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Insulin resistance & prediabetes

Insulin resistance, without the jargon

A plain-language walk through what insulin resistance is, why it is easy to miss, what the best evidence says actually changes the outlook — and where one well-known physician's ideas fit.

Pharmacist review pending94 verified passagesUpdated 2026-10-22

The hormone that opens the door

Every time you eat, food is broken down into sugar that travels in your blood. Your pancreas answers by releasing insulin, a hormone that helps that glucose get into your cells to be used for energy.1 The CDC's image is a good one: insulin acts like a key.2

Insulin resistance is what happens when the lock gets stiff. Cells in your muscles, fat and liver stop responding well to insulin.3 The pancreas does what you would expect: it releases more insulin to make the cells respond. For a while that works. Eventually it can't keep up, and blood sugar keeps rising.4

How insulin works — and what changes in insulin resistance

Simplified illustration, not to scale, based on the CDC and NIDDK descriptions.1234

BloodstreamPancreasreleases insulinMuscle, fat or liver cellused for energyKey opens the lockGlucose (sugar)Insulin (the key)The cell's lockWorking normallyInsulin lets glucose into the cell.BloodstreamPancreasreleases MORE insulinMuscle, fat or liver cellGlucose builds up in the bloodLock responds poorlyGlucose (sugar)Insulin (the key)The cell's lockInsulin resistanceCells respond poorly; the pancreas makes more.

Why it is so easy to miss

When blood sugar is higher than normal but not yet in the diabetes range, the name for it is prediabetes.5 In 2021, about 97.6 million American adults had it.8 Most people with prediabetes don't know they have it, because there are usually no symptoms.6

Appearance is no guide either. Overweight is a risk factor, but people without it can have insulin resistance too.9

How insulin resistance develops

The usual sequence, based on the CDC and NIDDK descriptions. Labels describe direction; they are not measurements.

Cells respond

Insulin moves sugar into cells at ordinary levels.

Insulin releasedNormal
Blood sugarNormal

Cells resist

Cells stop responding well. The pancreas releases more insulin to make them respond.34

Insulin releasedHigher
Blood sugarStarting to rise

Pancreas can't keep up

Blood sugar keeps rising — into the prediabetes range.45

Insulin releasedCan't keep up
Blood sugarPrediabetes range

Type 2 diabetes

A high chance within 5 to 10 years, but not inevitable.18

Insulin releasedCan't keep up
Blood sugarDiabetes range
Insulin resistance and prediabetes usually cause no symptoms. Testing is how they are found.7
The silent stage is the useful stage. People with prediabetes have a high chance of developing type 2 diabetes within 5 to 10 years — but not everyone does.18 What happens next is, to a real degree, changeable.

How it is found

You will rarely be tested for insulin resistance itself; that test is mainly used in research.10 What you will be offered is a measure of blood sugar.

  • A1C reflects your average blood sugar over about three months. Prediabetes is 5.7% to 6.4%.1114
  • Fasting plasma glucose is a snapshot after not eating. Prediabetes is 100 to 125 mg/dL.1114
  • An oral glucose tolerance test is used less often. Prediabetes is 140 to 199 mg/dL.11

Testing is usually suggested from age 35, or earlier if you have overweight or obesity plus other risk factors.15 If your results are normal but you have risk factors, a retest at least every three years is typical; with prediabetes, a yearly test for type 2 diabetes.17

The tests, and what the numbers mean

TestNormalPrediabetesDiabetesWhat it measures
A1CBelow 5.7%125.7% – 6.4%116.5% or above13Average blood sugar over about 3 months.14
Fasting plasma glucose99 mg/dL or below12100 – 125 mg/dL11126 mg/dL or above13Blood sugar at one moment, after not eating.14
Oral glucose tolerance test—140 – 199 mg/dL11—How you handle a measured sugar drink. Used less often.
Insulin-resistance test———Mainly used in research, not routine care.10

A1C can miss prediabetes in some health conditions, so your clinician may use more than one test.14

What actually changes the outlook

The clearest evidence comes from the Diabetes Prevention Program, a large randomized trial in adults at high risk. People were assigned to a structured lifestyle program, to metformin, or to a placebo pill.

The lifestyle program aimed for a 7% weight loss, kept off, through fewer calories and 150 minutes of exercise a week.25 After about three years it had lowered the chance of developing type 2 diabetes by 58% compared with placebo. Metformin lowered it by 31%.2021 Put another way: each year, about 5% of the lifestyle group developed diabetes, against 11% on placebo.22

Lower chance of developing type 2 diabetes, compared with placebo — Diabetes Prevention Program

About 3 years2021
58%Lifestyle program
31%Metformin
10 years23
34%Lifestyle program
18%Metformin
15 years24
27%Lifestyle program
18%Metformin

Who was studied, and what each group received

  • Who: 3,234 adults at high risk for type 2 diabetes, at 27 U.S. centers, 1996–2001.2627
  • Lifestyle group: aimed for 7% weight loss and 150 minutes of exercise a week, with intensive coaching.2528
  • Metformin group: 850 mg twice a day, plus standard advice.29
  • Placebo group: a dummy pill twice a day, plus standard advice.30

These are results from a research trial in these participants. They are not evidence for any ProperHealth or Clarkson service.

Relative reductions versus placebo, as reported by NIDDK. After the trial ended, all groups were offered a group lifestyle program, which is one reason the gap narrows.

The effect narrowed over the following years but did not disappear. At 15 years, the lifestyle group was still 27% lower and the metformin group 18% lower than placebo.24

NIDDK's summary is careful and encouraging: healthy living may help prevent or reverse insulin resistance and prediabetes.33 In NIDDK's description that means healthy foods and drinks, physical activity, managing weight and getting enough sleep.35 For people at high risk, losing 5% to 7% of starting weight helped.32 Clinicians may also prescribe metformin.36

The clinic's approach

The Pakistan Institute of Medical Advancement in Karachi, whose documents inform this site, offers a diabetes "reversal plan". Here is what its brochures propose, and what independent evidence shows. The quotations come from a printed English page and an Urdu brochure. The Urdu is given in ProperHealth's translation.

The clinic and current evidence share a goal. Prediabetes can be reversed, and some people with type 2 diabetes reach remission, through sustained diet and lifestyle programs.49 They differ on the method and on how much can be promised.

The clinic's approach, and what the evidence shows

Two parts of the clinic's diabetes program, each with the clinic's words first, then independent evidence.

  1. A "sugar reversal plan" promising freedom from diabetes, with sugar controlled in about six weeks, described as guaranteed

    Proposed instead of standard careNot proven
    Where the clinic says this
    Urdu trifold brochure, side 1 (ProperHealth translation).45
    The clinic's stated rationale
    The clinic describes diabetes as "an oxygen problem" and "an insulin toxicity before it becomes a sugar problem".46
    Evidence and limitations
    Reversal is a real goal for some people: sustained diet and lifestyle programs can reverse prediabetes, and remission may be possible for some people with type 2 diabetes.49 That evidence comes from structured lifestyle programs. The brochure does not say what the clinic's plan contains beyond its oxygen therapies, and it gives no results. The FDA warns about diabetes products that promise a "natural diabetes cure" or to replace diabetes medicine.43
    What this means for you
    Ask any program what it involves and how results are measured, using A1C. Do not stop diabetes medicine without your prescriber.

  2. Oxygen given by IV, by mouth and on the skin as a "detergent" to clear fat said to block insulin from cells

    Proposed instead of standard careNot proven
    Where the clinic says this
    Urdu trifold brochure, side 2;47 English page, brochure set page 6.46
    The clinic's stated rationale
    The brochure states that fat around cells keeps insulin out and that oxygen is the best "detergent" to clean it.47
    Evidence and limitations
    Part of this picture matches the mainstream account: in insulin resistance, cells respond poorly to insulin and the pancreas makes more to compensate.4 The proposed remedy does not appear in NIH or CDC guidance. ProperHealth found no published trial of oxygen therapy for insulin resistance. The success figures the brochure gives ("up to 100%" against "2%") come with no source.48
    What this means for you
    Treat this as unproven. Lifestyle change and, where needed, medicine are the approaches with trial evidence.
Clinic documents are private scans, cited by page; the Urdu brochure is quoted in ProperHealth's translation.
A trial result is not a clinic result. The Diabetes Prevention Program results on this page describe what a structured lifestyle program achieved in its participants. They are not evidence for the clinic's plan, or for any pharmacy or clinic service.

A historical perspective: Dr. Majid Ali

“Diabetes is not a sugar problem.”

— Dr. Majid Ali, 26 February 2019

For years, Dr. Ali argued that medicine watched the wrong number — glucose, which rises late — and neglected insulin, which changes first. Current guidance describes the same sequence: the pancreas compensates by releasing more insulin, and that phase is usually silent.46

His conclusions went further. He built reversal programmes on this framework, argued that standard blood sugar tests were inappropriate, and proposed diabetes subtypes of his own. The sources used here do not support those conclusions, and standard A1C and glucose tests remain the tests to use.11

Historical perspective, not current guidance. Drawn from Dr. Ali's authorized writings in the Clarkson archive. The records used, and the claims we deliberately did not carry, are listed on the sources page.

Medicines, supplements and one important caution

If you already take a diabetes medicine, the most important safety point is low blood sugar. Some medicines can push glucose too low if they aren't balanced with food and activity.37 Sulfonylureas, for example, increase insulin over several hours.38 Changing how you eat without telling your prescriber can tip the balance.

Supplements sold for blood sugar deserve a pause. Evidence for chromium, cinnamon and berberine is weak, with no clear conclusions,41 and berberine may interact with some medicines.42 The FDA warns about products that claim to be a "natural diabetes cure" or to "replace your diabetes medicine".43 And if you have taken metformin for a long time, it is reasonable to ask about vitamin B12.44

What to do this week

  1. Find your last A1C

    Or note that you've never had one. That is your question for the next visit.

  2. Ask to be tested if you qualify

    35 or older, or younger with overweight plus another risk factor.15

  3. Move after your largest meal

    Activity makes your body more sensitive to insulin.34 A short walk is an easy habit to attach to an existing one.

  4. Ask about a structured program

    Losing 5% to 7% of starting weight helped people at high risk.32 Ask your clinician about the CDC's National Diabetes Prevention Program.31

  5. Bring every medicine and supplement

    Some products sold for blood sugar interact with diabetes medicines.42 A pharmacist can check.

Nothing here is a reason to change a medicine, skip a dose or refuse a test. Changes to treatment are a conversation with your prescriber — one a pharmacist can help you prepare for.

When to get help now

Each warning sign cites the official guidance behind it. The wording still needs pharmacist sign-off.

  • Very high readings with thirst, frequent urination, blurred vision or weight loss — contact your provider.5051
  • Shaking, sweating, confusion or unusual drowsiness on a glucose-lowering medicine — treat the low as you were taught. If it does not improve after sugar, or the person becomes less alert, call 911.5253
  • Fruity-smelling breath, deep fast breathing, vomiting or stomach pain with high sugars — call 911.54
  • A foot cut, blister or sore that does not start to heal in a few days — call your provider right away. New numbness in your feet — book an appointment.5556
  • A sudden change in vision, flashes of light or many new floaters in anyone with diabetes — call a doctor right away.57

Every numbered marker links to the exact passage it rests on. Check the sources.