Insulin Resistance Symptoms: Signs, Tests and What Helps
Medically reviewed by Sabeen Munib M.D.Most people with insulin resistance have no symptoms at all, which is why a blood test matters more than how you feel. When signs do show up, the most common are dark, velvety skin on the neck or underarms, skin tags, and extra weight around the waist. An A1C or fasting glucose test shows whether your blood sugar has started to rise, and regular activity, better sleep and modest weight loss can lower your risk of type 2 diabetes.
What is insulin resistance?
Insulin is the hormone that moves sugar from your blood into your muscles, liver and fat cells for energy. With insulin resistance, those cells stop responding well, so your pancreas has to make more insulin to keep blood sugar normal.
For a while, the extra insulin keeps your numbers in range. Over time the pancreas may not keep up, and blood sugar starts to climb. That stage is called prediabetes. If it keeps rising, it becomes type 2 diabetes. Insulin resistance can sit quietly for years before any of this shows on a test.
What are the symptoms of insulin resistance?
Usually there are none you can feel. Many people find out only when a routine blood test comes back high. When there are visible signs, they tend to be these:
- Dark, thick, velvety patches of skin, most often on the back of the neck, the underarms or the groin (called acanthosis nigricans)
- Skin tags, especially on the neck, eyelids or underarms
- Weight that settles around the belly, or a waist size that keeps growing
- High blood pressure, high triglycerides or low HDL (good) cholesterol on a checkup
- Irregular periods, acne or extra facial hair in women, which can point to PCOS
Tiredness, sugar cravings and trouble losing weight are common complaints, but they have many causes and are not reliable signs on their own. A blood test is the only way to know where you stand.
Symptoms that mean blood sugar may already be high
If insulin resistance has moved on to diabetes, you may notice symptoms. Some people with prediabetes feel them too:
- Being very thirsty and urinating more often
- Blurry vision
- Feeling unusually tired
- Cuts or sores that heal slowly
- Tingling or numbness in the hands or feet
- Losing weight without trying
Who is at risk for insulin resistance?
Anyone can develop it, including children and teens, but the risk is higher if you:
- Are 35 or older
- Have overweight or obesity, or a large waist
- Have a parent, brother or sister with type 2 diabetes
- Are African American, Hispanic or Latino, Asian American, American Indian or Pacific Islander
- Are not physically active, or smoke or vape
- Had diabetes during pregnancy, or had a baby who weighed 9 pounds or more
- Have PCOS or sleep apnea
- Take long-term steroid medicines, some antipsychotics or some HIV medicines
Asian Americans can develop insulin resistance and diabetes at a lower body weight, which is why screening starts at a lower BMI for them.
How do you test for insulin resistance?
There is no single routine test that measures insulin resistance directly. Instead, doctors check what it does to your blood sugar, along with the other signs that tend to come with it.
These are the blood sugar tests and what the results mean:
- A1C (your average blood sugar over about three months): below 5.7% is normal, 5.7% to 6.4% is prediabetes, 6.5% or higher is diabetes
- Fasting glucose: below 100 mg/dL is normal, 100 to 125 mg/dL is prediabetes, 126 mg/dL or higher is diabetes
- Two-hour glucose tolerance test: below 140 mg/dL is normal, 140 to 199 mg/dL is prediabetes, 200 mg/dL or higher is diabetes
A diabetes result is usually confirmed with a second test. A fasting insulin level is not part of standard screening. Results vary between labs and, for most people, do not change the plan.
When should you get tested?
- All adults from age 35
- Earlier, at any adult age, if you have overweight (a BMI of 25 or more, or 23 or more for Asian Americans) plus another risk factor from the list above
- Anyone with PCOS, and anyone who had diabetes in pregnancy
- Children and teens with overweight and a risk factor, starting at age 10 or puberty
If your results are normal, repeat the test at least every three years. If you have prediabetes, check yearly.
Is insulin resistance the same as prediabetes?
Not quite. Insulin resistance is the underlying problem: your body needs extra insulin to do its job. Prediabetes is a lab result showing your blood sugar has started to rise because of it. You can have insulin resistance with a normal A1C, which is why the risk factors and body signs matter too.
Can insulin resistance be reversed?
For many people it can improve a lot, and prediabetes can return to normal. Daily habits make the biggest difference:
- Move more: aim for at least 150 minutes a week of brisk walking or similar activity, spread over at least three days
- Add strength work two or three days a week, since muscle uses blood sugar
- Break up long periods of sitting with a few minutes of movement
- Eat mostly vegetables, beans, whole grains, fish, nuts and lean protein, and cut back on sugary drinks and refined carbs
- If you carry extra weight, a modest loss of about 5% to 7% of your body weight lowers the chance of developing type 2 diabetes
- Sleep at least seven hours, and get checked for sleep apnea if you snore or wake up tired
- Stop smoking or vaping
Are there medicines for insulin resistance?
No medicine is approved for insulin resistance itself, but some may be part of the plan. Metformin is sometimes used for prediabetes, most often for people under 60, people with a BMI of 35 or more, or women who had diabetes in pregnancy. For adults who qualify by weight and health, a brand-name GLP-1 medicine such as Wegovy or Zepbound may be used for weight. Ozempic and Mounjaro are approved for type 2 diabetes. Whether any of these fits you depends on your labs, your health history and your goals.
When should you see a doctor?
Book a visit if you have any of the risk factors above and have not had an A1C or fasting glucose test in the last three years, or if you notice dark velvety skin patches, new skin tags or a growing waistline.
See a doctor soon if you are very thirsty, urinating often, losing weight without trying or seeing blurry vision. Go to urgent care or the emergency room if you are vomiting, confused, breathing fast or very drowsy, especially with a known high blood sugar.
How Dr. Munib approaches insulin resistance
Dr. Munib starts with your history: family diabetes, pregnancy history, periods, sleep, medicines and how your weight has changed. The exam includes blood pressure, waist size and a look at the skin for velvety patches or tags.
Labs usually include an A1C or fasting glucose and a cholesterol panel. Depending on what she finds, she may add thyroid tests, a glucose tolerance test, or a check for PCOS or sleep apnea. The plan then depends on your results: habit changes for most people, and for some, medicine options she may discuss.
Read about hormone balancing and insulin resistance care at The Pur Health
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If you think you might have insulin resistance, a simple blood test is the place to start. The Pur Health is in-network with most PPO plans, and cash visits are $190 for new patients and $150 for returning patients. Book a visit at our Irvine office at 114 Pacifica, Suite 280, or call (949) 647-5234.