How Do You Know If You Are Insulin Resistant?

Insulin resistance is one of the most important early warning signs in metabolic health.

The problem is that many people do not know they have it.

You can have normal fasting glucose. You can have a normal HbA1c. You may not have diabetes. But underneath the surface, your body may be producing more and more insulin to keep blood sugar in the normal range.

That is why insulin resistance can be missed if we only look at glucose.

The good news is that insulin resistance is not a fixed diagnosis. It is a manageable metabolic state. If identified early, it gives people a chance to change the risk trajectory for type 2 diabetes, fatty liver disease, NASH, cardiovascular disease, PCOS related metabolic issues and long-term inflammation.

In other words, insulin resistance is not just a problem. It is also an opportunity to intervene earlier.

Insulin resistance often comes before diabetes

Insulin is the hormone that helps move glucose from the blood into cells, where it can be used for energy or stored.

When the body becomes less sensitive to insulin, the pancreas compensates by producing more of it. In the early stages, this extra insulin may keep blood glucose looking normal.

This is why someone can be told their “sugar is fine” while still experiencing signs of insulin resistance such as fatigue, constant hunger, food noise, central weight gain, blood sugar crashes, high triglycerides, fatty liver or PCOS symptoms.

A glucose-centric approach asks: “Is the blood sugar high?”

An insulin-centric approach asks: “How hard is the body working to keep blood sugar normal?”

That second question is often where the earlier story begins.

Why early identification matters

Insulin resistance is linked to several major health conditions.

It is closely connected to fatty liver disease and NASH, where excess fat builds up in the liver and can eventually lead to inflammation and scarring. It is also a key driver of type 2 diabetes risk. In PCOS, insulin resistance can worsen androgen excess, irregular periods, acne, unwanted hair growth, fertility issues and long-term cardiometabolic risk.

It is also part of the wider picture of metabolic syndrome, which includes central weight gain, high blood pressure, high triglycerides, low HDL cholesterol and abnormal glucose.

This is why identifying insulin resistance earlier matters. It allows people to act before the problem progresses.

Common signs that may suggest insulin resistance

Insulin resistance does not always look the same in every person. Some people may have obvious weight gain, while others may not.

Common signs can include:

• High blood pressure.

• Skin tags.

• Darkening of the skin, especially around the neck, underarms or skin folds. This is called acanthosis nigricans.

• Increased waist circumference, especially around the abdomen.

• A waist to height ratio above 0.5.

• Constant hunger or difficulty feeling full.

• Food noise.

• Blood sugar crashes or feeling shaky, irritable or exhausted between meals.

• Difficulty accessing body fat for energy, meaning fatigue and poor exercise tolerance despite trying to eat less.

• Fatty liver on ultrasound.

• Irregular periods, acne or androgen-related symptoms in PCOS.

These signs do not prove insulin resistance on their own, but they can be useful clues.

 

Blood tests that may help

There is no single perfect test for insulin resistance in routine clinical practice, but several markers can help build the picture.

Useful tests to discuss with a clinician may include:

• Fasting insulin.

• Fasting glucose.

• HbA1c.

• Fasting lipid profile, especially triglycerides and HDL cholesterol.

• Liver enzymes, especially ALT.

• Uric acid.

• High-sensitivity CRP or CRP as a marker of inflammation.

• Ferritin, especially if raised without another clear explanation.

• HOMA IR, which is calculated using fasting glucose and fasting insulin.

Some clinicians may also use insulin levels during an oral glucose tolerance test, such as 1 hour or 2 hour insulin, to understand how much insulin the body produces after a glucose load.

A high fasting insulin can suggest insulin resistance, especially when seen alongside other metabolic signs. However, insulin testing and HOMA IR cut offs vary between laboratories and populations, so results should be interpreted in context rather than used in isolation.

What about metabolic syndrome?

Metabolic syndrome was historically one of the clinical ways of recognising the insulin-resistance pattern.

It usually refers to a cluster of findings: increased waist circumference, high blood pressure, high triglycerides, low HDL cholesterol and raised fasting glucose.

But waiting for full metabolic syndrome can mean waiting too long.

Many people are already insulin resistant before glucose becomes abnormal or before all the criteria are met. That is why looking earlier at symptoms, waist to height ratio, triglycerides, fatty liver, fasting insulin and PCOS features can be helpful.

 

The goal is not fear. It is earlier action.

Identifying insulin resistance should not be about blame.

It should not make someone feel that they have “failed” or “let themselves go”. Insulin resistance is shaped by modern food environments, ultra processed foods, sleep disruption, stress, low muscle mass, hormonal changes, medications, genetics and repeated dieting.

The point of identifying it is to act sooner.

The first step is often not restriction. It is nourishment.

Meals that are higher in fibre and protein, lower in glycaemic load, less processed and culturally familiar can help stabilise energy and reduce the spike crash cycle. For Indian diets, improving the daily staple rice or roti can be one of the most practical places to start.

Once energy improves, movement becomes easier. Muscle building, walking after meals, sleep, gut health, stress reduction and addressing hormonal issues can all support insulin sensitivity.

Insulin resistance is manageable.

But first, we have to look for it.