Insulin resistance means the body responds less readily to its own insulin, so more is produced to do the same job. High circulating insulin favours storage and discourages release, particularly around the abdomen — which is why weight there is commonly the hardest to shift and why the usual advice to eat less often does not work.
Each type is treated differently, so this is the first thing the doctor checks at your consultation.
Waist rising, energy dipping an hour or two after meals, and a blood sugar reading that still looks fine. Insulin resistance precedes a raised blood sugar by years, which is why waist and fasting insulin can tell you something a glucose test alone does not.
Blood sugar above normal but below the diabetic range. This is the stage at which the picture is most reversible, and the stage at which most people are told nothing is wrong yet.
Common, and present in women of any size. Raised insulin drives androgen production, which is why the weight, the cycles and the skin often move together.
Insulin resistance and fat accumulating in the liver travel together. Often found incidentally on a scan or through liver enzymes on a routine blood test, and usually without any symptoms at all.
Waist circumference, fasting glucose and HbA1c, with fasting insulin and lipids where the picture calls for it, plus liver enzymes where there is reason. Body composition analysis estimates the visceral portion directly — which is the fat that matters here, and the fat a scale cannot see.
Skeletal muscle is where most glucose is taken up, so resistance training changes insulin handling in a way that eating less alone does not. This is the single most commonly skipped element, and in South Asian bodies — which tend to carry less muscle for a given weight — it matters more rather than less.
Long empty stretches followed by a heavy late meal is the pattern that suits insulin handling worst, and it is the commonest working pattern here. Fixing the shape of the day often does more than removing anything from it.
It is considered only where clinically indicated after assessment, prescribed by a doctor and monitored at review. It is never the first move, it is never the whole plan, and no clinic can tell you over the phone whether it applies to you.
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The body responding less readily to its own insulin, so more is produced to do the same job. High circulating insulin favours storage and discourages release, particularly around the abdomen — which is why weight there is commonly the hardest to shift.
Fat around and inside the abdomen is metabolically active rather than inert, and it both drives and responds to raised insulin. That makes it a self-reinforcing pattern rather than a matter of effort — and it is why the advice to simply eat less so often fails here.
There is no single one. Waist circumference, fasting glucose and HbA1c are the practical starting point, with fasting insulin and lipids added where the picture calls for it. Body composition analysis estimates the visceral fat directly, which a scale cannot.
It can usually be improved, and at the pre-diabetes stage substantially so. Resistance training and consistent sleep are the two most reliably useful things, and they are the two most often skipped in favour of eating less.
South Asian bodies tend to carry more visceral fat and less muscle at a given weight than the populations most reference ranges were built on. That is why waist thresholds are lower for South Asians and why muscle-building matters more rather than less.
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