Condition
Insulin Resistance
Insulin resistance describes a reduced cellular response to a given amount of insulin. The pancreas compensates by secreting more insulin to keep blood glucose in range — for years or decades, often silently.
What's happening biologically
Skeletal muscle, liver, and adipose tissue each respond to insulin. When that response is blunted — by visceral and ectopic fat, inflammation, certain medications, sleep disruption, or genetic factors — beta cells in the pancreas secrete more insulin to achieve the same glucose-lowering effect. Sustained hyperinsulinemia is associated with weight gain, dyslipidemia, and ultimately, in many people, beta-cell exhaustion and progression to type 2 diabetes.
Clinical clues
Insulin resistance is often subclinical. Possible clues include elevated fasting triglycerides, low HDL, abdominal adiposity, acanthosis nigricans (darkening of skin folds), elevated fasting insulin, polycystic ovary syndrome, MASLD, and a family history of type 2 diabetes.
What may improve insulin sensitivity
- Regular aerobic and resistance exercise.
- Weight loss, particularly visceral fat loss.
- Improved sleep duration and quality; treatment of sleep apnea.
- Nutritional patterns rich in fiber, whole foods, and unsaturated fats.
- Selected medications (e.g., metformin, GLP-1 receptor agonists) when clinically indicated.
Why it matters
Insulin resistance is upstream of many of the conditions in the metabolic disease continuum. Improvements in insulin sensitivity frequently translate into improvements across several cardiometabolic markers simultaneously.