Insulin resistance: the silent problem behind belly fat and diabetes
Long before diabetes shows up in a blood test, many people already have a hidden problem: their body has stopped responding well to insulin. It is called insulin resistance, it is very common in Pakistan and India, and the good news is that it can be improved.
Quick answer
- Insulin is the hormone that moves sugar from your blood into your cells. In insulin resistance, the cells do not respond well, so the body has to make more and more insulin.
- South Asians are more likely to have it, even at a normal weight, mainly because of more belly fat and less muscle.
- Warning signs include a large waist, dark velvety skin on the neck or armpits, skin tags, high triglycerides and, in women, PCOS.
- Losing a little weight, eating fewer refined carbs and sugar, walking after meals and building muscle all make the body more sensitive to insulin.
What is insulin resistance, in simple words?
When you eat roti, rice, fruit or sugar, it turns into glucose (sugar) in your blood. Your pancreas then releases insulin, which works like a key. It opens the doors of your muscle, liver and fat cells so the sugar can go inside and be used for energy.
In insulin resistance, the locks on those doors become stiff. The key still works, but the body needs more and more insulin to push the same amount of sugar inside. For years, the pancreas manages to keep up by making extra insulin, so your blood sugar test looks normal. Over time, the pancreas gets tired. Sugar starts to rise, first into prediabetes, and then type 2 diabetes.
Why it is so common in South Asians
- More belly and liver fat. At the same BMI, South Asians usually carry more fat inside the belly and in the liver, and this fat makes insulin work less well. See belly fat and waist size.
- Less muscle. Muscle is the biggest user of blood sugar. Less muscle means less space to store sugar.
- Diet. Large portions of white rice, maida, sugar in chai and sweet drinks, and fried snacks raise insulin many times a day.
- Less activity, long hours of sitting, and poor sleep.
- Family history and genes. If your parents have diabetes, your risk is higher.
Signs you may have insulin resistance
Insulin resistance often has no symptoms. But these signs make it more likely:
- A waist of 90 cm (35.5 in) or more in men, or 80 cm (31.5 in) or more in women
- Dark, thick, velvety skin on the back of the neck, armpits or groin (called acanthosis nigricans). Many people think it is dirt that will not wash off.
- Many small skin tags on the neck or under the arms
- High triglycerides and low HDL ("good") cholesterol in a blood test
- High blood pressure
- Fatty liver on an ultrasound
- In women: PCOS (irregular periods, extra facial hair, acne, trouble getting pregnant)
- Feeling very sleepy or hungry soon after a meal high in carbs
Which tests should I ask for?
There is no single simple test that doctors use for insulin resistance in daily practice. Instead, they look at a group of signs. Ask your doctor about:
- Fasting blood sugar and HbA1c, to check for prediabetes or diabetes
- Lipid profile (cholesterol and triglycerides)
- Blood pressure and waist size
- Liver tests or an ultrasound, if fatty liver is suspected
Some doctors also check fasting insulin and work out a score called HOMA-IR. It is useful in research, but results vary between labs, so it is best read by a doctor along with your other results.
When a person has a large waist plus two of these (high triglycerides, low HDL, high blood pressure, high fasting sugar), doctors call it metabolic syndrome, which is a strong sign of insulin resistance.
How to improve insulin resistance
1. Lose a little weight, especially from the belly
You do not need to reach a "perfect" weight. Losing 5 to 10 percent of your weight (4 to 7 kg for a 70 kg person) can greatly improve how your body uses insulin. Read how to lose weight eating normal desi food.
2. Change the carbs, not just the amount
- Smaller portions of white rice, naan and maida. Choose whole wheat or multigrain roti.
- Cut out sugary drinks and reduce sugar in chai.
- Fill half the plate with vegetables, and add daal, chana, eggs, dahi or chicken to every meal.
- Eat the salad and salan first, and the roti or rice last.
3. Move after meals
A 10 to 15 minute walk after lunch and dinner helps your muscles pull sugar out of the blood without needing as much insulin. See walking for weight loss.
4. Build muscle
Strength exercise 2 to 3 times a week (squats, push-ups, lunges, resistance bands) gives your body more "storage space" for sugar. This is one of the most powerful tools against insulin resistance.
5. Sleep and stress
Even a few nights of poor sleep can make the body more insulin resistant. Aim for 7 to 8 hours. Long-term stress also raises blood sugar.
6. Medicine, if your doctor advises
For some people, especially those with prediabetes or PCOS, doctors may prescribe a medicine such as metformin along with lifestyle changes. Do not take any medicine for this without a doctor's advice.
Is it reversible?
For many people, yes. Studies show that insulin sensitivity improves within weeks of more activity, and keeps improving with weight loss. The changes need to become a normal part of life. If old habits return, insulin resistance usually comes back too.
Common questions
Can thin people have insulin resistance?
Yes. This is common in South Asians. A person can have a normal BMI but still carry a lot of belly and liver fat and little muscle. This is sometimes called "thin outside, fat inside".
Is insulin resistance the same as diabetes?
No. Insulin resistance comes first, often years before diabetes. Many people with insulin resistance still have normal blood sugar because the pancreas makes extra insulin.
What is the best diet for insulin resistance?
There is no single best diet. A diet with fewer refined carbs and sugar, more vegetables, pulses and protein, and controlled portions works well with desi food. Low carb diets also help some people.
Does the dark skin on my neck go away?
It often gets lighter when insulin resistance improves with weight loss and activity. See a doctor to confirm the cause.
Sources
- Freeman AM, Acevedo LA, Pennings N. Insulin resistance. StatPearls, NCBI Bookshelf, updated 2023. www.ncbi.nlm.nih.gov/books/NBK507839
- Misra A, Khurana L. Obesity-related non-communicable diseases: South Asians vs White Caucasians. International Journal of Obesity, 2011;35:167-187. doi.org/10.1038/ijo.2010.135
- Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome. Circulation, 2009;120:1640-1645. doi.org/10.1161/CIRCULATIONAHA.109.192644
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Insulin resistance and prediabetes. www.niddk.nih.gov
- Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care, 2016;39:2065-2079. doi.org/10.2337/dc16-1728
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Journal of Clinical Endocrinology & Metabolism, 2023;108:2447-2469. doi.org/10.1210/clinem/dgad463
How we write our articles: sources and editorial policy. Found a mistake? Tell us.