Insulin resistance is one of the most underestimated reasons why women feel tired, low on energy or hormonally out of balance. With insulin resistance your cells respond less well to the hormone insulin, so your pancreas has to make more and more of it to keep your blood sugar stable. Often you notice nothing for years, while it slowly rises in the background.
I think this is a topic that gets far too little attention, especially in women. Many complaints that can be linked to insulin resistance are dismissed as busyness, stress or simply getting older. In this overview article you will read what insulin resistance is, which symptoms can fit and which blood values you can test to get a clearer picture.
This is the hub article of our series on blood sugar and insulin, with a deeper article per topic.
What is insulin resistance?
Insulin resistance means your cells have become less sensitive to insulin, the hormone that helps sugar move from your blood into your cells. Your pancreas then makes more insulin to keep your blood sugar normal anyway. As long as that works, your glucose can stay fine for a long time.
Insulin is a key that opens the door of your cells for glucose. With insulin resistance that key fits less well, so more keys are needed for the same effect. That explains why your insulin can rise while your glucose still looks normal.
According to the Diabetes Fonds, insulin resistance is an important forerunner of type 2 diabetes. It is not a disease in itself, but a signal that your metabolism is under pressure. That is exactly why it is so hard to spot without measuring.
What I find important to mention: insulin resistance is not the same as eating too much sugar. Slim women can have it too, and it mainly plays out at cell level. That is exactly why you cannot simply see it from the outside.
What are the symptoms of insulin resistance in women?
Insulin resistance often gives vague complaints that are easily attributed to something else. Think of tiredness after eating, strong cravings for sweets, difficulty losing belly fat and energy dips in the afternoon. In women there can be hormonal signals too, such as an irregular cycle.
The symptoms arise because your blood sugar and insulin fluctuate. After a meal with a lot of fast carbohydrates your blood sugar shoots up and then drops again, which gives a hungry and tired feeling.
In women the complaints sometimes vary with the cycle. Just before your period your sensitivity to insulin can change a little, so your cravings and energy fluctuate. That does not always make the pattern easy to recognise.
Frequently mentioned complaints that can fit insulin resistance are:
- tiredness, especially after a carbohydrate-rich meal
- recurring cravings for sweets or quick hunger
- an increase in belly fat that is hard to lose
- an irregular menstrual cycle or complaints that fit PCOS
- dark, velvety discolourations in skin folds (acanthosis nigricans)
Important to know: these complaints are not proof. They can also belong to thyroid problems, anaemia, stress or simply a busy life. That is why measuring is more useful than guessing, and you should always discuss persistent complaints with your GP.
What causes insulin resistance?
Insulin resistance usually arises from a combination of factors, not from a single cause. Excess weight around the belly, little exercise, too little sleep and a lot of fast sugars all play a part. Your genes, age and hormones also have an influence.
Belly fat is metabolically active and releases substances that disrupt insulin action. That is why insulin resistance often goes together with an increase in fat around the organs. It partly explains why your waist size says more than your weight alone.
In women, hormones play an extra role. PCOS and menopause can lower sensitivity to insulin, even without excess weight. Sleep shortage and chronic stress also raise your cortisol, which can push your blood sugar up further.
Some things you cannot change, such as your predisposition and your age. Other factors, such as your diet, exercise and sleep, are partly in your own hands. That makes insulin resistance influenceable to a certain extent.
Which blood values do you test for insulin resistance?
You do not see insulin resistance in a single value, but in the whole picture. The main blood values are your fasting glucose, your fasting insulin and your HbA1c, which shows your long-term blood sugar. From your fasting glucose and insulin you can also calculate the HOMA-IR, a derived indication of insulin resistance.
These values complement each other. Your glucose can still be normal while your insulin is already raised, because your pancreas is working hard to compensate. It is exactly that combination that makes early insulin resistance visible.
The table below links each value to what it shows. Remember that reference ranges differ per laboratory and that a single result always belongs in context.
| Blood value | What it shows |
|---|---|
| Fasting glucose | Your blood sugar after an overnight fast; a raised value can point to prediabetes or diabetes |
| Fasting insulin | How much insulin your pancreas makes at rest; a high value can be an early sign of insulin resistance |
| HbA1c | Your average blood sugar over roughly the last two to three months |
| HOMA-IR (derived) | A calculated indication from fasting glucose and insulin; not a diagnosis in itself |
Note: the HOMA-IR is a calculation model and not a standalone diagnosis. Reference ranges differ per lab and per method, so a cut-off at one lab does not have to mean the same at another. A result only gets meaning once you look at it together with your complaints and your other values.
If you want to understand what your HbA1c says exactly, read our article on what your HbA1c value means for your long-term blood sugar. If you wonder how to calculate the HOMA-IR, we explain it step by step in our article on how you measure insulin resistance with HOMA-IR.
Insulin resistance, PCOS and menopause
In women, insulin resistance often goes together with hormonal phases. PCOS and menopause are two periods in which sensitivity to insulin can decrease. That can strengthen the complaints and sometimes even partly cause them.
In PCOS, insulin resistance plays a central role. Raised insulin can prompt the ovaries to make more male hormones, which contributes to an irregular cycle, acne and excess hair growth. Read more about it in our article on PCOS and insulin resistance as a hidden cause.
Around menopause your hormone balance changes again. The drop in oestrogen can lower insulin sensitivity and shift fat distribution towards your belly. As a result, insulin resistance can flare up more easily in this phase, even if your weight stays fairly stable.
This does not mean every woman with PCOS or in menopause has insulin resistance. It does show why, with these complaints, it can be useful to have your blood sugar and insulin measured. You discuss the outcome with your GP or gynaecologist.
What can you do about insulin resistance yourself?
Insulin resistance can often be influenced favourably with your lifestyle. Moving more, getting stronger, sleeping better and eating fewer fast sugars can make your cells more sensitive to insulin again. Small, sustainable changes work better here than a strict short-term diet.
Exercise is one of the strongest levers. Your muscles use glucose even without much insulin, especially after strength training and after a walk after eating. According to Thuisarts.nl and the Diabetes Fonds, regular exercise helps to keep your blood sugar better under control.
The make-up of your meal matters too. If you start with vegetables and protein before the carbohydrates, your blood sugar often rises a bit more calmly. This is no miracle fix, but a small aid that is easy to keep up.
What often helps with insulin resistance:
- regular exercise, with a combination of strength and walking
- fewer fast sugars and more fibre, vegetables and protein
- enough and regular sleep
- lowering stress where you can
- with excess weight, a gradual reduction in waist size
This approach is general and not personal advice. What suits you depends on your situation, your complaints and your values. Always discuss big changes and persistent complaints with your GP or a dietitian.
A blood test can help here as a baseline and as a way to track your progress.
Testing your own blood values
If you want to map your blood sugar and insulin yourself, you can do so at Lunara without a referral. You order your test online, get drawn while fasting at one of the more than 750 draw locations in the Netherlands and receive your results digitally. Every result is assessed by a BIG-registered doctor.
For insulin resistance you mainly look at fasting glucose, fasting insulin and HbA1c, from which the HOMA-IR also follows. Our Diabetes blood test brings these blood sugar values together clearly. Preferably get drawn fasting in the morning, because that gives the most usable baseline.
If you wonder whether your blood sugar is on the high side, read our article on high blood sugar, the symptoms and when to test. If you want to know whether you are in the prediabetes phase, our article on recognising prediabetes by symptoms and blood values helps you further.
Important: testing yourself does not replace a visit to your GP and does not make a diagnosis. It is meant as a starting point and as an addition to your own insight. You always discuss an abnormal or unclear result with a doctor.
Personally I find blood testing valuable mainly because it moves you from suspicion to facts. You do not have to keep guessing whether your complaints have to do with your blood sugar. With a few values and a doctor's assessment you know better where you stand and what a logical next step is.
Frequently asked questions
Can you see insulin resistance in a regular blood test?
Partly yes. A fasting glucose and HbA1c show your blood sugar, and with a fasting insulin you can calculate the HOMA-IR as an indication. A doctor always makes the diagnosis based on your whole picture, not on a single value.
What is a normal fasting insulin?
Reference ranges for fasting insulin differ per laboratory and per method. A raised fasting insulin with a still normal glucose can point to early insulin resistance. What your result means, you review together with your other values and your GP.
Is insulin resistance the same as diabetes?
No. Insulin resistance can be a forerunner of type 2 diabetes, but is not diabetes in itself. According to the Diabetes Fonds it is a signal that your metabolism is under pressure, which you can often still do something about.
Do I have to be fasting for this blood test?
For fasting glucose and fasting insulin, being fasting matters, usually eight to twelve hours without eating. HbA1c you can have drawn at any time, because it is an average. Preferably get drawn fasting in the morning for the most usable values.
Is insulin resistance reversible?
Insulin resistance can often be influenced favourably with lifestyle, such as more exercise, better sleep and fewer fast sugars. How much effect you have differs per person and is no guarantee. Discuss an approach that suits you with your GP or a dietitian.
With which complaints should I test my blood sugar?
Think of persistent tiredness after eating, strong cravings for sweets, belly fat that is hard to lose or an irregular cycle. These complaints are not proof, but can be a reason to measure. You discuss persistent complaints with your GP.
References
- NHG. NHG guideline Diabetes mellitus type 2. Dutch College of General Practitioners.
- Thuisarts.nl. I have (a chance of) type 2 diabetes. Dutch College of General Practitioners.
- Diabetes Fonds. Insulin resistance and type 2 diabetes. Diabetes Fonds.
- RIVM. Diabetes in the Netherlands and risk factors. National Institute for Public Health and the Environment.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. Blood testing through Lunara does not replace a visit to your GP and does not make a diagnosis. For treatment decisions, discuss your results with your GP.
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