My last post was about the basic biology of insulin resistance and about how it is the underlying root cause of type 2 diabetes, as well as a risk factor in its own right for many diseases. 

Today I’m going to answer the question of how to tell if you have insulin resistance. 

First, there are a large number of findings that can suggest you have insulin resistance. None of these are in and of themselves 100% diagnostic, but the more of these that you have, the more likely you are to have at least some insulin resistance. The most common of these are the following:

1. Abdominal obesity – to determine if you have this, take a tape measure and get a circumference of your body at the level of your belly button. Then do the same at the widest part of your hips. Divide the waist measurement by the hip measurement. If this measurement is greater than 0.9 for men or 0.8 for women, then you meet the criteria for abdominal obesity, meaning that you store excessive fat in your abdomen. Note that you can be a normal weight overall, but still meet the criteria for abdominal obesity. 
2. High blood pressure
3. Fatty liver – typically this is picked up incidentally on imaging, or else when a doctor notices that liver function numbers are abnormal on routine labwork. 
4. Low HDL cholesterol
5. Elevated triglycerides
6. PCOS (Polycystic Ovary Syndrome) – the most common cause of irregular menses for women
7. Elevated blood sugar
8. Elevated Hemoglobin a1c

Even without any additional testing, a patient who has at least three of the above findings almost certainly has insulin resistance. 

There are two more direct ways to check for insulin resistance, and I utilize both of them frequently in my practice, and in fact already discussed them in my post entitled Tests You Should Have – But (Probably) Haven’t. 

The first is a blood test to check a fasting insulin level. There’s some nuance to interpreting this result, but if your fasting levels of insulin are above normal (or even in the higher range of normal) on multiple checks over time, you almost certainly have insulin resistance. 

The other way is to visualize your internal abdominal cavity. Almost all people with insulin resistance have an excess of visceral fat, the dangerous type of fat that is hidden deep inside the body and covers the key organs such as the heart, liver, kidneys, and intestines. Here at Dr. Fischer, MD, I will soon have a Styku body composition scanner that will allow me to perform this test on any of my patients multiple times per year, at no extra charge to them. 

So you should now understand the basics of what insulin resistance is and how it is diagnosed. But that still leaves the question of what to do about it. That will be the topic of my next blog post. 

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Originally posted on March 20, 2024