“Please don’t embarrass me,” I pleaded with my body yet again as I stepped on what felt like the millionth doctor’s office scale. “At least they could let me take off my shoes,” I thought begrudgingly after seeing the number climb higher than it did at home. The scene was uncomfortably familiar: me, at another doctor’s appointment, hoping this time I’d get the answers I was looking for to explain my seemingly endless weight gain. And I did. I was diagnosed with insulin resistance.
The words stung in my ears as a coded way to say “type 2 diabetes,” which somehow felt like I was to blame. Luckily, my all-female health team wouldn’t let me go down that road. As my healthcare provider Courtney Blue, nurse practitioner of reproductive endocrinology at Atlanta-based Reproductive Endocrinology and Infertility Group explains, “Insulin resistance is a condition that causes the body to be less responsive to insulin, leading to high sugar levels in the blood.”
Unlike diabetes, a condition in which the body is unable to produce its own insulin, insulin resistance occurs when your body isn’t responding effectively to the insulin it’s already producing. Think of your cells as a door and insulin as the key. Insulin’s job is to open the door and usher in the sugars from the foods you consume. In the case of insulin resistance, the door gets stuck and it takes more insulin to jimmy it open. This leads to those sugars lingering longer in your bloodstream, resulting in both elevated blood sugar levels and your cells not getting the energy they need.
So, why was I experiencing weight gain? “Insulin resistance promotes fat storage because your cells are more focused on storing rather than burning it, making it more challenging to lose weight,” Blue says. Because your body isn’t responding to the insulin it already has, the pancreas goes into overdrive to produce more of the hormone, often resulting in complications like fatigue, skin darkening in the armpits or around the neck, brain fog, increased testosterone production (and subsequently excess body hair), and, most notably for me, difficulty losing weight.
Hearing that was my “eureka” moment: I wasn’t entirely at fault here. There were factors that I didn’t understand working against me, no matter how much time and energy I put into my health. Still, while certainly vindicating, I left my initial doctor’s appointment with more questions than answers. Even though some research estimates that up to one-third of the general population is insulin resistant (with more women diagnosed with the condition than men), not much is known about why it occurs. I hope that in sharing my story and what I’ve learned about insulin resistance, others can better understand and manage the condition.
My Journey With Insulin Resistance
My story isn’t that different from that of millions of other women across the U.S. My journey thus far might even sound eerily familiar: You finally decide to take charge of your health after years of post-college/baby/significant life event weight gain. You work hard to pick up healthier habits instead of jumping on a weight-loss fad hoping for lasting change. You completely alter your diet with the help of a nutrition coach; tweak your workout routine to include both strength training and cardio; add meditation to your daily to-do list; and listen to podcast after podcast offering life advice and mindset shifts to bolster your journey. Months and even years of work (not to mention financial investment, gyms and organic produce aren’t cheap) later, and the scale has barely shifted, leading your PCP to recommend generic “lifestyle changes” (without bothering to ask what you’ve already done) and suggesting GLP-1 medications like Ozempic or Zepbound.
For me, Ozempic was a no-go. I had seen it work for plenty of people, especially those struggling with obesity and type 2 diabetes, but my gut told me that it wasn’t the right path. I’ve always had a sensitive stomach and was worried about the potential side effects of an appetite suppressant, not to mention the untold long-term effects of GLP-1s used for weight loss. I’d come across dozens of stories in my research from people who had great success with Ozempic and other GLP-1 meds only to come off of the injectables and suffer “Ozempic rebound.” In other words, they’d gain the weight back in classic yo-yo diet fashion. According to one study, those using GLP-1 meds typically gain back two-thirds of the weight lost within a year of stopping the medication.
Since Ozempic was off the table, my doctors and I decided to go another route: a medication called Metformin. As Blue explains, “Metformin is an insulin sensitizer that works by decreasing the liver’s glucose production, improving the body’s sensitivity to insulin, and decreasing the absorption of glucose from the intestine into the bloodstream.” Often used to treat type 2 diabetes or pre-diabetes, Metformin gives your system an extra nudge to work more efficiently so that it can remove the extra sugar in your blood so that it ends up feeding your cells instead of getting stored as excess fat.
Aside from some initial gastrointestinal upset (par for the course with my sensitive stomach), I haven’t experienced any side effects with Metformin, which seems to be doing its job. At the time of writing, I’m down eight pounds in two months.
Why Are More Women Affected By Insulin Resistance?
According to Blue, insulin resistance is much more common than we might realize. “[It] often goes undiagnosed because patients don’t know they are experiencing it…oftentimes, patients are eager to see weight loss without considering that there may be an underlying condition occurring.”
Women in particular might not recognize insulin resistance in their bodies because it can manifest in a wide variety of symptoms. “Insulin resistance can affect women differently than men due to hormonal, metabolic, and physiological differences,” says Dina Absi, ND, DMD, CNC, DHS. For example, insulin resistance is often associated with PCOS (polycystic ovary syndrome) and can cause irregular periods because of its effect on hormone production. This hormone imbalance can cause weight gain in both men and women, but women may have a harder time losing weight, especially around the abdomen, because of how we metabolize fat.
One of the most notable and often overlooked symptoms of insulin resistance is inflammation or autoimmune responses. “Women have a more active immune response than men and insulin resistance can trigger an inflammatory state,” says Dr. Absi. “This heightened inflammatory response in women is linked to greater risk of developing autoimmune conditions, such as lupus and rheumatoid arthritis.”
If any of these symptoms resonate with you, consider talking to your primary care provider about insulin resistance. Testing for the condition is fairly straightforward, requiring just some bloodwork and a glucose test. Armed with your newfound knowledge, you and your provider can come up with a plan that makes the most sense for you.
There Are Lifestyle Changes That Can Combat Insulin Resistance
While Metformin seems to be the route for me, it’s important to acknowledge that all bodies react differently. Medical practitioners across the spectrum generally agree that lifestyle changes are the first defense against insulin resistance. Blue recommends limiting simple carbohydrates and sugar as well as increasing physical activity, namely incorporating both high-intensity interval training and low-impact weight training.
Among the key elements in your lifestyle changes? Reducing stress. “Chronic stress increases cortisol, which in turn can raise blood glucose levels and exacerbate insulin resistance,” says Blue. A study published in the Experimental and Clinical Sciences Journal backs up this claim, stating that stress-induced inflammatory responses negatively impact insulin signaling pathways and can lead to the onset of diabetes.
Dr. Absi agrees that lowering stress is key to managing insulin resistance and improving your overall health. She recommends going a step further by optimizing sleep patterns, balancing your microbiome (working on your gut health), and utilizing herbal and supplementary supports like cinnamon and ashwagandha to improve glucose metabolism and manage cortisol.
If you’ve committed to lifestyle changes for six to nine months without seeing progress, it may be time to discuss alternative options, such as weight-loss medications, with your doctor.
How I Learned to Manage a Life With Insulin Resistance
After implementing various lifestyle changes over the course of three years without seeing lasting results, I received my insulin diagnosis in August 2024. Blue and I decided to pursue Metformin as a treatment option, slowly building up to a dose of two, 850 milligram pills per day. At my three-month check-in, we decided to increase the dose to two 1,000 milligram pills per day to help combat my busy travel schedule over the holidays.
While on the medication, I’ve continued my regimen of alternating strength training and cardio paired with a diet of mostly whole foods and a limited gluten, dairy, and sugar. On the mental health side, I’m learning to make space for occasional indulgences without feeling guilty – a hugely important piece of the puzzle that isn’t often discussed. While progress is slow and steady, the biggest change I’ve noticed is that my weight no longer jumps up when I stray from my daily routine – a major win for someone who has spent years dealing with the physical and mental repercussions of inconsistent weight fluctuations.
My road has been long with plenty of ground still to cover. But finding doctors who actually listen to my concerns and finally receiving a diagnosis has been a huge relief. While I can’t say for sure if my current medical regimen will lead to lasting weight loss, at least it’s a clear path forward.
Sarah Bisacca is an Atlanta-based freelance writer specializing in travel, food, and leisure. In addition to PS, she has bylines in Forbes Travel Guide, Eater Atlanta, and Tasting Table.
