You've had your blood sugar checked, and it's "normal." But you're gaining weight around your midsection, experiencing energy crashes, constantly craving carbs, and can't seem to lose weight no matter what you do.
Here's what many doctors miss: insulin resistance can be present for years - even decades - before blood sugar becomes abnormal. By the time you're diagnosed with prediabetes, your body has been struggling for a long time.
What Is Insulin Resistance?
Insulin is a hormone that tells your cells to absorb glucose (sugar) from your blood. When you eat carbohydrates, your blood sugar rises, and your pancreas releases insulin to shuttle that sugar into cells for energy.
In insulin resistance, your cells become "deaf" to insulin's signal. Your pancreas responds by producing more and more insulin to overcome this resistance. This works - for a while. Your blood sugar stays normal because you're pumping out extra insulin to compensate.
But that elevated insulin has consequences:
- Weight gain: Insulin promotes fat storage, especially around the abdomen
- Hunger and cravings: High insulin triggers hunger and carb cravings
- Energy crashes: Blood sugar swings cause fatigue after meals
- Hormone disruption: Excess insulin increases androgens, worsening PCOS
- Inflammation: Insulin resistance drives chronic inflammation
Why Fasting Glucose Isn't Enough
Standard bloodwork checks fasting glucose - your blood sugar after not eating for 8+ hours. The "normal" range is typically 70-99 mg/dL, with 100-125 mg/dL considered prediabetic.
The problem? Fasting glucose is a late marker. Your body works hard to keep blood sugar stable, so it can appear normal even when insulin resistance is severe. By the time glucose rises, you've likely been insulin resistant for years.
Key insight: Fasting insulin becomes elevated long before fasting glucose does. Testing insulin catches the problem at a much earlier stage.
Better Tests for Insulin Resistance
Fasting Insulin
This is the most important test that most doctors don't order. Optimal fasting insulin is typically under 5-8 uIU/mL. Levels above 10 suggest insulin resistance, even if glucose is normal.
HOMA-IR
HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) is calculated from fasting glucose and fasting insulin. A HOMA-IR under 1.0 is optimal; above 2.0 indicates significant insulin resistance.
HbA1c
This measures average blood sugar over 3 months. Normal is under 5.7%, prediabetic is 5.7-6.4%. Even levels at the high end of "normal" (5.5-5.6%) may indicate emerging issues.
Oral Glucose Tolerance Test (OGTT) with Insulin
This tracks how both glucose AND insulin respond to consuming sugar. It's the gold standard for detecting insulin resistance early.
Signs You Might Be Insulin Resistant
- Difficulty losing weight, especially from the midsection
- Sugar and carb cravings
- Energy crashes after meals
- Hunger shortly after eating
- Brain fog
- Skin tags or dark patches on neck/armpits (acanthosis nigricans)
- PCOS symptoms (irregular periods, acne, excess hair growth)
- High triglycerides or low HDL on cholesterol panel
- Family history of type 2 diabetes
The PCOS Connection
Insulin resistance and PCOS are deeply intertwined. Up to 70% of women with PCOS have insulin resistance, regardless of their weight. Elevated insulin:
- Stimulates the ovaries to produce more testosterone
- Reduces SHBG (sex hormone binding globulin), leaving more free testosterone active
- Disrupts ovulation
- Makes weight loss nearly impossible
Addressing insulin resistance is often the key to improving PCOS symptoms - even more than reducing calories.
What Causes Insulin Resistance?
- Excess body fat: Especially visceral fat around organs
- Sedentary lifestyle: Muscles become less sensitive to insulin without exercise
- High-sugar, high-refined-carb diet: Keeps insulin chronically elevated
- Chronic stress: Cortisol promotes insulin resistance
- Poor sleep: Even a few nights of bad sleep reduces insulin sensitivity
- Genetics: Family history increases risk
- Age: Insulin sensitivity naturally decreases with age
Reversing Insulin Resistance
The good news: insulin resistance is often reversible with lifestyle changes.
- Reduce refined carbohydrates: Focus on whole foods, protein, healthy fats, and fiber
- Exercise: Both cardio and strength training improve insulin sensitivity
- Prioritize sleep: Aim for 7-9 hours of quality sleep
- Manage stress: Chronic stress worsens insulin resistance
- Build muscle: Muscle tissue is a major site for glucose uptake
- Consider time-restricted eating: Giving your body breaks from insulin can help
Test, Don't Guess
If you're struggling with stubborn weight, energy crashes, or symptoms that don't make sense with "normal" bloodwork, request a fasting insulin test. It's a simple add-on that could reveal the root cause of your symptoms.
Early detection of insulin resistance gives you time to make changes before it progresses to prediabetes or type 2 diabetes.
Stop guessing, start knowing. Get your fasting insulin tested with EllaDx's metabolic health panel.