Insulin Resistance - What It Is, Causes, Symptoms & Treatment

1/31/24, 7:44 PM Insulin Resistance: What It Is, Causes, Symptoms & Treatment
Insulin Resistance
Insulin resistance is a complex condition in which your body does not respond as
it should to insulin, a hormone your pancreas makes that’s essential for regulating
blood sugar levels. Several genetic and lifestyle factors can contribute to insulin
resistance.
Contents Overview Symptoms and Causes Diagnosis and Tests
Management and Treatment Prevention Outlook / Prognosis Living With
Overview
What Is Insulin Resistance?
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Learn about insulin resistance and what insulin does in your body.
What is insulin resistance?

Insulin resistance, also known as impaired insulin sensitivity, happens when cells
in your muscles, fat and liver don’t respond as they should to insulin, a hormone
your pancreas makes that’s essential for life and regulating blood glucose (sugar)
levels. Insulin resistance can be temporary or chronic and is treatable in some
cases.
Under normal circumstances, insulin functions in the following steps:
Your body breaks down the food you eat into glucose (sugar), which is your
body’s main source of energy.
Glucose enters your bloodstream, which signals your pancreas to release

insulin.
Insulin helps glucose in your blood enter your muscle, fat and liver cells so
they can use it for energy or store it for later use.
When glucose enters your cells and the levels in your bloodstream decrease,
it signals your pancreas to stop producing insulin.
For several reasons, your muscle, fat and liver cells can respond inappropriately
to insulin, which means they can’t efficiently take up glucose from your blood or
store it. This is insulin resistance. As a result, your pancreas makes more insulin
to try to overcome your increasing blood glucose levels. This is called
hyperinsulinemia.
As long as your pancreas can make enough insulin to overcome your cells’ weak
response to insulin, your blood sugar levels will stay in a healthy range. If your
cells become too resistant to insulin, it leads to elevated blood glucose levels
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(hyperglycemia), which, over time, leads to prediabetes and Type 2 diabetes.
In addition to Type 2 diabetes, insulin resistance is associated with several other

conditions, including:
Obesity.
Cardiovascular disease.
Nonalcoholic fatty liver disease.
Metabolic syndrome.
Polycystic ovary syndrome (PCOS).
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What is the difference between insulin resistance and

diabetes?
Anyone can develop insulin resistance — temporarily or chronically. Over time,
chronic insulin resistance can lead to prediabetes and then Type 2 diabetes if it’s
not treated or able to be treated. Ad
Prediabetes happens when your blood glucose levels are higher than normal, but
not high enough to be diagnosed as diabetes. Prediabetes usually occurs in
people who already have some insulin resistance.
Prediabetes can lead to Type 2 diabetes (T2D), the most common type of
diabetes. T2D happens when your pancreas doesn’t make enough insulin or your
body doesn’t use insulin well (insulin resistance), resulting in high blood glucose
levels.
Type 1 diabetes (T1D) happens when your body’s immune system attacks and
destroys the insulin-producing cells in your pancreas for an unknown reason. T1D
is an autoimmune and chronic disease, and people with T1D have to inject
synthetic insulin to live and be healthy. While T1D is not caused by insulin
resistance, people with T1D can experience levels of insulin resistance in which
their cells don’t respond well to the insulin they inject.
Gestational diabetes is a temporary form of diabetes that can happen during

pregnancy. It’s caused by insulin resistance that’s due to the hormones the
placenta makes. Gestational diabetes goes away once you deliver your baby.
Approximately 3% to 8% of all people who are pregnant people in the United
States are diagnosed with gestational diabetes.
Healthcare providers often use a blood test called glycated hemoglobin (A1c) to
diagnose diabetes. It shows your average blood sugar level for the past three
months. In general:
An A1c level below 5.7% is considered normal.
An A1c level between 5.7% and 6.4% is considered prediabetes.
An A1c level of 6.5% or higher on two separate tests indicates type 2

diabetes.
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People with Type 1 diabetes usually have a very high A1C and very high blood
glucose levels upon diagnosis because their pancreas is producing very little or
no insulin.
Who does insulin resistance affect?

Insulin resistance can affect anyone — you don’t have to have diabetes — and it
can be temporary (for example, using steroid medication for a brief period causes
insulin resistance) or chronic. The two main factors that seem to contribute to
insulin resistance are excess body fat, especially around your belly, and a lack of
physical activity.
People who have prediabetes and Type 2 diabetes usually have some level of
insulin resistance. People with Type 1 diabetes can also experience insulin
resistance.
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How common is insulin resistance?

Since there aren’t any common tests to check for insulin resistance and there
aren’t any symptoms until it turns into prediabetes or Type 2 diabetes, the best
way to measure the prevalence of insulin resistance is through the number of
prediabetes cases. More than 84 million adults in the United States have Ad
prediabetes. That’s about 1 out of every 3 adults.
How does insulin resistance affect my body?

The development of insulin resistance typically increases insulin production
(hyperinsulinemia) so your body can maintain healthy blood sugar levels.
Elevated levels of insulin can result in weight gain, which, in turn, makes insulin
resistance worse.
Hyperinsulinemia is also associated with the following conditions:
Higher triglyceride levels.
Hardening of the arteries (atherosclerosis).
High blood pressure (hypertension).
Insulin resistance is also the main feature of metabolic syndrome, which is a set
of features that link excess fat around the waist and insulin resistance to
increased risk of cardiovascular disease, stroke and Type 2 diabetes.
Features of metabolic syndrome include:
Elevated blood glucose levels.
An elevated triglyceride level.
Low levels of high-density lipoprotein (HDL) cholesterol.
High blood pressure.
You don’t have to have all four of these features to have metabolic syndrome.
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Symptoms and Causes

What are the symptoms of insulin resistance?
If you have insulin resistance, but your pancreas can increase insulin production
to keep your blood sugar levels in range, you won’t have any symptoms.
However, over time, insulin resistance can get worse, and the cells in your
pancreas that make insulin can wear out. Eventually, your pancreas is no longer
able to produce enough insulin to overcome the resistance, leading to elevated
blood sugar (hyperglycemia), which does cause symptoms.
Symptoms of high blood sugar include:
Increased thirst.
Frequent urination (peeing).
Increased hunger.
Blurred vision.
Headaches.
Vaginal and skin infections.
Slow-healing cuts and sores.
Many people have no symptoms of prediabetes, often for years. Prediabetes may
be invisible until it develops into Type 2 diabetes. Some people with prediabetes
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may experience the following symptoms:
Darkened skin in your armpit or back and sides of your neck, called
acanthosis nigricans.
Skin tags (small skin growths).
Eye changes that can lead to diabetes-related retinopathy.
If you’re experiencing any of these symptoms, it’s important to see your

healthcare provider.
What causes insulin resistance?

Scientists still have a lot to discover about how exactly insulin resistance
develops. So far, they’ve identified several genes that make a person more or less
likely to develop insulin resistance. In addition, older people are more prone to
insulin resistance.
Several factors and conditions can cause varying degrees of insulin resistance.
Scientists believe that excess body fat, especially around your belly, and physical
inactivity are the two main contributing factors to insulin resistance.
Acquired causes of insulin resistance
Acquired causes, meaning you’re not born with the cause, of insulin resistance
include:
Excess body fat: Scientists believe obesity, especially excess fat in your belly
and around your organs (visceral fat), is a primary cause of insulin resistance.
A waist measurement of 40 inches or more for men and people assigned
male at birth and 35 inches or more for women and people assigned female
at birth is linked to insulin resistance. Studies have shown that belly fat
makes hormones and other substances that can contribute to long-term
inflammation in your body. This inflammation may play a role in insulin Ad
resistance
Physical inactivity: Physical activity makes your body more sensitive to

insulin and builds muscle that can absorb blood glucose. A lack of physical
activity can have opposite effects and cause insulin resistance. In addition, a
lack of physical activity and a sedentary lifestyle are associated with weight
gain, which can also contribute to insulin resistance.
Diet: A diet of highly processed, high-carbohydrate foods and saturated fats

has been linked to insulin resistance. Your body digests highly processed,
high-carbohydrate foods very quickly, which causes your blood sugar to spike.
This puts extra stress on your pancreas to produce a lot of insulin, which, over
time, can lead to insulin resistance.
Certain medications: Certain medications can cause insulin resistance,

including steroids, some blood pressure medications, certain HIV treatments
and some psychiatric medications.
Hormonal disorders that can cause insulin resistance
Your body makes hundreds of hormones, which are chemicals that coordinate
different functions in your body by carrying messages through your blood to your
organs, muscles and other tissues. These signals tell your body what to do and
when to do it.
Issues with certain hormones can affect how well your body uses insulin.
Hormonal disorders that can cause insulin resistance include:
Cushing’s syndrome: This condition happens when there’s extra cortisol in

your body. Cortisol, the “stress hormone,” is vital to regulating your blood
sugar levels (by increasing them) and turning food into energy. Excess
cortisol can counteract the effects of insulin, causing insulin resistance.
Acromegaly: This is a rare but serious condition that happens when you have
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high levels of growth hormone (GH). High levels of GH can cause increased
production of glucose, which can lead to insulin resistance.
Hypothyroidism: This condition happens when your thyroid is underactive and

doesn’t produce enough thyroid hormone. Your thyroid plays a large role in
regulating your metabolism (how your body transforms the food you eat into
energy). When it makes too little thyroid hormone, it slows down your
metabolism, including your glucose metabolism, which can lead to insulin
resistance.
Genetic conditions that cause insulin resistance
Certain inherited genetic conditions (conditions you’re born with) can cause
insulin resistance for various reasons.
There’s a group of rare related conditions described as inherited severe insulin

resistance syndromes that are considered part of a spectrum. Listed from most
mild to most severe, these syndromes include:
Type A insulin resistance syndrome: In people with Type A insulin resistance

syndrome, insulin resistance impairs blood sugar regulation and ultimately
leads to diabetes. The insulin resistance and other symptoms often don’t
become apparent until puberty or later. It’s generally not life-threatening.
Rabson-Mendenhall syndrome: People who have Rabson-Mendenhall

syndrome are unusually small starting before birth, and affected infants
experience failure to thrive, which means they don’t grow and gain weight at
the expected rate. People with Rabson-Mendenhall syndrome develop signs
and symptoms early in life and live into their teens or 20s. Death usually
results from complications related to diabetes.
Donohue syndrome: People with Donohue syndrome are unusually small

starting before birth, and affected infants experience failure to thrive.
Additional symptoms that become apparent soon after birth include a lack of
fatty tissue under the skin, wasting (atrophy) of muscles and excessive bodyAd
hair growth (hirsutism). Most children with this condition don’t survive beyond
age 2.
Other inherited conditions that cause insulin resistance include:
Myotonic dystrophy: This is a form of muscular dystrophy that affects your

muscles, eyes and endocrine system organs, which includes your pancreas.
Muscle insulin sensitivity is decreased by about 70% in people with myotonic
dystrophy, which leads to insulin resistance.
Alström syndrome: This is a rare inherited condition that’s characterized by a

progressive loss of vision and hearing, dilated cardiomyopathy, obesity, Type
2 diabetes and short stature.
Werner syndrome: This is a rare progressive disorder that’s characterized by

the appearance of unusually accelerated aging (progeria). It affects many
aspects of your body, including abnormal production of insulin and resistance
to the effects of insulin.
Inherited lipodystrophy: This is a condition in which your body doesn’t use

and store fat properly. The main cause of insulin resistance in lipodystrophy is
that excess glucose cannot be stored in fat tissue.
Diagnosis and Tests

How is insulin resistance diagnosed?
Insulin resistance is difficult to diagnose because there isn’t routine testing for it,
and as long as your pancreas is producing enough insulin to overcome the
resistance, you won’t have any symptoms.
As there’s no single test that can directly diagnose insulin resistance, your
healthcare provider will consider several factors when assessing insulin
resistance, including your:
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Medical history.
Family history.
Physical exam.
Signs and symptoms.
Test results.
What tests will be done to evaluate insulin resistance?

Your healthcare provider may order the following blood tests to diagnose insulin
resistance and/or prediabetes or diabetes:
Glucose: A fasting plasma glucose (FPG) or a glucose tolerance test (GTT)

may be used to screen for, diagnose and/or monitor prediabetes, type 2
diabetes or gestational diabetes.
Glycated hemoglobin A1c (A1c): This test reveals your average blood glucose
levels over the past three months.
Lipid panel: This is a group of tests that measure specific lipids in your blood,
such as total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.
Your healthcare provider may also order tests that can help diagnose other
conditions that are associated with insulin resistance, such as metabolic
syndrome, cardiovascular disease and polycystic ovary syndrome (PCOS).
Management and Treatment

How is insulin resistance treated?
Since not all factors that contribute to insulin resistance can be treated, such as
genetic factors and age, lifestyle modifications are the primary treatment for
insulin resistance. Lifestyle modifications include:
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Eating a healthy diet: Your healthcare provider or nutritionist may recommend
avoiding eating excessive amounts of carbohydrates (which stimulate excess
insulin production) and eating less unhealthy fat, sugar, red meats and
processed starches. Instead, they’ll likely recommend eating a diet of whole
foods that includes more vegetables, fruits, whole grains, fish and lean
poultry.
Physical activity: Getting regular amounts of moderate-intensity physical

activity helps increase glucose energy usage and improve muscle insulin
sensitivity. A single session of moderate-intensity exercise can increase
glucose uptake by at least 40%.
Losing excess weight: Your healthcare provider may recommend trying to

lose excess weight to try treating insulin resistance. One study revealed that
losing 7% of your excess weight can reduce the onset of Type 2 diabetes by
58%.
Over time, these lifestyle modifications can:
Increase insulin sensitivity (reduce insulin resistance).
Lower your blood glucose levels.
Decrease blood pressure.
Decrease triglyceride and LDL (“bad”) cholesterol levels.
Raise HDL (“good”) cholesterol levels.
You may work with other healthcare providers, such as a nutritionist and
endocrinologist, in addition to your regular doctor to come up with an
individualized treatment plan that works best for you.
What medications are used to treat insulin resistance?

While there are currently no medications that treat insulin resistance specifically,
your healthcare provider may prescribe medications to treat coexisting Ad
conditions. Some examples include:
Blood pressure medication.
Metformin for diabetes.
Statins to lower LDL cholesterol.
Can I reverse insulin resistance?

Insulin resistance has several causes and contributing factors. While lifestyle
changes, such as eating a healthy diet, exercising regularly and losing excess
weight, can increase insulin sensitivity and decrease insulin resistance, not all
causes are reversible.
Talk you your healthcare provider about what you can do to best manage insulin
resistance.
How can diet affect insulin resistance?

Your diet has a big impact on your blood sugar and insulin levels. Highly
processed, high-carbohydrate and high-fat foods require more insulin.
In general, eating foods that have a low to medium glycemic index and limiting
foods that have a high glycemic index can help you reverse and/or manage
insulin resistance. Eating foods with fiber also helps regulate blood sugar levels
because it takes your body longer to digest fiber, meaning your blood sugar levels
don’t spike as much.
The glycemic index (GI) is a measurement that ranks foods containing

carbohydrates according to how much they affect your blood sugar levels. The
Glycemic Index Foundation (GIF) classifies the GI of foods as either low, medium
or high, with pure glucose generally as a reference at 100:
Low GI: 55 or less.

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Medium GI: 56–69.
High GI: 70 or greater
High-GI foods generally have a lot of carbohydrates and/or sugar and low to no
fiber content. Low-GI foods generally have low amounts of carbohydrates and
higher amounts of fiber.
Examples of foods with a high GI include:
White bread.
Potatoes.
Breakfast cereals.
Cakes and cookies.
Fruits such as watermelon and dates.
Examples of foods with a low GI include:
Beans and legumes.
Fruits such as apples and berries.
Non-starchy vegetables, such as asparagus, cauliflower and leafy greens.
Nuts.
Dairy, fish and meat.
Always talk to your healthcare provider before making extreme changes to your
diet.
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Prevention
What are the risk factors for developing insulin resistance?
Certain genetic and lifestyle risk factors make it more likely that you’ll develop
insulin resistance or prediabetes. Risk factors include:
Overweight or obesity, especially excess fat around your belly.
Being age 45 or older.
A first-degree relative (parent or sibling) with diabetes.
Having a sedentary lifestyle.
Certain health conditions, such as high blood pressure and abnormal

cholesterol levels.
A history of gestational diabetes.
A history of heart disease or stroke.
Having a sleeping disorder, such as sleep apnea.
Smoking.
People of the following racial or ethnic backgrounds are also at a higher risk of
having insulin resistance or prediabetes:
Asian American.
Black.
Hispanic/Latino.
Indigenous people from Alaska.
Indigenous people from the continental United States.

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Indigenous people from the Pacific Islands.
Although you can’t change certain risk factors for insulin resistance, such as
family history or age, you can try lowering your chances of developing it by
maintaining a healthy weight, eating a healthy diet and exercising regularly.
Outlook / Prognosis
What is the prognosis (outlook) for insulin resistance?
The prognosis (outlook) of insulin resistance depends on several factors,
including:
The cause of insulin resistance.
The severity of insulin resistance.
How well your insulin-producing cells are working.
How susceptible you are to developing complications from insulin resistance.
Adherence to treatment and your body’s response to treatment.
People can have mild insulin resistance that never turns into prediabetes or Type
2 diabetes. People can also have insulin resistance that’s reversible or very
manageable with lifestyle changes. For some people who have inherited
conditions that cause severe insulin resistance, it can be life-threatening or lead
to death.
If you have insulin resistance, ask your healthcare provider about what you can
expect and how best to manage it.
What are the complications of insulin resistance?

The majority of the complications that can result from insulin resistance are
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related to the development of vascular (blood vessel) complications due to
elevated blood sugar levels and elevated insulin levels (hyperinsulinemia).
Not everyone who has insulin resistance will have complications. If you’ve been
diagnosed with insulin resistance, Type 2 diabetes or metabolic syndrome, it’s
important to see your healthcare provider regularly and follow your treatment plan
to try to prevent these complications.
Living With
When should I see my healthcare provider about insulin
resistance?
If you’ve been diagnosed with insulin resistance or conditions related to insulin
resistance, it’s important to see your healthcare provider regularly to make sure
your blood sugar levels are in a healthy range and that your treatment is working.
If you’re experiencing symptoms of high blood sugar or prediabetes, contact your

healthcare provider. They can run simple tests to check your blood sugar levels.
If you have a family history of diabetes or conditions that can cause insulin
resistance, talk to your healthcare provider about your risk of developing insulin
resistance.
What questions should I ask my doctor?

If you’ve been diagnosed with insulin resistance, it may be helpful to ask your
healthcare provider the following questions:
What’s causing my insulin resistance?
What can I do to increase my insulin sensitivity?
What’s my risk of developing prediabetes or Type 2 diabetes?
Is there any medication I can take? Ad
Should I see a specialist for insulin resistance?
A note from Cleveland Clinic
Insulin resistance is a complex condition that can affect your health in several
ways. Since it doesn’t have any symptoms until it turns into prediabetes or Type 2
diabetes, the best thing you can do is try to prevent and reverse insulin resistance
by maintaining a healthy weight, exercising regularly and eating a healthy diet.
Unfortunately, though, not all causes of insulin resistance can be prevented or
treated. If you have any questions about your risk of developing insulin resistance
or conditions associated with it, talk you your healthcare provider. They’re there to
help you.
Medically Reviewed
Last reviewed by a Cleveland Clinic medical professional on 12/16/2021.

Learn more about our editorial process.
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1/31/24, 7:44 PM Insulin Resistance: What It Is, Causes, Symptoms & Treatment

Contents Overview Symptoms and Causes Diagnosis and Tests

Management and Treatment Prevention Outlook / Prognosis Living With

What Is Insulin Resistance?

What is insulin resistance?

Under normal circumstances, insulin functions in the following steps:

Glucose enters your bloodstream, which signals your pancreas to release

In addition to Type 2 diabetes, insulin resistance is associated with several other

Nonalcoholic fatty liver disease.

Polycystic ovary syndrome (PCOS).

Cleveland Clinic is a non-profit academic medical

What is the difference between insulin resistance and

Gestational diabetes is a temporary form of diabetes that can happen during

An A1c level below 5.7% is considered normal.

An A1c level between 5.7% and 6.4% is considered prediabetes.

An A1c level of 6.5% or higher on two separate tests indicates type 2

Who does insulin resistance affect?

How common is insulin resistance?

prediabetes. That’s about 1 out of every 3 adults.

How does insulin resistance affect my body?

Hyperinsulinemia is also associated with the following conditions:

Higher triglyceride levels.

Hardening of the arteries (atherosclerosis).

High blood pressure (hypertension).

Features of metabolic syndrome include:

Elevated blood glucose levels.

An elevated triglyceride level.

Low levels of high-density lipoprotein (HDL) cholesterol.

High blood pressure.

Symptoms and Causes

Symptoms of high blood sugar include:

Frequent urination (peeing).

Vaginal and skin infections.

Slow-healing cuts and sores.

Skin tags (small skin growths).

Eye changes that can lead to diabetes-related retinopathy.

If you’re experiencing any of these symptoms, it’s important to see your

What causes insulin resistance?

Acquired causes of insulin resistance

Physical inactivity: Physical activity makes your body more sensitive to

Diet: A diet of highly processed, high-carbohydrate foods and saturated fats

Certain medications: Certain medications can cause insulin resistance,

Hormonal disorders that can cause insulin resistance

Cushing’s syndrome: This condition happens when there’s extra cortisol in

Hypothyroidism: This condition happens when your thyroid is underactive and

Genetic conditions that cause insulin resistance

There’s a group of rare related conditions described as inherited severe insulin

Type A insulin resistance syndrome: In people with Type A insulin resistance

Rabson-Mendenhall syndrome: People who have Rabson-Mendenhall

Donohue syndrome: People with Donohue syndrome are unusually small

Other inherited conditions that cause insulin resistance include:

Myotonic dystrophy: This is a form of muscular dystrophy that affects your

Alström syndrome: This is a rare inherited condition that’s characterized by a

Werner syndrome: This is a rare progressive disorder that’s characterized by

Inherited lipodystrophy: This is a condition in which your body doesn’t use

Diagnosis and Tests

Signs and symptoms.

What tests will be done to evaluate insulin resistance?

Glucose: A fasting plasma glucose (FPG) or a glucose tolerance test (GTT)

Management and Treatment

Physical activity: Getting regular amounts of moderate-intensity physical

Losing excess weight: Your healthcare provider may recommend trying to