Insulin resistance can develop years before a person is diagnosed with Type 2 diabetes, often without obvious symptoms or abnormal blood sugar readings. This is because the pancreas initially compensates for the body’s reduced response to insulin by producing more of the hormone to keep glucose levels within the normal range.
However, this does not mean everything is functioning normally. Gradually, the body’s ability to compensate can weaken, allowing blood sugar levels to rise and eventually progress to prediabetes and Type 2 diabetes.
Dr Himika Chawla, Senior Consultant, Endocrinology and Diabetology, PSRI Hospital, explains what happens inside the body when insulin resistance begins, the warning signs to watch for and how it can be identified early.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
What happens inside the body when insulin resistance develops?
Insulin is a hormone that helps glucose move from the bloodstream into cells, where it is used for energy. When insulin resistance develops, cells in the liver, muscles and fat tissues become less responsive to the hormone.
“This means that it is harder for glucose to get into cells and more insulin is needed to get glucose into cells. At first, the pancreas creates more insulin to overcome this resistance. At this stage, the blood glucose level may be normal,” says Dr Chawla.
However, as insulin resistance continues, the pancreatic beta cells may eventually struggle to produce enough insulin to meet the body’s increasing demands.
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“This eventually results in glucose accumulating in the blood, first leading to prediabetes and eventually to Type 2 diabetes if the metabolic disturbance continues,” she explains.
Can you have insulin resistance even when blood sugar is normal?
Dr Chawla explains that during the early stages, the pancreas compensates for reduced insulin sensitivity by producing more insulin. This phase is sometimes called compensatory hyperinsulinaemia.
“Metabolic changes can occur even with normal blood sugar tests. These include elevated insulin, abnormal liver control of glucose output, excessive fat around the abdomen and liver, and high triglycerides,” she says.
These changes can develop gradually without obvious symptoms. There is no fixed timeline for how long someone can remain insulin-resistant before blood sugar levels begin to rise. According to Dr Chawla, this can vary depending on body composition, genetics, lifestyle and pancreatic beta-cell function. Some people may remain insulin-resistant for years without developing high blood sugar.
Lifestyle modifications can improve insulin sensitivity and, in some people, help prevent or delay the progression to Type 2 diabetes.
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What are the early warning signs of insulin resistance?
Dr Chawla lists the following warning signs:
* Increasing waist circumference: A growing waistline and excess abdominal fat can indicate increased metabolic risk.
* Difficulty losing weight: Insulin resistance may coexist with excess body fat and metabolic disturbances.
* Frequent hunger: Feeling hungry soon after eating may be one of the associated symptoms.
* Sleepiness after meals: Feeling unusually sleepy after eating can sometimes accompany metabolic disturbances.
* Dark patches of skin: Dark, thick, velvety patches around the neck, armpits or groin may indicate acanthosis nigricans, a skin condition associated with insulin resistance.
However, these signs alone cannot confirm the condition and need to be interpreted alongside clinical and metabolic assessments.
Which tests can help detect insulin resistance early?
Dr Chawla recommends discussing the following tests with a healthcare professional:
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1. Fasting blood glucose: Measures blood glucose after at least eight hours of fasting. It helps identify elevated blood sugar.
2. HbA1c: Provides an estimate of average blood sugar levels over the previous two to three months.
3. Glucose tolerance test (GTT): Assesses how the body processes glucose after consuming a measured glucose drink.
4. Lipid profile: Triglycerides, HDL and other cholesterol levels can offer insights into metabolic health.
5. Fasting insulin and HOMA-IR: These may help assess insulin resistance, but they are not routinely recommended for everyone and do not have universally accepted diagnostic cut-offs.
Importantly, normal fasting glucose and HbA1c results do not necessarily rule out early insulin resistance. People with a family history of diabetes, abdominal obesity, polycystic ovary syndrome (PCOS), high blood pressure or abnormal cholesterol levels should discuss appropriate screening and follow-up with their doctor.
“Early diagnosis and regular physical activity, along with the appropriate diet, sleep and weight control, may help improve insulin sensitivity and prevent the onset of Type 2 diabetes,” Dr Chawla says.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
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