You're Doing Everything Reasonably Right — So Why Do You Feel So Off?
This is one of the most common things I hear in practice. You're not eating badly, you're reasonably active, and your doctor says your bloodwork looks fine. But you're carrying weight around your midsection that wasn't there five years ago, you're tired in a way that sleep doesn't fully fix, and something just feels metabolically off.
Insulin resistance is frequently the missing piece of that puzzle — and it's one of the most underdiagnosed conditions in adults because standard lab testing often doesn't catch it until it's been developing quietly for years.
What Insulin Resistance Actually Means
Insulin is a hormone produced by the pancreas. Its primary job is to act like a key, unlocking your cells so glucose from the food you eat can enter and be used for energy. When you're insulin resistant, the locks become less responsive. Your cells aren't opening efficiently, so glucose stays elevated in the bloodstream and your pancreas compensates by producing even more insulin to get the job done.
For a period of time — often years — this compensation works well enough that your fasting blood sugar stays normal. But the elevated insulin itself is doing quiet damage in the background: promoting fat storage, driving inflammation, disrupting hormones, and contributing to fatigue.
This is the window most people want to catch. Not after a diabetes diagnosis, but during the years when the trajectory can be meaningfully changed.
Why Standard Bloodwork Often Misses It
The conventional screening markers for metabolic health — fasting glucose and HbA1c — are relatively late indicators. By the time fasting glucose is elevated, insulin has often been running high for years. Fasting insulin is a far more sensitive early marker, but it's not part of most routine panels.
In practice, I also look at the HOMA-IR score (calculated from fasting insulin and fasting glucose together), fasting triglycerides, HDL cholesterol, waist circumference, and blood pressure patterns. No single number tells the whole story — but the pattern across these markers is very informative.
If your triglycerides are creeping up, your HDL is on the lower end, your fasting glucose is in the higher-normal range, and you're carrying weight centrally, that constellation is clinically meaningful even if every individual value falls within the reference range.
Symptoms That Often Precede Abnormal Labs
Before bloodwork shifts, many people notice fatigue that feels disproportionate to their lifestyle, difficulty losing weight despite reasonable effort, strong carbohydrate cravings especially in the afternoon or evening, energy crashes after meals, brain fog, and disrupted sleep. These aren't vague complaints — they're physiologically consistent with insulin dysregulation.
For women in perimenopause, the picture is often more complicated because declining estrogen independently worsens insulin sensitivity. Fatigue and weight gain during this transition are frequently attributed to hormones alone, when often it's the combination of hormonal change and insulin resistance acting together.
What You Can Ask For
If you suspect insulin resistance is a factor for you, it's worth having a conversation with your healthcare provider about testing fasting insulin alongside your standard glucose and HbA1c. A lipid panel, waist circumference measurement, and blood pressure reading round out a practical baseline assessment.
In Part 2 of this series, we look at the specific connection between insulin, blood sugar swings, and that afternoon slump — and what you can do about it through practical, evidence-based nutrition strategies.
