
- Diets high in refined carbohydrates and sugary drinks
- Short or poor-quality sleep
- Chronic stress and elevated cortisol
- Family history
- Hormonal changes, including menopause and PCOS
- Certain medications, such as steroids
Insulin resistance symptoms and signs
Many people have no obvious symptoms at first. When signs do appear, they can include:
- Weight gain around the waist, or difficulty losing weight
- Sugar or carbohydrate cravings
- Feeling tired, foggy or hungry soon after meals
- Dark, velvety patches of skin on the neck or in the armpits
- Skin tags
- High blood pressure, high triglycerides or low HDL cholesterol
- Irregular periods or PCOS in women
Tiredness after meals overlaps with many other causes of low energy, which is why testing matters more than any single sign.
Insulin resistance in women: PCOS, perimenopause and menopause
Insulin resistance is common in polycystic ovary syndrome (PCOS), including in women who are not overweight, and higher insulin can worsen irregular cycles, acne and excess hair growth. A history of gestational diabetes also raises the later risk of type 2 diabetes.
Around perimenopause and menopause, falling estrogen shifts fat toward the abdomen and insulin sensitivity tends to decline, so blood sugar markers can drift even without a big change on the scale. Poorer sleep from night sweats adds to the effect, which is why blood sugar is part of a midlife hormone evaluation.
Tests for insulin resistance and how prediabetes is diagnosed
There is no single routine test for insulin resistance. Doctors usually recognize it from a pattern: fasting glucose and A1C, sometimes an oral glucose tolerance test, plus triglycerides, HDL cholesterol, blood pressure and waist size. Fasting insulin can add supporting information, but it is not a diagnosis on its own and results vary between labs.
More than 1 in 3 American adults have prediabetes, and most do not know it, according to the CDC. It is diagnosed with standard blood tests:
- A1C of 5.7% to 6.4%
- Fasting blood glucose of 100 to 125 mg/dL
- A two-hour oral glucose tolerance test result of 140 to 199 mg/dL
Insulin resistance often begins before these numbers change. That is why we look at markers of blood sugar control and insulin resistance alongside lipids, blood pressure, waist circumference and inflammation as part of metabolic health testing.
How insulin resistance is treated
Insulin resistance responds to change. In the large Diabetes Prevention Program study, a structured program of modest weight loss and regular physical activity substantially lowered the risk of developing type 2 diabetes in people with elevated blood sugar.
Your plan may include nutrition strategies with our registered dietitian, strength training to build muscle, sleep and stress support, metabolic support and, when indicated, medically supervised weight loss medication. Hormone therapy is not a treatment for insulin resistance; if testing shows a separate hormonal condition, it is evaluated on its own. Learn more about our medical weight loss approach.
Insulin resistance often travels with weight and hormonal concerns. Without other medical conditions, the four-month Vital Wellness program may fit; with conditions such as diabetes, high blood pressure or high cholesterol, Restore Wellness (six months), Longevity Wellness (nine) or Vibrant Wellness (12) may. Compare them on our wellness programs page.
When to see a doctor urgently
See your primary care doctor promptly if you have extreme thirst, frequent urination, blurred vision, slow-healing sores or unexplained weight loss. These can be signs that blood sugar is already high.
Call 911 or go to an emergency room for confusion, vomiting, rapid breathing, fruity-smelling breath or extreme drowsiness, which can signal a dangerous blood sugar emergency.
Getting evaluated in Little Rock, Searcy or Miami
Insulin resistance is evaluated in person by Dr. Tancinco, a board-certified internist and diplomate of the American Board of Obesity Medicine. See medical weight loss in Little Rock, medical weight loss in Searcy or medical weight loss in Miami for each office. When you are ready, request a free 15-minute discovery call, or see our symptom guide for related concerns.
Questions
Common questions about insulin resistance
What are the first signs of insulin resistance?
Early insulin resistance often has no clear symptoms. When signs appear, they commonly include weight gain around the waist, cravings for sugar or carbohydrates, tiredness or hunger soon after meals, and darkened, velvety skin on the neck or underarms. Lab findings such as rising triglycerides, low HDL cholesterol or creeping fasting glucose can be earlier clues than how you feel.
How do doctors test for insulin resistance?
There is no single routine test. Doctors usually look at a pattern of results: fasting glucose and A1C, sometimes an oral glucose tolerance test, along with triglycerides, HDL cholesterol, blood pressure and waist circumference. Fasting insulin can add supporting information but is not a diagnosis on its own. Results are read together with your history, family history and symptoms.
What kind of doctor treats insulin resistance?
Primary care and internal medicine physicians commonly diagnose and treat insulin resistance and prediabetes. Endocrinologists see more complex cases, and obesity medicine physicians focus on weight-related metabolic disease. At Vital Longevity Clinic, care is led by Dr. Tancinco, who is board certified in internal medicine and a diplomate of the American Board of Obesity Medicine, with support from our registered dietitian.
Is insulin resistance linked to PCOS?
Yes. Many women with polycystic ovary syndrome have insulin resistance, including women who are not overweight. Higher insulin levels can prompt the ovaries to make more androgens, which can worsen irregular periods, acne and excess hair growth. PCOS also raises the risk of prediabetes and type 2 diabetes, so blood sugar markers are worth checking periodically if you have it.
Does menopause cause insulin resistance?
Menopause does not cause it on its own, but it often makes it more likely. Falling estrogen shifts fat toward the abdomen, insulin sensitivity tends to decline, and poorer sleep and less muscle mass add to the effect. That is why blood sugar markers can drift in midlife even when weight changes little, and why they are worth checking during a menopause evaluation.
Can thin people have insulin resistance?
Yes. Weight is only one factor. People at a normal weight can have insulin resistance because of visceral fat stored around the organs, low muscle mass, inactivity, family history, PCOS, poor sleep or certain medications. Some ethnic groups also develop it at lower body weights. Blood sugar markers, triglycerides and waist size can reveal it when the scale does not.