Understanding Insulin Resistance
Based on the work of Ben Bikman, a professor and metabolic scientist
Ben Bikman, Ph.D., is a professor and metabolic scientist whose research focuses on insulin, insulin resistance, and metabolic health.
Insulin resistance develops when tissues become less responsive to insulin, requiring the body to produce more of it to maintain normal blood glucose.
Bikman emphasizes an important point: insulin resistance can begin long before a person develops type 2 diabetes. Blood glucose may still look normal while insulin levels are already elevated.
His approach focuses on reducing the demand for insulin through carbohydrate restriction, eating adequate protein, exercising—particularly resistance training—and improving sleep and other aspects of metabolic health.
What Is Insulin Resistance?
After a meal, carbohydrates are broken down into glucose. Insulin helps move glucose into cells, where it can be used for energy or stored.
When cells become less responsive to insulin, the pancreas compensates by producing more. This can lead to hyperinsulinemia—higher-than-normal levels of insulin in the blood.
For some time, the extra insulin may keep blood glucose normal. Eventually, the pancreas may no longer compensate adequately, and blood glucose can rise, potentially progressing to prediabetes and type 2 diabetes.
This is why Bikman argues that looking only at blood glucose may miss an earlier stage of metabolic dysfunction.
What Contributes to Insulin Resistance?
Insulin resistance can result from a combination of genetics, excess body fat, diet, physical inactivity, poor sleep, stress, medications, and hormonal conditions.
Excess abdominal fat is particularly associated with insulin resistance. Regular exercise improves insulin sensitivity, while diets high in refined carbohydrates and ultra-processed foods can contribute to poor metabolic health.
Why Does It Matter?
Insulin resistance is strongly associated with type 2 diabetes and fatty liver disease. It also commonly occurs with high triglycerides, low HDL cholesterol, high blood pressure, and abdominal obesity.
Metabolic dysfunction has also been associated with cardiovascular disease, certain cancers, and cognitive decline. These associations do not mean that insulin resistance alone causes these diseases, but they help explain why metabolic health matters.
How Do You Know If You're Insulin Resistant?
There is no single routinely used test that definitively diagnoses insulin resistance. Several measurements can provide useful clues:
Fasting insulin: Elevated levels may indicate that the pancreas is producing extra insulin to maintain normal glucose.
HOMA-IR: A calculation using fasting glucose and fasting insulin.
Triglyceride-to-HDL ratio: A higher ratio can be a marker of metabolic dysfunction.
Waist circumference: Excess abdominal fat is strongly associated with insulin resistance.
Glucose testing: Fasting glucose and A1C can identify abnormal glucose regulation, although they may remain normal during earlier stages.
Bikman particularly emphasizes looking beyond blood glucose alone.
Improving Insulin Sensitivity
Bikman emphasizes several strategies:
Reduce refined carbohydrates and sugar. He favors lower-carbohydrate diets because reducing carbohydrate intake generally reduces the body's demand for insulin.
Eat adequate protein. Protein helps preserve muscle and promotes satiety.
Exercise. Both aerobic exercise and resistance training improve insulin sensitivity. Strength training is particularly valuable because muscle plays an important role in glucose disposal.
Improve sleep. Poor sleep can interfere with glucose regulation and insulin sensitivity.
Minimize ultra-processed foods. Replacing sugary drinks, refined carbohydrates, and highly processed foods with minimally processed foods can improve metabolic health.
Bikman also discusses time-restricted eating and periods without food as possible ways of reducing insulin exposure. For more information, see Intermittent Fasting: What Does the Research Show?
A Word About Medication
A low-carbohydrate diet can lower blood glucose relatively quickly. People taking insulin or medications that can cause hypoglycemia may therefore require medication adjustment.
Medication should not be reduced or discontinued without appropriate medical supervision.
Why I Find Bikman's Work Useful
Before learning about insulin resistance, I tended to think primarily about blood sugar.
Bikman's work encouraged me to think about what may be happening before blood sugar becomes abnormal. The pancreas may already be working harder and producing more insulin to keep glucose under control.
For me, that is the most useful lesson from his work: metabolic problems may begin long before a diagnosis of diabetes.