What is insulin resistance?
Insulin resistance is a state in which the body’s cells respond less to the hormone insulin, so more insulin is secreted to achieve the same effect. It is not the name of a disease but a metabolic state. It is not identified from a single symptom; the examination, the measurements and the laboratory results are assessed together.
Insulin is a hormone that helps take blood sugar into the cells. When the response is reduced, the pancreas tries to keep the balance by secreting more insulin. That balance may hold for a time; when it no longer does, blood sugar values begin to rise.
Insulin resistance is one of the factors associated with the development of type 2 diabetes. The World Health Organization (opens in a new tab) reports that, as of 2022, 830 million people worldwide were living with diabetes, and that more than 95% of cases are type 2 diabetes.
Based on the results of the Türkiye Beslenme ve Sağlık Araştırması-2017, the Ministry of Health of the Republic of Türkiye, General Directorate of Public Health (opens in a new tab), reports the prevalence of obesity over the age of 15 as 31.5% (39.1% in women, 24.6% in men), and states that obesity increases the risk of type 2 diabetes, hypertension, coronary artery disease, hyperlipidaemia and metabolic syndrome.
Which symptoms lead to it being assessed?
These symptoms do not establish a diagnosis on their own; they are considered together in the assessment.
- Marked drowsiness after meals
- Recurring cravings for sweet foods during the day
- Shaking, sweating and irritability when a meal is missed
- Difficulty losing weight, and weight gain particularly around the waist
- Long-standing fatigue
- Darkening of the skin, particularly on the neck and under the arms
- Menstrual irregularity and increased hair growth in women
- A family history of type 2 diabetes
How is it assessed?
- Medical history. How long the complaints have lasted, meal routine and the intervals between meals, sleep, activity habits, weight history, family history, and all current medication and supplements are recorded.
- Measurements. Height, weight, body mass index, waist circumference and blood pressure are measured. Waist circumference is particularly important because it shows where the weight is carried.
- Laboratory assessment. Fasting blood sugar, HbA1c, fasting insulin and the calculations derived from them; a lipid profile, liver function tests and thyroid function tests may also be requested.
- Excluding other conditions. Thyroid disease and some medicines may produce a similar clinical picture, so these are assessed separately.
- Drawing up the plan. Eating routine, activity and sleep are planned together; where necessary the medication is adjusted, and the follow-up interval is set.
A diagnosis is not made by looking at a single value. The calculations give an indication, but the results become meaningful alongside the complaint and the examination findings.
In which patients is it assessed differently?
- In patients who are pregnant or breastfeeding, blood sugar follow-up and changes to the eating routine are handled separately; the criteria used in pregnancy are different
- In patients with a known diagnosis of diabetes, the assessment takes the form of a review of the current treatment
- In patients with a history of an eating disorder, dietary recommendations are adjusted accordingly; restrictive recommendations may not be suitable
- In patients with thyroid disease, the symptoms may overlap, so this is assessed first
- In patients taking corticosteroids or medicines that affect blood sugar
- In patients with advanced kidney or liver disease
- In patients under 18 years of age, assessment lies within the field of paediatrics; this page has been prepared for adults
- In patients over 65 and in patients taking more than one medicine
How is follow-up planned, and how often is it needed?
Follow-up is built around lifestyle changes and, where necessary, medication. Because every patient’s course unfolds differently, it would be wrong to give a definite answer on how often follow-up is needed. The usual sequence is a first consultation, a second consultation at which the investigations are assessed, and further follow-ups guided by the clinical picture.
The measurements are repeated at each follow-up and the course is monitored. A single result shows one point; measurements repeated at set intervals show a direction.
The World Health Organization recommends reaching and maintaining a healthy body weight, and doing at least 150 minutes of moderate-intensity physical activity per week. These recommendations are general; the level appropriate for you is determined after examination.
What should you do before and after the consultation?
Before the consultation, prepare and bring:
- A list of all the medicines and supplements you use
- Your test results from the past year
- Your eating and sleep records from the past few days
When you make your appointment, ask whether you need to come fasting.
After the consultation, you are given a written plan. Apply the changes to meal routine, activity and sleep gradually. The time taken for an effect to appear varies from person to person; it generally takes weeks to months for this to be reflected in laboratory values.
Risks and points to be aware of
A symptom is not a diagnosis. Drowsiness after meals or cravings for sweet foods do not on their own mean insulin resistance.
Meal plans circulating on the internet are not suitable for everyone. Restrictive eating routines require separate assessment in pregnancy, in kidney disease, where there is a history of an eating disorder, and where certain medicines are being taken.
Do not start a medicine or a supplement on your own initiative. Products said to affect blood sugar may interact with your current medication and may lead to an excessive fall in blood sugar.
No rapid weight-loss target is set. Gradual and sustainable changes are preferred.
The assessment is based on metabolic risk, not on body shape or appearance.
Results vary from person to person.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Frequent urination, excessive thirst, dry mouth
- Unintentional weight loss
- Blurring of vision
- Slow healing of wounds
- Numbness and tingling in the hands and feet
- Recurring complaints of shaking, sweating and palpitations when a meal is missed
In the event of confusion, disturbance of speech or fainting, go directly to the emergency department.
Frequently asked questions
Is insulin resistance a disease?
It is not the name of a disease but a metabolic state: a reduction in the response of the body’s cells to insulin. It is one of the factors associated with the development of type 2 diabetes, and it is assessed for that reason.
Which tests are requested for insulin resistance?
Fasting blood sugar, HbA1c, fasting insulin and the calculations derived from them are generally assessed, along with a lipid profile, liver function tests and thyroid function tests. Which are needed depends on your complaint and the examination findings.
Is a diagnosis made with a single value?
No. The calculations may give an indication but they do not establish a diagnosis on their own. The measurements, the complaints and the other laboratory results are assessed together.
Can insulin resistance be reversed?
The course varies from person to person and no outcome can be stated in advance. Changes to eating routine, activity and sleep, together with weight management, are known to be reflected in metabolic measurements; the degree of change achieved, however, differs from person to person.
Will I need to take medicine for insulin resistance?
This depends on your measurements, your co-existing conditions and your level of risk. For some people, monitoring with lifestyle changes is preferred; for others, medication may be needed. The decision is made at the end of the consultation.
Why is waist circumference measured in insulin resistance?
Waist circumference indicates where body weight is carried. In two people of the same weight, the distribution of fat may differ; this is why the scales alone do not give enough information. For the measurement technique, you can see our article How Is Waist Circumference Measured?.
Is it linked to menstrual irregularity in women?
Insulin resistance is one of the factors that may accompany menstrual irregularity and increased hair growth. If these complaints are present, the assessment may be planned together with obstetrics and gynaecology.
Sources
- World Health Organization, Diabetes fact sheet, 14 November 2024. https://www.who.int/news-room/fact-sheets/detail/diabetes (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, General Directorate of Public Health, Obezite (data from the Türkiye Beslenme ve Sağlık Araştırması-2017). https://hsgm.saglik.gov.tr/tr/obezite (opens in a new tab)
