Insulin ResistanceWhat it is, and what we can do about it.

The condition that usually has no symptoms

Most conditions on this website announce themselves. You see a line, a patch of pigment, a vein. Insulin resistance generally does not. It is found on blood work, and a great many people carrying it feel perfectly well.

Insulin is the hormone that lets glucose move out of the blood and into muscle, fat and liver cells. In insulin resistance those cells respond poorly to it, so the pancreas compensates by producing more. For a while that works and blood glucose stays normal. The trouble is that the compensation is doing real work in the background, and eventually it cannot keep pace. That is the point at which prediabetes and then type 2 diabetes appear.

Being early in that sequence is the good news, not the bad news. It is the stage at which the most can still be changed.

The few things you might notice

There are a handful of visible signs, and two of them turn up in an aesthetics clinic more often than you would expect.

Acanthosis nigricans is velvety, darkened skin in the neck folds, the armpits or the groin. People regularly ask us to treat it as pigmentation. Lightening the surface does not touch what is producing it, and the honest answer is that the finding is a reason to have blood work rather than a reason to book a facial.

Multiple skin tags, particularly around the neck and underarms, are associated with it too. We remove skin tags here, and we will still remove them, but if somebody arrives with a lot of them and other risk factors, it is worth mentioning why.

Beyond that: weight that has become much harder to shift than it used to be, weight gathering around the middle in particular, and strong afternoon energy dips. All of them are non-specific on their own.

Why it happens

Excess weight around the abdomen is the strongest modifiable factor, and family history is a strong non-modifiable one. Polycystic ovary syndrome is closely associated with insulin resistance and is part of why weight, periods and skin so often move together in PCOS.

Physical inactivity matters more than most people assume, because working muscle takes up glucose largely without needing insulin to do it. Short or disrupted sleep and shift work both reduce insulin sensitivity. Gestational diabetes in a previous pregnancy is a recognised marker. Some medications, including steroids, contribute.

What we do about it here

We assess it through our medical weight loss program, which is prescriber-led rather than sold as a product. That means a consultation with our Nurse Practitioner, blood work where it is indicated, and a plan reviewed monthly.

The reason this sits in a weight program rather than in a skin one is that the interventions with the best evidence behind them are weight loss, activity and particularly resistance training, and those need following over months rather than recommending once. Where medication is clinically appropriate it is prescribed and monitored.

When this belongs with somebody else

If your blood work shows established diabetes, ongoing care belongs with your family physician or an endocrinologist. We can identify it, explain it and make sure it is followed up properly, and then we will send you to the right person. Symptoms suggesting very high blood sugar, such as heavy thirst, passing large volumes of urine, blurred vision or unexplained weight loss, need same-day medical attention rather than an appointment here.