Metabolic Health Check
The signs of insulin resistance, most of which are easy to explain away.
Insulin resistance usually announces itself long before glucose does — but through signs that are easy to attribute to something else. This questionnaire runs through the ones that come up most often in clinic.
Quick Test: Is your metabolism slowed down?
Answer 4 simple Yes/No questions to discover if your symptoms could be related to a hormonal or thyroid imbalance.
Why insulin resistance goes unnoticed
For years before blood glucose rises, the pancreas compensates by producing more insulin. Glucose stays normal, so routine testing looks reassuring, while insulin levels climb quietly.
The consequences show up elsewhere. Insulin is a growth and storage signal, not only a glucose one, so persistently high insulin affects skin, ovaries, liver and blood pressure well before it affects a glucose reading.
The signs worth knowing
Fat that accumulates around the abdomen rather than the hips and thighs. This is both consequence and cause: visceral fat is metabolically active tissue that worsens the resistance that produced it.
Acanthosis nigricans — darkened, velvety skin at the back of the neck, in the armpits, or in the groin. It is frequently mistaken for poor hygiene or tanning. It is one of the more specific visible signs of hyperinsulinaemia, and it should never be dismissed.
Skin tags in the same areas, for the same reason.
Marked sleepiness after eating, particularly after a carbohydrate-heavy meal.
Cravings for sugar or starch that follow a predictable rhythm rather than appearing at random.
Irregular periods, acne or unwanted hair growth in women. Insulin resistance is central to polycystic ovary syndrome, and often the driver rather than a side effect.
Raised triglycerides with low HDL cholesterol — a lipid pattern that points at insulin resistance more specifically than total cholesterol does.
Fatty liver found on an ultrasound, often as an incidental finding during a scan for something else.
High blood pressure at a relatively young age.
What confirms it
There is no single perfect test, but the useful combination is straightforward:
- Fasting glucose and fasting insulin, which together give the HOMA-IR index
- HbA1c
- Lipid profile, with attention to triglycerides and HDL
- Liver function tests
- Waist circumference and blood pressure
Fasting insulin is the one most often omitted from a general check-up, and it is frequently the one that shows the problem earliest.
Why it's worth catching early
Insulin resistance is not a mild version of diabetes. It is the mechanism underneath type 2 diabetes, metabolic fatty liver disease, much of polycystic ovary syndrome, and a meaningful share of cardiovascular risk.
It is also, at this stage, highly responsive to intervention. Reversing established diabetes is difficult. Interrupting insulin resistance before glucose ever rises is considerably more achievable — which is the entire argument for looking for it.
Common questions
Can I have insulin resistance with a normal weight?
Yes, and it is more common than most people expect. Body fat distribution and muscle mass matter more than total weight — someone with a normal BMI, little muscle and central fat can be considerably more insulin resistant than someone heavier and more muscular.
Is insulin resistance reversible?
In large part, yes, particularly when addressed early. Physical activity — resistance training especially — improves insulin sensitivity through a mechanism independent of weight loss. Losing visceral fat improves it further.
Does a normal glucose result rule it out?
No, and this is the central point. A normal fasting glucose is compatible with substantial insulin resistance, because the pancreas is compensating. That is precisely why fasting insulin adds information a glucose reading cannot.
Further reading
Diabetes Care
Type 1, type 2 and gestational diabetes managed in English in San Borja, Lima. Dr. Claudia Michahelles — HbA1c monitoring, insulin adjustment and complication screening.
Managing Type 2 Diabetes After Moving to Peru
Keeping diabetes control steady through an international move — prescriptions, lab units, medication availability in Lima, and the specific ways that Peruvian food and altitude change the picture.
5 min readTools point you in a direction. Diagnosis happens in the consulting room.
If your result raised more questions than it answered, book an evaluation in San Borja or a video consultation from wherever you are.