Insulin resistance is a silent blood sugar disorder that, over time, can lead to prediabetes, Type 2 diabetes, metabolic syndrome, atherosclerosis, heart attack, and stroke. Called silent because there are no symptoms, insulin resistance occurs at the cellular level. Muscle, liver, and fat cells lose their sensitivity to insulin, a hormone that signals those cells to take glucose from the bloodstream. Glucose is what those cells use as energy. When the body’s cells ignore glucose, it builds up in the bloodstream. For 10 to 15 years, on average, the body keeps up with this blood sugar disorder by increasing insulin production by the pancreas, a condition called hyperinsulinemia. High insulin levels cause weight gain, high cholesterol levels, high blood pressure, and metabolic syndrome. Eventually, the pancreas can’t keep up with insulin resistance, and prediabetes and Type 2 diabetes develop.
Although no symptoms or clinical tests identify insulin resistance, early warning signs exist. The most obvious is excess weight. Suppose one’s waist size is greater than size 35 for women and over a size 40 for men, this is an indication that insulin resistance may be occurring. Other signs of insulin resistance include high blood pressure, high cholesterol, and high-fat levels. All of them are early consequences of insulin resistance.
Insulin resistance is a common health condition that affects anyone regardless of age, sex, race, or ethnicity.
Early signs of insulin resistance include weight gain, obesity, high blood pressure, high cholesterol, and high triglyceride levels in the blood.
Insulin resistance does not have serious symptoms by itself. But it often results in complications such as Type 2 diabetes, atherosclerosis, or heart problems.
Insulin resistance is caused by obesity, diet, sedentary lifestyle, aging, medications, hormone disorders, pregnancy, polycystic ovary syndrome (PCOS), glucose toxicity, and inherited conditions such as Type A or Type B insulin resistance. You may be at risk for developing insulin resistance if you are overweight, physically inactive, older than 45, have had gestational diabetes, have sleep apnea, or a family history of diabetes. Certain racial and ethnic backgrounds are significant risk factors for insulin resistance. These include Asian Americans, African Americans, Pacific Islanders, and Indigenous Americans.
Insulin resistance requires a medical diagnosis.
Insulin resistance requires lifestyle changes, including healthy diet and increasing physical activity. Medication is not needed unless it has caused complications such as prediabetes, Type 2 diabetes, high cholesterol, or cardiovascular problems. Insulin resistance typically improves with intensive lifestyle changes.
Untreated insulin resistance could result in complications like obesity, metabolic syndrome, prediabetes, Type 2 diabetes, atherosclerosis, heart attack, stroke, and complications associated with Type 2 diabetes.
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Insulin resistance is a silent health threat. There are no symptoms of insulin resistance or clinical tests that can spot it until insulin resistance causes complications such as prediabetes or Type 2 diabetes. There are early warning signs of insulin resistance, however. These include:
Weight gain
Obesity
High blood pressure
High cholesterol
These problems may not be related to insulin resistance, but they are a sign that it is possible even though there are no symptoms.
Insulin resistance will not have symptoms until it develops into prediabetes or Type 2 diabetes. These blood sugar disorders are caused by insulin resistance, but problems with insulin production are also a factor. Symptoms of prediabetes and Type 2 diabetes include:
High blood sugar (hyperglycemia)
Excess weight (BMI > 25)
Excess hunger
Weight gain
Darkened skin under the armpits or on the back of the neck or groin (acanthosis nigricans)
Skin tags
Feeling tired
Sweating
Feeling weak
Cuts and bruises that don’t heal as quickly as they used to
Skin infections
Gum bleeding
Blurred vision
Insulin resistance is not an illness but a medical condition that causes more serious illnesses such as metabolic syndrome, diabetes, or cardiovascular disease. Though sometimes caused by insulin resistance, Type 2 diabetes differs from insulin resistance. Prediabetes and Type 2 diabetes are diagnosed when blood sugar levels are high. While most cases of Type 2 diabetes are due to insulin resistance, some are not. More importantly, insulin resistance silently causes problems throughout the body. High blood sugar levels cause more obvious damage to the body and noticeable symptoms.
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RELATED: Diabetes symptoms: what are the early signs of diabetes?
Insulin resistance isn’t a medical diagnosis but a metabolic disorder that causes many problems. Left ignored, insulin resistance often develops into prediabetes and Type 2 diabetes. It’s also associated with hypertension, high cholesterol, atherosclerosis, and obesity. Combined, these are components of what healthcare professionals call insulin resistance syndrome.
Insulin resistance in its earliest stages does not produce symptoms or complications. Later stages can also involve other health problems such as weight gain, high blood pressure, or cholesterol dysregulation.
Prediabetes is a stage of insulin resistance in which the pancreas cannot produce enough insulin to overcome insulin resistance, resulting in higher-than-normal blood glucose levels. The glucose levels are not high enough to qualify as diabetes, but prediabetes is a risk factor of progression to Type 2 diabetes. Prediabetes rarely has symptoms and is typically spotted on a routine blood glucose test (fasting blood sugar between 100 - 126).
Type 2 diabetes is a later stage of insulin resistance in which both insulin resistance and impaired insulin production result in blood sugar levels high enough to damage blood vessels (fasting blood sugar > 126). This is the stage where both symptoms and complications begin to appear.
Insulin resistance in its early stages is not treated with prescription medication. Instead, lifestyle changes of weight loss, exercise, and dietary changes are often enough to manage the disorder and prevent complications. When insulin resistance evolves into prediabetes or Type 2 diabetes, medical help is needed to control blood sugar levels. A healthcare professional should evaluate anyone with symptoms of diabetes (excessive thirst, excessive hunger, increase in frequency of urination).
There are no tests for insulin resistance. Instead, healthcare providers notice signs of metabolic syndrome such as excess weight, weight gain, high blood pressure, or high cholesterol levels in the blood. They will infer from these other conditions that insulin resistance is a possibility. Prediabetes and Type 2 diabetes are diagnosed with blood tests that measure glucose levels in the blood, including:
A fasting blood glucose test, which gives a snapshot of blood sugar levels
A glucose tolerance test, which measures how efficiently blood sugar is removed from your blood
A glycated hemoglobin A1c test, which measures the average blood sugar level over the past three months.
The complications of insulin resistance include:
Prediabetes
Type 2 diabetes
Metabolic syndrome (weight gain, obesity, high blood pressure, high triglycerides, cholesterol problems, and high blood sugar)
Fatty liver disease
Coronary artery disease
Heart disease
Heart attack
Stroke
Cancer
The most common complications of Type 2 diabetes include:
Peripheral artery disease
Kidney disease
Kidney failure
Limb amputations
Retinal damage (diabetic retinopathy)
Vision loss
Nerve damage (diabetic neuropathy)
Diabetic ketoacidosis
Diabetic coma
Early-stage insulin resistance can be successfully managed with lifestyle changes:
Weight loss (even loss of 10% of body weight can stop insulin resistance)
Dietary changes including calorie restrictions, eliminating foods from the diet that cause high blood sugar, and eating more dietary fiber
30 minutes of exercise on most days
Type 2 diabetes is typically treated with prescription drugs that increase insulin sensitivity, such as metformin, or reduce blood sugar in other ways. In more advanced cases, insulin injections will be necessary.
RELATED: How to lose weight with insulin resistance
Early-stage insulin resistance and prediabetes can be managed with lifestyle changes. Even people with Type 2 diabetes can dramatically improve insulin sensitivity with lifestyle changes. These include:
Lose weight if you are currently overweight—aim for at least 7% of your current body weight.
Maintain a healthy weight.
Do at least 30 minutes of moderately intense exercise per day—even walking every day improves insulin sensitivity.
Reduce calorie intake—a reduced calorie diet immediately improves insulin sensitivity, even if there’s no weight loss.
Eat a healthy diet—the American Diabetes Association has a number of dietary recommendations that can work here.
Avoid foods that dramatically raise blood sugar, such as sweetened beverages, sugary foods, and any food containing refined carbohydrates.
Add more fiber to your diet, especially natural sources of fiber such as vegetables and whole grains.
Join the National Diabetes Prevention Program sponsored by the Centers for Disease Control and Prevention (CDC).
RELATED: The best diet for prediabetes
Lifestyle changes are the most effective way to treat and reverse insulin resistance. Weight loss, calorie reduction, healthy eating, and dietary fiber all have a pronounced effect on insulin sensitivity. They also improve other blood pressure issues, blood fat levels, cholesterol, mood, and quality of life. Only a healthcare provider can diagnose and treat insulin resistance, but only you can make lifestyle changes.
RELATED: What is insulin resistance—and can you reverse it?
Insulin resistance happens at the cellular level. Cells in the muscles and the liver, as well as fat cells, don’t respond to insulin, which normally triggers those cells to take in glucose floating around in the blood. Instead, the glucose builds up in the liver, which then turns it into fat. All that extra fat is turned into fatty acids. Because there’s so much fat, the fat gets deposited in cells that typically don’t store fat, like muscle and liver cells. That causes inflammation and makes insulin resistance even worse.
Additionally, insulin resistance in the liver causes it to make glucose even when it doesn’t need to. Of course, this both raises blood sugar and worsens insulin resistance. At the cellular level, insulin resistance is a vicious cycle.
When cells do not take up blood glucose as they should, the liver transforms all that extra glucose into fat and releases it into the bloodstream. The fat builds up in muscle, liver, and fat cells. This triggers the release of inflammatory substances, particularly from fat cells, so insulin resistance eventually results in inflammation.
High blood sugar due to Type 1 diabetes or Type 2 diabetes can damage nerves. Insulin resistance is one mechanism that contributes to diabetes, but it does not directly cause the complications or symptoms of diabetes.
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Insulin resistance is not necessarily an essential component of Type 2 diabetes, The Journal of Clinical Endocrinology & Metabolism
Metabolic syndrome: updates on pathophysiology and management, International Journal of Molecular Sciences
Blood pressure treatments and medications, SingleCare
Guide to prediabetes: symptoms, causes, and treatments, SingleCare
High cholesterol treatments and medications, SingleCare
Type 2 diabetes treatments and medications, SingleCare
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