Yes, it is possible, and it is common. Insulin resistance can be present for years while a standard blood sugar test still comes back normal. In his 1988 Banting Lecture, published in Diabetes, Stanford's Gerald Reaven estimated that roughly a quarter of apparently healthy, non-diabetic people were as insulin resistant as people who had already been diagnosed with type 2 diabetes. In other words, somewhere around 25 to 30 percent of people may be carrying significant insulin resistance without knowing it, because the body compensates by making more insulin and glucose stays in range for a long time.
What is insulin resistance, in plain language?
Insulin is the hormone that tells your cells to take glucose out of the bloodstream. Insulin resistance means your cells respond less readily to that signal. Your pancreas notices, and it does the obvious thing: it sends more insulin. For a while, that works. Blood glucose stays normal because insulin levels are quietly climbing to keep it there.
This is the part most people miss. A normal fasting glucose reading does not mean insulin is normal. It can mean your body is working much harder behind the scenes to produce that normal number. Reaven called this compensatory hyperinsulinemia, and it is the core of what he described as Syndrome X.
How common is insulin resistance?
Reaven's work suggested that insulin resistance is not a rare metabolic quirk but a widespread trait spread across the population. His estimate was that about 25 percent of non-diabetic people showed insulin resistance in the same range as people with type 2 diabetes. That framing changed how researchers think about metabolic disease: not a switch that flips on the day of diagnosis, but a spectrum that most people sit somewhere on.
If you are reading this and feeling reasonably healthy, that is exactly the point. A meaningful share of people who feel fine and test fine are further along this spectrum than they realise.
Why does insulin resistance show up before a diabetes diagnosis?
Because diagnosis is based on glucose, and glucose is the last thing to go. The sequence tends to run like this:
- Cells become less responsive to insulin.
- The pancreas compensates by producing more insulin.
- Blood glucose stays in the normal range, sometimes for years.
- Eventually compensation falls short, glucose starts to drift up, and a test finally catches it.
By the time a routine test flags prediabetes or diabetes, the underlying resistance has usually been building for a long stretch. That is not a reason for alarm. It is a reason to pay attention to insulin load now rather than waiting for a number to change.
What else does insulin resistance connect to?
Reaven's central insight was that insulin resistance rarely travels alone. He described a cluster that tends to appear together: insulin resistance, high circulating insulin, impaired glucose tolerance, raised triglycerides, low HDL cholesterol, and elevated blood pressure. He linked that cluster to cardiovascular disease risk.
This is why insulin resistance is worth treating as a common thread rather than a single item on a checklist. If several of those markers have been nudging in the wrong direction on your bloodwork over the years, they may not be six separate problems. They may be one.
What are the everyday signs worth noticing?
None of these confirm anything on their own, and only a clinician can assess you properly. But they are the patterns people tend to describe:
- A heavy crash an hour or two after a bread, pasta or cereal based meal.
- Hunger returning quickly after eating, even after a decent sized meal.
- Weight that accumulates around the middle and resists the usual efforts.
- Strong afternoon cravings for something sweet, at roughly the same time each day.
- Bloodwork where triglycerides have crept up and HDL has crept down.
If several of these sound familiar, it is worth asking your doctor about fasting insulin alongside the usual glucose and HbA1c, and about your triglyceride and HDL numbers.
How do you lower insulin load without changing everything at once?
The Insulin Fix score runs from 0 to 100, and a higher score means a lower insulin load. It weighs glycemic load, protein, fibre, how processed a food is, fat quality, liquid calories and the order you eat things in. You do not need the score to start. You need a handful of changes that shift those same levers.
- Food order. Eat vegetables and protein first, starch last. Same meal, different sequence. Research suggests this can blunt the glucose and insulin response to a meal.
- Low-glycemic swaps. Lentils or chickpeas instead of white rice. A whole orange instead of orange juice. Eggs and avocado instead of breakfast cereal. Sourdough or seeded rye instead of soft white bread.
- Movement after eating. A 10 to 15 minute walk after your largest meal. Muscle pulls glucose out of the blood without needing much insulin to do it.
- Cut liquid sugar first. Juice, sweetened coffee drinks and soda deliver sugar with no fibre to slow it down. This is usually the single highest-leverage change.
- Healthy fats and real food. Olive oil, nuts, oily fish, whole ingredients you could picture growing or walking around. Ultra-processed foods tend to drive a sharper response than their whole-food equivalents.
- A longer overnight gap. Finishing dinner earlier and delaying breakfast gives insulin a stretch of time to come down.
- 80/20. Get it right most of the time and stop auditing the rest. Perfection is the thing that makes people quit in week three.
What is the single best place to start?
Pick the meal you eat most predictably, usually breakfast or lunch, and fix that one. Change the order you eat it in and make one swap. Keep everything else exactly as it is. When that feels automatic, which usually takes a couple of weeks, add the post-meal walk. Insulin resistance took years to build. You are not going to undo it in a weekend, and you do not need to.
Frequently asked questions
Can I have insulin resistance if I am not overweight?
Yes. Reaven described insulin resistance as a trait distributed across the population rather than something confined to people with obesity. Body size is one signal, not the whole picture.
Will a normal HbA1c rule out insulin resistance?
Not reliably. HbA1c reflects average blood glucose, and glucose can stay normal for years while insulin levels are elevated to keep it there. Ask your clinician whether fasting insulin, triglycerides and HDL would add useful context.
Is insulin resistance reversible?
Insulin sensitivity can improve with changes to diet, movement and body composition, and many people see markers move in a better direction. How much improvement is possible varies a lot from person to person, so work with your doctor, especially if you take medication.
Do I need to give up carbohydrates?
No. The Insulin Fix approach is about glycemic load, fibre, protein, processing and food order, not elimination. Lentils, oats and whole fruit behave very differently from juice and white bread, even though all of them contain carbohydrate.