Insulin Resistance
In Brief
Dr. Sanika Kshirsagar at Soma Naturopathic in Kirkland, WA identifies insulin resistance years before it shows up as prediabetes by measuring fasting insulin and HOMA-IR rather than glucose alone, then treats it with nutrition, resistance training, sleep and targeted supplementation — which is also the single highest-leverage intervention in PCOS.
Insulin resistance is a state in which cells respond poorly to insulin, so the pancreas compensates by producing more of it. Blood glucose can stay entirely normal for years while insulin runs high — which is why standard fasting glucose and HbA1c testing frequently miss the condition during the long window when it is most reversible. In women, insulin resistance is central to polycystic ovary syndrome, where high insulin drives ovarian androgen production and disrupts ovulation, and it becomes more common through perimenopause as declining estrogen worsens insulin sensitivity. It is a major driver of type 2 diabetes, cardiovascular disease, fatty liver and pregnancy complications.
Symptoms
- •Energy crashes and intense hunger a couple of hours after eating
- •Strong carbohydrate and sugar cravings, particularly in the afternoon
- •Weight gain around the midsection that resists usual dieting
- •Difficulty losing weight despite genuine dietary effort
- •Skin tags and darkened, velvety skin at the neck, armpits or groin (acanthosis nigricans)
- •Irregular cycles, acne and unwanted hair growth where PCOS is present
- •Fatigue after meals, brain fog, and elevated triglycerides with low HDL
Causes & Risk Factors
- •Chronically elevated refined carbohydrate and added sugar intake
- •Low muscle mass and insufficient resistance training
- •Visceral fat accumulation driving inflammatory signalling
- •Genetic predisposition, including strong family history of type 2 diabetes
- •Chronic sleep deprivation and poor sleep quality, which impair insulin sensitivity directly
- •Chronic stress and sustained cortisol elevation raising blood glucose
- •Polycystic ovary syndrome, which both causes and is worsened by insulin resistance
- •Declining estrogen through perimenopause and menopause
Naturopathic Approach
The defining feature of Dr. Sanika’s approach here is measuring the right thing early. Fasting glucose and HbA1c only become abnormal once compensation is failing, which can be a decade after insulin resistance begins; by then a substantial amount of pancreatic beta cell function has already been lost. She orders fasting insulin alongside fasting glucose and calculates HOMA-IR, which identifies the problem while it is still highly reversible, and adds a lipid panel with triglyceride-to-HDL ratio, liver enzymes to screen for fatty liver, and — in women with irregular cycles, acne or unwanted hair growth — androgens, since PCOS and insulin resistance are so tightly linked that treating one requires treating the other. Clinical nutrition is the foundation, but it is specific rather than generic: prioritising protein and fibre, ordering carbohydrates within a meal so they are not eaten first or alone, distributing protein across the day, and reducing refined carbohydrate and added sugar rather than pursuing arbitrary low-carbohydrate targets. Lifestyle medicine carries more weight here than in most conditions, and resistance training in particular — skeletal muscle is the principal site of glucose disposal, and building muscle increases the tissue available to take glucose out of the bloodstream, which is why strength training often outperforms cardiovascular exercise for insulin sensitivity. Walking after meals is used deliberately because it blunts postprandial glucose. Sleep is treated as a metabolic intervention rather than a lifestyle nicety, since even short-term sleep restriction measurably reduces insulin sensitivity in healthy people. Nutraceutical support may include inositol, which has good evidence in PCOS-related insulin resistance and ovulatory function, along with magnesium, berberine and chromium where indicated. Dr. Sanika co-manages with prescribing physicians where metformin or GLP-1 agents are appropriate, and monitors response with repeat fasting insulin and HOMA-IR rather than weight alone.
Related Modalities
Frequently Asked Questions
My glucose and HbA1c are normal. Can I still have insulin resistance?
Yes, and this is the central diagnostic problem. Insulin resistance can be present for years while glucose stays normal, because your pancreas is compensating by producing extra insulin. Glucose only rises once that compensation begins to fail. Measuring fasting insulin and calculating HOMA-IR reveals the problem during the window when it is most reversible — but fasting insulin is rarely ordered in routine care, so most people are only diagnosed once they reach prediabetes.
What is the connection between insulin resistance and PCOS?
It is direct and central. High insulin stimulates the ovaries to produce more androgens, and it lowers sex hormone binding globulin, which raises free testosterone further. That drives the acne, unwanted hair growth and disrupted ovulation of PCOS. This is why improving insulin sensitivity is the highest-leverage intervention in PCOS — it addresses the upstream driver rather than each downstream symptom separately, and it commonly restores ovulation.
Do I have to eat low-carb?
Not necessarily. What matters more than total carbohydrate is the type, what it is eaten with, and the order. Refined carbohydrate eaten alone produces a much larger glucose and insulin response than the same carbohydrate eaten after protein, fat and fibre. Many women do well by prioritising protein and fibre, keeping carbohydrates whole, and walking after meals — without severe restriction, which is difficult to sustain and can worsen cycles in some women.
Is insulin resistance reversible?
Often substantially, particularly when it is caught before glucose has risen. Insulin sensitivity responds well to building muscle through resistance training, improving diet quality, correcting sleep, and reducing visceral fat. Improvements in fasting insulin frequently appear within eight to twelve weeks. The earlier it is identified the better the outcome, which is the argument for measuring insulin rather than waiting for glucose to drift upward.
References
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Dr. Sanika Kshirsagar, ND
Doctorate of Naturopathic Medicine (ND)
Bastyr University, Kenmore, WA
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