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Heart & metabolism

Insulin resistance & prediabetes

Most people with prediabetes don't know they have it. Could you?

Insulin resistance and prediabetes usually cause no symptoms. They are found with ordinary blood tests, and this is the stage where change measurably lowers the chance of type 2 diabetes.

Pharmacist review pending94 verified passagesUpdated 2026-10-22

In 30 seconds

The short answer

Insulin is a hormone made by the pancreas that helps glucose into your cells.1 With insulin resistance, cells in your muscles, fat and liver stop responding well to it.3 The pancreas releases more insulin to compensate; eventually it can't keep up, and blood sugar rises.4 Higher than normal but below the diabetes range is called prediabetes.5

  • It is usually silent. Most people with prediabetes don't know they have it.6
  • It is found with ordinary blood tests — A1C or fasting glucose. A direct insulin-resistance test is mainly a research tool.1011
  • It can change. Healthy living may help prevent or reverse insulin resistance and prediabetes.33
  • The evidence is strong. A structured lifestyle program cut new type 2 diabetes by 58% over about 3 years.20

What is happening in the body

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.

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

What the research says

  • In 2021, about 97.6 million U.S. adults had prediabetes.8
  • You can't tell by looking. Overweight is a risk factor, but people without it can have insulin resistance too.9
  • People with prediabetes have a high chance of type 2 diabetes within 5 to 10 years — but not everyone develops it.18
  • Type 2 diabetes can affect almost every part of the body, including the heart, eyes, kidneys and nerves.19
  • Physical activity makes your body more sensitive to insulin.34
  • For people at high risk, losing 5% to 7% of starting weight helped reduce the chance of diabetes.32

How the approaches compare

The Diabetes Prevention Program was a large U.S. randomized trial in adults at high risk. It compared a structured lifestyle program, the medicine metformin, and a placebo pill.

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.
  1. Both lowered risk. The lifestyle program lowered it more.2021
  2. Each year of the trial, about 5% of the lifestyle group developed diabetes, against 11% on placebo.22
  3. The benefit narrowed with time but was still present at 15 years.24
  4. A group version of the lifestyle program is offered in the U.S. through the CDC's National Diabetes Prevention Program.31

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

Who should ask to be tested

  • Anyone 35 or older.15
  • Younger adults with overweight or obesity plus another risk factor.15
  • Risk factors include a family history of diabetes, low physical activity, diabetes in a past pregnancy, and conditions such as PCOS.16
  • Normal result but risk factors: retest at least every 3 years. Prediabetes: test every year.17

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 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.

From the Dr. Majid Ali archive

A historical perspective

“Diabetes is not a sugar problem.”
— Dr. Majid Ali, 2019-02-26

Insulin was the centre of Dr. Ali's later writing. His core complaint was that medicine watched glucose, the downstream number, and paid too little attention to insulin, the upstream one.

On the mechanism, current guidance describes the same sequence: the pancreas compensates by releasing more insulin, and that stage is usually silent.46 The conclusions he drew from it, including reversal programmes and rejecting standard tests, are not supported by the sources used here.

Where ProperHealth stops. We do not carry forward his reversal programmes, his view that standard blood sugar tests are inappropriate, or his own diabetes subtypes. Standard A1C and glucose tests remain the tests to use.11

Read the full historical section

What to do next

  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.

Medicines, supplements and safety

A pharmacist can review interactions, check your meter technique and help you prepare questions for your prescriber. A pharmacist does not diagnose diabetes or change your doses.

  • Low blood sugar is the main safety risk. Some diabetes 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 If you take one, talk to your prescriber before changing how you eat.
  • Know the signs. Feeling shaky, hungry, dizzy, confused or irritable can mean low blood glucose.39 Severely low blood glucose can cause passing out, coma or death.40
  • Supplements: evidence that chromium, cinnamon or berberine help blood sugar is weak, with no clear conclusions,41 and berberine may interact with some medicines.42
  • Be wary of cure claims. The FDA warns about products claiming to be a "natural diabetes cure" or to "replace your diabetes medicine".43
  • Metformin and vitamin B12. Metformin might lower B12 levels.44 Worth asking about if you have taken it for a long time.

Compared

Conventional and integrative care, compared

What medicines do here, where they stop, what drives the condition, and which other approaches the evidence actually supports.

What conventional treatment does

  • Clinicians may prescribe metformin to help manage glucose and prevent type 2 diabetes.36 In the Diabetes Prevention Program it lowered the chance of developing diabetes by 31% compared with placebo, at 850 mg twice a day.2129
  • Testing, not treatment, is the first step: prediabetes ranges are A1C 5.7% to 6.4% or fasting glucose 100 to 125 mg/dL,11 with a diabetes test every year once prediabetes is found.17

Limits and adverse effects

  • Some diabetes medicines can push glucose too low when they are not balanced with food and activity;37 sulfonylureas raise insulin for several hours.38 Low glucose can mean shakiness, hunger, dizziness or confusion,39 and severe lows can cause passing out, coma or death.40
  • Metformin may reduce vitamin B12 absorption and lower B12 levels.44
  • Its effect faded faster than the lifestyle program's: at 10 years, 18% lower risk with metformin against 34% with lifestyle; at 15 years, 18% against 27%.2324

What contributes to the condition

  • Cells in muscle, fat and liver stop responding well to insulin;3 the pancreas makes more until it cannot keep up and blood sugar rises.4
  • Overweight is a risk factor, but people without it can have insulin resistance too.9 Family history, low physical activity, diabetes in a past pregnancy and conditions such as PCOS add risk.16
  • Most people have no symptoms, so it is found by testing, not by how you feel.67

Integrative and naturopathic approaches, by evidence

Evidence levels: EstablishedEmergingHypothesisNot supported

  • Established

    A structured lifestyle program (7% weight loss kept off, 150 minutes of activity a week) lowered the chance of type 2 diabetes by 58% over about 3 years — more than metformin — and a group version is widely available through the CDC.202531

  • Established

    Physical activity makes the body more sensitive to insulin;34 healthy food and drink, weight management and enough sleep are the components NIDDK names.35 Losing 5% to 7% of starting weight helped people at high risk.32

  • Emerging

    Sustained diet and lifestyle programs can help reverse prediabetes, and research on one long-term program suggests remission of type 2 diabetes may be possible for some people.49

  • Hypothesis

    Evidence that chromium, cinnamon or berberine help blood sugar is weak, with no clear conclusions;41 berberine may interact with some medicines.42

  • Not supported

    The clinic's statement that diabetes is "an oxygen problem" treated with oxygen given by IV, by mouth and on the skin,4647 and its "up to 100%" success rate against "only 2%" for conventional medicine, come without a source or study.48 The FDA warns about products claiming to be a natural diabetes cure or to replace diabetes medicine.43

Nothing here replaces a conversation with your prescriber. Do not stop or change a medicine because of a page; bring this comparison to your next visit.

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