Insulin resistance: the signs, the tests and what to eat.

What is insulin resistance?

Insulin resistance means your cells don't respond well to insulin, so your pancreas has to make more of it to keep your blood sugar in range. It often comes before prediabetes and type 2 diabetes, and it can go unnoticed for a long time.

Here's how it works. When you eat roti, rice or a sweet cup of chai, the carbohydrate is broken down into sugar that enters your blood. Insulin is the hormone that moves that sugar into your muscles and liver to be used or stored. When the cells resist, the body makes extra insulin to push the sugar through.

For a while, that extra insulin keeps your blood sugar normal. If the pancreas can't keep up, blood sugar starts to rise, first into the prediabetes range and then, for some people, into type 2 diabetes.

For South Asians, the risk of type 2 diabetes starts at a lower weight. A University of Warwick study of 1.5 million people in England found that the type 2 diabetes risk seen at a BMI of 30 in white populations was reached at a BMI of 23.9 in South Asian populations. Our guide to a healthy BMI for South Asians explains what that means for you.

What are the signs of insulin resistance?

Many people have no obvious signs at all. When there are clues, they're easy to miss, and each one can have other causes. Treat these as possible signs, not a diagnosis:

• A bigger waist. Fat around the middle is linked to insulin resistance, even when your weight looks normal. For adults with a BMI under 35, NICE suggests keeping your waist to less than half your height. If you're 5 feet 4 inches (64 inches) tall, that means a waist under 32 inches. A waist-to-height ratio of 0.5 to 0.59 means increased central fat, and 0.6 or more is high.
• Dark, velvety skin in the folds of the neck or underarms. Doctors call this acanthosis nigricans. It isn't dirt, so scrubbing won't remove it.
• PCOS. In May 2026, PCOS was officially renamed polyendocrine metabolic ovarian syndrome (PMOS). The 'metabolic' part refers to insulin resistance, a key part of the condition for many women. Our PCOS diet plan covers this in detail.
• Blood tests in the prediabetes range, such as an HbA1c of 5.7 to 6.4%.

Family history matters too. If a parent, brother or sister has type 2 diabetes, it's worth asking your doctor about a check, even in your twenties.

How do you test for insulin resistance?

There's no single routine test for insulin resistance itself. Doctors usually start with HbA1c and fasting glucose, which show if your blood sugar has started to rise, and some also check fasting insulin. These are the American Diabetes Association ranges:

A diagnosis usually needs two abnormal results. WHO and NICE use slightly different prediabetes ranges, so your doctor may read a borderline result a little differently.

Testing matters in Pakistan. According to the IDF Diabetes Atlas, 26.9% of Pakistani adults with diabetes, about 9.3 million people, are undiagnosed. And Diabetes UK says that for people of Pakistani, Indian or Bangladeshi background, risk rises from age 25 rather than 40. A fasting blood test, done before your morning chai, is a simple place to start.

What should you eat for insulin resistance?

Regular meals built around protein and fibre, with a sensible portion of roti or rice and fewer sugary drinks. You don't need special foods, just a better balance of what's already in your kitchen.

Protein at every meal

Protein helps slow how quickly a meal raises your blood sugar, and it keeps you fuller. Have anda (eggs) at breakfast, daal or chicken at lunch, and fish, chana or dahi (plain yoghurt) at dinner. A paratha on its own is mostly flour and ghee; add an omelette and it becomes a different meal.

Fibre from daal, chana and sabzi

Masoor, moong, chana, lobia and rajma give you protein and fibre together. Let sabzi or salad fill half your plate at lunch and dinner, the same plate method we use in our diabetic diet plan, and choose chakki atta (stone-ground whole wheat flour) over maida.

Sensible roti and rice portions

Roti and rice can stay. A roti made from 30 g of atta is roughly 100 calories before ghee, and a cup of cooked rice roughly 200. Have one or the other at a meal, not both, and eat it with protein and sabzi. Our article on roti and weight loss shows how to learn your usual roti size.

Fewer sugary drinks

Drinks are often the easiest place to cut sugar without missing any food. Sweet doodh patti, cold drinks, packaged juice, sharbat and sweet lassi all add up. Cut the sugar in your chai gradually, and switch to water, lemon water without sugar or namkeen lassi.

How much exercise do you need for insulin resistance?

Aim for at least 150 minutes a week of activity like brisk walking. That was the target in the Diabetes Prevention Program, a trial of 3,234 adults with raised blood sugar published in the New England Journal of Medicine in 2002.

In that trial, a lifestyle programme that paired this activity goal with a weight-loss goal of at least 7% cut the risk of developing type 2 diabetes by 58% compared with placebo. Metformin cut it by 31%. Food and movement were tested together, so it makes sense to work on both.

Broken down, that's 30 minutes on five days. In everyday Pakistani life, that might be a walk to the masjid and back, laps of the chhat (roof) after Maghrib, a mall walk when it's too hot outside, or rounds of the park while the children play. A short stroll after dinner counts towards your total too.

Muscles use sugar, so strength work helps as well. Squats, climbing the stairs a few extra times or a simple home routine all count.

What does an insulin resistance diet look like for a day?

Here's one example day with Pakistani food. It's an illustration, not a prescription: portions depend on your body, your activity and any medication you take.

At iftar, the same idea holds. Open your fast with water and a date, have chana chaat or fruit, keep the pakoray to a few, then sit down to a proper meal with protein and sabzi. At a dawat, start with salad and salan, and take one serving of biryani rather than two.

When should you talk to your doctor about insulin resistance?

Talk to your doctor if you notice any of the possible signs above, if diabetes runs in your family, or before you change your diet while taking medication.

If you take insulin or tablets such as gliclazide, cutting carbohydrates suddenly can cause low blood sugar. Plan any change with your doctor, and never stop or reduce medication on your own. If you've been prescribed metformin, keep taking it as directed.

You don't need teas, powders or supplements sold for insulin resistance. Regular meals and more movement are where the evidence points, with follow-up blood tests to see how you're doing.

If you'd like a plan built around your own kitchen, read about our insulin resistance and PCOS/PMOS care and 28-day plans, or book a consultation.