Most people would presume chronic diseases come with flashing indicators such as hyperglycemia, high blood pressure, abnormal levels of cholesterol, and other such parameters in a blood test. But for millions, especially in urban India, most chronic illness starts silently and without much visibility. Very often, the earliest signs are subtle: an afternoon slump in energy, stubborn belly fat, increasing sugar cravings, or inability to lose weight despite eating ‘healthily.’
Most of these symptoms are not taken seriously because they are thought to be due to stress or getting older, or just being out of shape. But behind the scenes, it may already create a complex metabolic imbalance. It is this ‘hidden’ dysfunction called insulin resistance that makes it one of the most ‘under-diagnosed’ and ‘misunderstood’ contributors to modern chronic diseases.
Insulin resistance is not one illness; rather, it is a metabolic condition that over time starts silently damaging the body, quite often for years prior to any clinical diagnosis. By the time the sugar level in the blood rises or a diagnosis of type 2 diabetes is received, the body has been struggling with impaired insulin signaling for many years.
The real ‘problem’ with insulin resistance is being subtle. Much less commonly, it does not cause pain and, unfortunately, does not appear in routine tests. Yet, silently, it is setting the stage for conditions such as diabetes, heart disease, fatty liver, PCOS — even cognitive decline.
To understand insulin resistance, we need to first understand what insulin is. Insulin is a hormone that is secreted by the pancreas and has a function in controlling the level of sugar in the blood. On consumption of food, particularly carbohydrates, sugar levels in the blood surge up. In response, the pancreas secretes insulin to carry the glucose across to cells, most muscles, the liver, and a little to fats. They either utilize it for energy or store it for later use.
This occurs in a healthy body. The problem arises when, after years of over-exposure to especially high levels of sugar and refined carbohydrates, the cells within the body ignore the signal of insulin. One may compare it to a key attempting to open a door. In insulin resistance, the locks have rusted. The key remains, but the door does not open as easily as before.
In response, the body produces even more insulin to catapult glucose into the cells, causing hyperinsulinemia – chronically high levels of insulin in the blood on an ongoing basis. For a while, this does work as blood sugar stays in the normal range, and the usual blood tests may still look “fine.” However, inside the body, high insulin is already doing damage, promoting fat storage, a lot of inflammation, and edging the body towards metabolic collapse.
Eventually, the pancreas loses the race, and sugar levels in the blood start to rise. This is when pre-diabetes or type 2 diabetes is diagnosed, but the actual trouble had begun much earlier.
South Asians, especially Indians, are far more prone to insulin resistance as compared to several other populations. Research consistently shows an earlier and faster progression of insulin resistance, even at lower weights in this group.
This phenomenon is often called the “South Asian phenotype” or “thin-fat” body type. Individuals could appear slim or with a normal BMI but carry extra visceral fat around the organs with lower muscle mass, all contributing to increased insulin resistance. Meanwhile, studies proposed that beta cells in the pancreas, producing insulin, work lesser in efficacy among South Asians, leading to an earlier dysfunction.
A 2014 study published in The Lancet Diabetes & Endocrinology highlighted that South Asians are more insulin resistant than white Europeans at every level of BMI. Another 2020 review in Diabetes Research and Clinical Practice emphasized that genetic predisposition, diet, early-life malnutrition, and rapid urbanization all contribute to this increased risk.
In practical terms, this means that a South Asian adult in their 30s or 40s could already have significant insulin resistance, even if they are not overweight, have normal blood sugar, and feel relatively healthy.
This is why early awareness and proactive testing are so critical.
Insulin resistance does not spring up suddenly or spontaneously; it builds up slowly from the interplay between daily lifestyle habits and genetic predisposition. Though genes may have their say, indeed, it is largely through lifestyle factors that most people are affected. Conditions of the modern urbanized way of life set the perfect stage for insulin resistance to thrive.
Major contributors to insulin resistance are high intake of refined carbohydrates. Staples in the general urban diet include white rice, white bread, sugary snacks, packaged cereals, and sweetened beverages. It raises a condition known as quick spikes in blood sugar that most of these foods precipitate by consuming them, necessitating large amounts of insulin to be continuously supplied by the body to keep the sugar levels down.
Eventually, this constant demand wears the system out. Also, processed foods usually don’t have much fiber or protein—two nutrients that play big roles in keeping blood sugar steady. Meals that are easy to prepare and not focused on being nutrient-dense can hurt metabolism even if the calorie counts look reasonable.
Muscles are among the tissues most responsive to insulin, like a sponge drawing up glucose after meals. However, with increased periods of inactivity on chairs and in cars, muscle mass drops. Not only does this reduce the metabolic rate, but it also reduces the capacity of the body to use glucose properly.
Sarcopenia, the loss of muscle mass that comes with aging, further exacerbates this problem;; by their late 30s or 40s, most people already have a reduced metabolic rate, regardless of how steady their weight might appear.
Long-term stress lets cortisol out. Cortisol is a hormone that raises the level of sugar in the blood and makes insulin resistance stronger. For many people, low-grade stress that does not ever stop—such as work, financial pressure, or digital overload—creates background noise that throws off metabolic balance.
Cortisol also has an effect on the quality of sleep, increases cravings for sugary or fatty foods, and allows fat to be stored around the abdomen, which increases insulin resistance even more.
Sleep is a major and often disregarded factor in the regulation of insulin sensitivity. Just a small number of nights with poor rest can bring about poor response to insulin and increased inflammation. Things like shift work, screen time late at night, and irregular sleep times cause misalignment in the circadian rhythm—the body’s internal clock that controls cycles of many hormones.
When sleep is irregular, insulin function suffers. And in the long term, poor sleep hygiene becomes a compounding factor in metabolic dysfunction.
Family history is not ‘destiny’. If your parents or close relatives have diabetes or heart disease, you are more likely to develop insulin resistance. The genetic code does not determine fate. What we inherit is a predisposition, not a certainty. Lifestyle choices can either trigger or mute this risk.
For South Asians, where a family history of diabetes runs in families, being aware and getting in early matters most.
Insulin resistance takes place in the participation of different body systems. When it sets in, it can easily destabilize fat storage, energy management, hormone regulation, and inflammation control. With time, insulin resistance is seen as a shared pathway to several chronic conditions.
Most people think of diabetes as just a problem with high blood sugar. By the time sugar in the blood goes up, insulin resistance can already be there for many years. In most cases, the body makes more insulin to help out with bad sensitivity to insulin until the pancreas cannot keep up anymore. This is what finally lets high blood sugar get inside the picture.
When it can’t keep up any longer, then sugar in the blood starts to rise. Diabetes is not the initial but rather the ultimate stage of long periods of metabolic stress. Insulin resistance is the real culprit behind the scenes.
Insulin does more than its common job related to blood sugar; it also meddles with blood vessels, ways cholesterol moves, and inflammation. Higher levels of insulin create more small dense LDL bits, which are a nastier type of “bad” cholesterol. This action lowers HDL (“good” cholesterol) and raises triglycerides, altogether increasing heart disease risk.
Insulin resistance also contributes to endothelial dysfunction-impaired function of the inner lining of blood vessels, making them more susceptible to plaque buildup and atherosclerosis. This explains why individuals with insulin resistance have significantly increased risks for heart attacks and strokes long before they ever develop diabetes.
Insulin is a fat-storage hormone. When it stays high all the time, this will make the body good at storing fat, particularly in the belly area. This brings about central obesity or visceral fat, which is very active metabolically and highly correlated with inflammation, plus fatty liver disease, as well as hormonal imbalances.
Many people with insulin resistance struggle to lose weight—not because of willpower, but because their metabolic hormones are working against them.
In the condition of women, insulin resistance has much to do with Polycystic Ovary Syndrome (PCOS). High levels of insulin can prompt the ovaries to produce more androgens (male hormones), thus resulting in irregular periods, acne problems, and issues related to fertility. Treating insulin resistance is one of the best ways to manage symptoms related to PCOS.
Non-alcoholic fatty liver disease is an early indicator of insulin resistance. This condition results from the accumulation of excess fat in the liver, typically among people who are non-alcoholics. High levels of insulin in the body help in more ways than one to add and build up this fat, as well as create low-grade inflammation that can fuel other chronic diseases.
Studies show that approximately 60 to 70 percent of individuals with insulin resistance have fatty liver. Sometimes, it can be just silent and does not show up through the normal enzyme levels in blood tests.
Recent studies show that insulin resistance has effects on the brain too. Increasingly, Alzheimer’s disease is being described as “type 3 diabetes” because it is so profoundly linked to disrupted insulin signaling in the brain. In fact, insulin has important functions for the health of brain cells and for memory and cognition. When the cells of the brain become insulin-resistant, there is an increased potential for cognitive decline.
Looking at chronic disease from the perspective of insulin resistance shows that it’s not about different problems͏, but rather the same dysfunction in one system manifesting through different organs. Be it diabetes, heart disease, PCOS, fatty liver, or cognitive decline, the metabolic root is often the same.
This puts Insulin resistance as a very important condition to identify and treat early on in terms of practicing the most effective forms of preventive medicine available today. When viewed through the lens of insulin resistance, chronic disease starts to look less like a set of separate problems and more like a single, systemic dysfunction playing out in different organs. Whether it manifests as diabetes, heart disease, PCOS, fatty liver, or cognitive decline, the metabolic root is often the same.
This is why identifying and addressing insulin resistance early is one of the most powerful forms of preventive medicine available today.
These are not random symptoms. Tiredness and cravings, weight gain, and skin tags. This is what a body under metabolic stress will present. If not caught in time, insulin resistance gradually develops into diabetes. And heart disease. PCOS. Fatty liver or something even more sinister.
So the real question is this:
Could you be metabolically at risk—even if your lab reports say you’re “normal”?
At Longeny, we believe prevention begins with awareness and early detection.
In Part 2, we explore how to uncover and reverse insulin resistance before it becomes a disease. Learn about the blood test that has been ignored, which could save you years of illness in the future, and find out what it really takes to reverse insulin resistance, sustainably and for life.
Ready to go deeper?
Learn how to detect insulin resistance early and reverse it before it becomes a chronic disease — [read Part 2 here].
