Plans for Your Body · Blood sugar & insulin
The insulin resistance plan
Normal blood sugar. High insulin. That’s the problem.
The goal: Insulin resistance shows up in your insulin, triglycerides and waist years before it shows up in your blood sugar. Test fasting insulin, not just glucose. Then lower it: cut sugar and refined carbs, eat in a window, fast once a week, lift, walk and sleep. Retest at 3 months, before it becomes prediabetes.
Most check-ups test glucose and stop there. Glucose is the last thing to go: for years your pancreas keeps it normal by pouring out more insulin. By the time the sugar number moves, you’ve been insulin resistant for a long time. This plan finds it early, from numbers you may already have, and brings the insulin down while that’s still easy.
- MeasureFasting insulin and glucose (HOMA-IR) · TG/HDL · waist · HbA1c
- ChangeCut refined carbs · eating window · weekly 36-hour fast · strength, walking, sleep
- RetestFasting insulin and lipids at 3 months; it moves faster than HbA1c
Prediabetes is the late sign. This is the early one.
Not medical advice
Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.
02 Why it matters
The quiet years are the cheap ones.
The default
Normal glucose, so nothing happens. Meanwhile the insulin rises, the waist grows, triglycerides creep up and HDL drifts down. Nobody connects them because each one is only “a bit off”.
What it drives
Insulin resistance sits underneath prediabetes, type 2 diabetes, fatty liver, high blood pressure, PCOS and the lipid pattern that raises heart risk. Gerald Reaven tied the blood pressure, triglyceride and HDL parts together in his 1988 Banting lecture; the link has held up. Improve it and several of those often move together.
The upside
It responds fast. In one controlled trial, eating in a six-hour daytime window improved insulin sensitivity in men with prediabetes without any weight loss. One short night of sleep pushes it the other way just as quickly.
It isn’t a diagnosis yet. That’s the point.
03 How it works
Your cells stop listening, so the pancreas shouts.
Insulin moves glucose into muscle, liver and fat, and tells the body to store rather than burn. When the liver and muscle are already full, especially with fat, they respond less. The pancreas compensates with more insulin. Glucose stays normal; insulin stays high; high insulin keeps the body in storage mode. That loop is what this plan breaks.
- Fasting insulin
- The direct reading. High fasting insulin with normal glucose means you’re compensating. Most labs give a wide “normal” range; lower is better, and your own trend matters most.
- HOMA-IR
- Fasting glucose and fasting insulin combined into one score. Developed in Oxford in 1985 and validated against the gold-standard clamp test. Cheap, simple, and good enough to track.
- Triglycerides and HDL
- High insulin pushes the liver to make triglycerides and drags HDL down. In Reaven’s Stanford group, triglycerides and the TG/HDL ratio picked out insulin-resistant overweight adults about as well as fasting insulin, with a ratio of about 3 (mg/dL) as the cut-off. A clue, not a diagnosis, and it’s on any lipid panel.
- Waist
- Visceral fat, around the organs, is both a cause and a result of high insulin. Waist more than half your height is the cheapest warning sign there is.
- Muscle
- The biggest place to store glucose, and often where resistance starts. Shulman’s Yale group found that young, lean, insulin-resistant people stored far less of a carb-heavy meal in muscle, and their livers turned more of it into fat, raising triglycerides. Muscle also becomes more sensitive fastest when you use it, which makes training the most direct fix in this plan.
04 The steps
Measure. Lower insulin. Retest at 3 months.
Measure · Week 0
Find out how hard your pancreas is working.
- Fasting insulin and glucosemorning, after an overnight fast
Together they give HOMA-IR, a simple insulin-resistance score. Fasting insulin often isn’t covered in Canada. It’s cheap to pay for. If your lab reports insulin in pmol/L (most Canadian labs do), divide by about 6 to get µU/mL for the HOMA-IR formula.
- Lipid paneltriglycerides and HDL
Divide triglycerides by HDL. In mmol/L, under 0.9 is good and over about 1.3 suggests insulin resistance (under 2 and over 3 in mg/dL).
- Waisttape measure, at the belly button
More than half your height means visceral fat. Canadian cut-offs for abdominal obesity are 102 cm for men and 88 cm for women, lower (90 and 80) for people of South Asian, Chinese and Japanese descent.
- HbA1c and blood pressureto rule things in or out
HbA1c of 6.0% or more is prediabetes in Canada: switch to that plan. Blood pressure of 130/85 or more is part of the same cluster.
Change the inputs · Months 1–3
Fewer insulin spikes, longer gaps between them.
- Sugar and refined carbscut hard
Sugar, sweet drinks, juice, white flour and most packaged snacks. The fastest lever on insulin, blood sugar and triglycerides. Each spike needs insulin to clear it. Fewer spikes, less insulin, and the cells start responding again.
- Real foodprotein first
Build meals on protein, vegetables and natural fats: fish, meat, eggs, dairy, legumes, nuts. Protein and fibre keep you full and flatten glucose spikes.
- Eating windowdaily, e.g. noon to 8 pm
Eat inside a fixed window and not outside it. Fewer insulin spikes per day, fewer chances to overeat. Earlier is better if you can: in the Sutton trial, finishing eating by mid-afternoon improved insulin sensitivity without weight loss.
- 36-hour fastonce a week
Dinner one day, then only water, black coffee or tea until breakfast two days later. A standard protocol in Dr. Fung’s clinic: long enough for insulin to fall and the body to draw on stored fat. A pinch of salt helps with headaches. The longest stretch of low insulin in your week, and the one that draws hardest on liver fat.
- Trainingstrength 2–3×/week, cardio 150+ min/week
Lift, and walk briskly or cycle most days. Muscle is where most of a meal’s glucose ends up, so more muscle means more room for it. Cardio makes that muscle more sensitive to insulin. Lifting is the priority here. Working muscle takes up glucose with less insulin, and the effect lasts for a day or two after each session. In a small study from Shulman’s lab, one 45-minute workout tripled how much of a meal went into muscle and cut the liver’s fat-making by about a third.
- Sleep7+ hours
One short night measurably worsens insulin sensitivity, blood sugar and appetite the next day. The cheapest part of the protocol, and the most skipped. In a Dutch clamp study, one night of four hours’ sleep cut insulin sensitivity by roughly a fifth in healthy people.
- Alcoholnone while fixing the numbers
It goes straight to the liver, raises triglycerides and adds to liver fat. Less is better; none is best while you’re fixing the numbers.
Before you fast
Don’t do extended fasts if you’re on insulin or other diabetes medication, pregnant, breastfeeding, underweight, or have a history of eating disorders, unless your doctor approves.
Supplements · optional, with your doctor’s OK
One that helps the meal. Two that help the numbers.
- Psyllium husk~5 g, twice a day, with a full glass of water
A soluble fibre. Always with plenty of water: taken dry, it can choke or block. Before meals, it slows how fast carbohydrates reach your blood, so the insulin response is smaller.
Find it on Amazon: Psyllium husk - Berberine500 mg, twice a day, with meals
A plant compound studied for blood sugar and lipids; about 1 g a day worked best in pooled trials. Stomach upset is common. It interacts with several medications, adds to the effect of diabetes drugs, and isn’t for pregnancy or breastfeeding. Pooled trials found lower fasting glucose and insulin. Food and training come first.
Find it on Amazon: Berberine - Magnesium~300–400 mg a day of elemental magnesium, with food
Lowered blood pressure by about 2 mmHg in pooled trials, and modestly improved blood sugar in people with or at risk of diabetes. Small, but cheap and safe for most. Loose stools are the usual side effect. Avoid with kidney disease, and take it a few hours apart from thyroid pills, osteoporosis pills and some antibiotics. Improved insulin sensitivity in people at risk of diabetes. Small, but cheap.
Find it on Amazon: Magnesium
Retest · Month 3
Insulin moves first. Check it.
- Fasting insulin, glucose and lipidssame lab, same time of day
Recalculate HOMA-IR and TG/HDL. Both can move within weeks; three months gives a fair read. Use the same lab: insulin assays differ between labs.
- Waistmonthly
Visceral fat often goes before the scale shows much. The tape is the better tool.
- If you’re back in rangemaintenance
Keep the training and the window; the weekly fast can become occasional. Retest yearly.
- If the numbers won’t moveyour doctor
Take the before-and-after numbers to your doctor. Whether you need medication is their call. Needing it isn’t failure. If HbA1c reaches 6.0%, or fasting glucose 6.1 mmol/L (110 mg/dL), it’s now prediabetes, and that plan takes over.
05 The rules
Short list. No exceptions.
Choose
- Protein and vegetables at every meal
- A fixed eating window, ideally finishing early
- Strength training 2–3 times a week, and a walk after your biggest meal
- 7+ hours of sleep, at roughly the same times
Avoid
- Sugar, sweet drinks, juice and white flour
- Grazing. Every snack is another insulin release
- Judging yourself by fasting glucose alone
- Late-night eating
Non-negotiables
- Get fasting insulin measured, not just glucose.
- Talk to a medical doctor before you fast or start a supplement.
- If you smoke, quit. It worsens insulin resistance, and quitting cuts the extra heart risk it adds, fast at first, though that risk stays above a never-smoker’s for years.
- Retest at 3 months, at the same lab.
06 Checkpoints
What to track, and what good looks like.
There’s no official diagnosis of insulin resistance, so there are no official targets. These are the cut-offs used in research and by insulin-focused clinicians. Your doctor reads them with you.
| What | Target | How and when |
|---|---|---|
| HOMA-IR | Under ~1.0 is ideal; over ~2 to 2.5 suggests insulin resistance | Fasting glucose (mmol/L) × fasting insulin (µU/mL) ÷ 22.5. Cut-offs vary by population. |
| Fasting insulin | No agreed cut-off; lower is better, single digits (µU/mL) is a common goal | Morning, after an overnight fast. Same lab every time. |
| TG/HDL ratio | <0.9 (mmol/L) · <2 (mg/dL) | From your lipid panel. |
| Triglycerides | <1.7 mmol/L (150 mg/dL) | Fasting lipid panel. Higher is part of the metabolic syndrome definition. |
| Waist-to-height | <0.5 | Waist at the belly button divided by height, same units. |
| HbA1c | <6.0% (Canada) · <5.7% (US) | To make sure insulin resistance hasn’t become prediabetes. Yearly. |
Converted values are rounded. Insulin results depend on the lab’s assay, so compare yourself with yourself, not with a number from the internet.
07 Where experts disagree
Where the experts don’t agree.
Nobody disputes that insulin resistance is real or that lifestyle change improves it. The fights are about what comes first, and whether you should be measuring it at all.
Does high insulin cause insulin resistance, or the other way round?
Insulin first: Bikman, Corkey
Too much insulin, from constant eating and refined carbs, is itself a cause. In her 2011 Banting lecture, Barbara Corkey laid out evidence that raised insulin can produce insulin resistance, and that lowering it can reverse it.
Overflow first: Shulman and the mainstream
Fat spilling into liver and muscle leaves fat by-products inside the cells that jam insulin’s signal. High insulin is mostly the pancreas compensating. Remove the excess fat and sensitivity usually returns.
Our read It’s probably a loop, with each feeding the other. The useful part: both camps break it the same way, by lowering intake and emptying the liver.
Is it the carbohydrates, or the calories?
Carbohydrate-insulin model: Ludwig
A diet high in fast-digesting carbohydrate drives insulin up, pushes calories into fat cells and leaves you hungry. Cutting the glycemic load addresses the cause.
Energy balance model: Hall and colleagues
The brain regulates intake and weight through many signals. Carbohydrate quality matters, but the carbohydrate-insulin model is too narrow, and controlled feeding studies don’t back its strongest claims.
Our read For insulin resistance specifically, cutting refined carbs lowers insulin directly and usually lowers intake too. You don’t need to settle the theory to use both effects.
Should you test fasting insulin at all?
Yes: insulin-focused clinicians
It’s the earliest signal you can get from a routine blood draw, years before glucose. Not testing it means waiting for damage.
Not routinely: guideline bodies, Reaven’s group
Insulin assays aren’t standardised, there’s no agreed cut-off, and screening guidance is built on glucose and HbA1c, which predict outcomes. Reaven’s group suggested triglycerides or TG/HDL as the practical screen for exactly that reason.
Our read Test it, at the same lab each time, and use it to track your own trend, not to diagnose. It’s a fuel gauge, not a verdict.
08 Limits
What no plan fixes.
Genes and ethnicity
Some people become insulin resistant at much lower weights, including many of South Asian, Indigenous, African and Hispanic descent. Same effort, different starting line.
Medications and conditions
Steroids, some antipsychotics and other drugs raise insulin resistance, as do conditions such as Cushing’s and some thyroid problems. If you take one or suspect one, this goes through your doctor.
It comes back
Sensitivity returns quickly, and leaves quickly. A few weeks of the old habits and the numbers follow. This is maintained, not cured.
The plan lowers your insulin. It doesn’t rewrite your genes.
09 Resources
Worth your time.
Why We Get Sick
The most readable case that insulin resistance sits under most chronic disease, and what lowers it.
Role of insulin resistance in human disease (Banting Lecture 1988)
The lecture that tied insulin resistance to blood pressure, triglycerides and HDL, and started the idea of the metabolic syndrome.
Mechanisms of insulin action and insulin resistance
The fat-overflow side of the argument, in full. Long and technical; skim the summary and figures.
Always Hungry?
The carbohydrate-insulin model, written for readers by the researcher who argues it.
The energy balance model of obesity: beyond calories in, calories out
The best statement of the other side. Worth reading so you know what the insulin camp is arguing against.
10 Questions
Questions, answered plainly.
How is insulin resistance different from prediabetes?
Insulin resistance comes first. Your blood sugar is still normal because your pancreas is making extra insulin to hold it there. Prediabetes is when even the extra insulin can’t keep up and glucose starts rising. Same road, later stop.
How do I know if I’m insulin resistant?
Ask for fasting insulin with your fasting glucose and calculate HOMA-IR. A high triglyceride-to-HDL ratio, a waist more than half your height and high blood pressure are strong clues you can get without any special test.
Can insulin resistance be reversed?
For most people it can be improved a lot, often quickly. Insulin sensitivity starts to improve within days to weeks of cutting refined carbs, fasting, training and sleeping enough. How far it goes depends on genes, age and how long it’s been building, and it stays improved only as long as the habits do.
Can thin people be insulin resistant?
Yes. Fat in the liver and around the organs matters more than weight, and Shulman’s studies found insulin-resistant muscle in young, lean adults. A normal BMI with a growing waist, high triglycerides or a family history of type 2 diabetes is worth testing.
What’s the best exercise for insulin resistance?
Both, but if you only pick one, lift. Muscle is where most glucose goes. Add walking, especially after meals.
Do I need medication?
There’s no approved drug for insulin resistance alone. If it has turned into prediabetes or diabetes, or comes with PCOS or fatty liver, ask your doctor what fits.
11 Sources
Where this comes from.
Experts drawn on
- Gerald Shulman, MD, PhD — Professor of medicine and cellular and molecular physiology, Yale. Mapped how fat inside muscle and liver cells causes insulin resistance.
- Gerald Reaven, MD (1928–2018) — Endocrinologist, Stanford. Defined insulin resistance syndrome in his 1988 Banting lecture; his group developed the TG/HDL screen.
- Benjamin Bikman, PhD — Professor of cell biology and physiology, Brigham Young University. Researches insulin resistance; author of Why We Get Sick.
- David Ludwig, MD, PhD — Endocrinologist, Boston Children’s Hospital and Harvard Medical School. Lead author of the carbohydrate-insulin model.
- Barbara Corkey, PhD — Professor emerita, Boston University. Gave the 2011 Banting lecture on hyperinsulinemia as cause rather than consequence.
- Kevin Hall, PhD — Metabolism researcher, long at the US National Institutes of Health. Lead author of the energy balance model.
Sources
- Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 1985.
- Role of insulin resistance in human disease (Banting Lecture 1988). Diabetes, 1988.
- Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals of Internal Medicine, 2003.
- The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome. Proceedings of the National Academy of Sciences, 2007.
- Reversal of muscle insulin resistance with exercise reduces postprandial hepatic de novo lipogenesis in insulin resistant individuals. Proceedings of the National Academy of Sciences, 2011.
- Mechanisms of insulin action and insulin resistance. Physiological Reviews, 2018.
- Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA, 2019.
- Harmonizing the metabolic syndrome: a joint interim statement. Circulation, 2009.
- Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Diabetes Canada Clinical Practice Guidelines.
- Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metabolism, 2018.
- A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. Journal of Clinical Endocrinology & Metabolism, 2010.
- Banting lecture 2011: hyperinsulinemia: cause or consequence?. Diabetes, 2012.
- The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. American Journal of Clinical Nutrition, 2021.
- The energy balance model of obesity: beyond calories in, calories out. American Journal of Clinical Nutrition, 2022.
- Keep the size of your waist to less than half of your height, NICE recommends. National Institute for Health and Care Excellence, 2022.
- Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis. American Journal of Clinical Nutrition, 2015.
- Effect of berberine on cardiovascular risk factors: systematic review and dose-response meta-analysis. Frontiers in Nutrition, 2022.
- Oral magnesium supplementation for treating glucose metabolism parameters in people with or at risk of diabetes: a systematic review and meta-analysis of double-blind randomized controlled trials. Nutrients, 2021.
Not medical advice
Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.