Insulin resistance, explained once, properly

Insulin is a delivery instruction. It tells cells to take glucose out of the blood and use it or store it. Insulin resistance means the cells have stopped listening properly, so the pancreas shouts louder — more insulin for the same job.

That shouting is the part that matters. Blood glucose can look completely normal for years while insulin quietly doubles behind it. This is why a normal fasting sugar report is not the reassurance you were told it was, and why I ask for fasting insulin.

What high insulin does that nobody mentions

• It suppresses fat release from fat cells, which is why the weight feels welded on.
• In the ovary it pushes theca cells toward androgen production — the acne, the hair, the missed cycles.
• It drives the liver to make more triglyceride, which is why your lipids look odd despite a low-fat diet.
• It makes hunger louder about ninety minutes after a carbohydrate-heavy meal eaten alone.

Why "just cut carbs" is the wrong conclusion

It is the obvious conclusion and it works, briefly. Remove the stimulus and insulin falls. But you have not made the cells listen again — you have arranged your life so that they never have to. The day rice comes back, and it will, you are exactly where you started, minus some muscle.

Sensitivity is built by muscle, sleep and consistent moderate intake. It is not built by avoidance.

The things that genuinely restore insulin sensitivity are unglamorous: resistance training two or three times a week, enough protein that you are not running on carbohydrate alone, seven hours of sleep, and eating fibre and protein before the starch rather than after. Sequence is free. Nobody sells sequence, which is possibly why you have not heard about it.

What to ask for at your next blood test

Fasting insulin alongside fasting glucose, so HOMA-IR can be calculated. HbA1c. A lipid panel with triglycerides. If PCOS is on the table, total and free testosterone, SHBG, LH and FSH, taken on day two or three of a cycle if you have one. Most labs will not run fasting insulin unless it is asked for by name.

Written by Meera Bhandari, MSc Clinical Nutrition · Registered Dietitian (IDA). General information, not a diagnosis or a prescription, and not a substitute for advice from your treating physician.