Metabolic Health

Methods to Lower Insulin Resistance

Mohammad Ghalichi, M.D. on December 6, 2025

When we talk about insulin sensitivity and insulin resistance, we are really talking about how our cells utilize energy and how well our metabolism works. The worse someone’s metabolism works, the faster chronic diseases develop. The extreme end of this spectrum is diabetes. People with diabetes experience more heart attacks, strokes, dementia, and cancer than those without it. This makes sense if you think about it conceptually: their cells are not functioning as well.

After we eat, our blood sugar (glucose) rises. This signals an organ called the pancreas to release a hormone called insulin. Insulin sends different instructions to various parts of the body. One of its main roles is telling muscle cells to use blood glucose as their primary fuel.

Insulin resistance means muscle cells require higher amounts of insulin to move the same amount of glucose out of the bloodstream. As a result, the pancreas must work overtime to produce more and more insulin. If this continues for years, the pancreas eventually becomes fatigued and cannot keep up. This is when the most common form of diabetes, type II diabetes, develops.

A major problem is that standard blood tests often miss early insulin resistance. Glucose and hemoglobin A1c can remain normal for years while insulin levels quietly rise. A person may feel reassured by “normal labs” even though their metabolism is worsening beneath the surface.

More accurate ways to detect insulin resistance earlier include also checking fasting insulin levels, calculating an index that estimates insulin resistance (HOMA-IR), performing an oral glucose tolerance test, and using a continuous glucose monitor.

The encouraging news is that insulin resistance is highly modifiable. Many of the same steps that lower the risk of diabetes also improve heart health, brain health, kidney health, and support longer, healthier living.

Targeting insulin resistance early is one of the most effective ways to reduce the long term burden of chronic disease.

Ways to Lower Insulin Resistance

• Exercise more and build muscle mass
• Fix your sleep
• Reduce abdominal and visceral fat
• Improve your food choices and overall energy balance
• Time your meals wisely
• Tame stress, quit smoking, and cut back on alcohol
• Use medications when lifestyle is not enough
• Combine these steps for long term protection

1. Exercise More and Build Muscle Mass

Muscles are the big reservoir for glucose. After you eat, most of the sugar that leaves the bloodstream goes into muscle. More muscle, and more active muscle, means better glucose uptake and better insulin sensitivity.

Randomized trials show that aerobic exercise, resistance training, and programs that combine both all improve insulin sensitivity in adults with overweight, prediabetes, and type 2 diabetes.

Key findings:

• Eight to twelve weeks of structured aerobic exercise improves insulin sensitivity and cardiovascular fitness.
• Resistance training improves insulin sensitivity even without major changes in aerobic fitness and is especially important for older adults.
• Combined aerobic and resistance training produces the largest metabolic benefits.

Action steps

• Aim for 150 to 300 minutes per week of moderate aerobic activity such as brisk walking, swimming, or cycling.
• Add resistance training 2 to 3 times per week focusing on all major muscle groups.
• Avoid prolonged sitting. Short 5 to 10 minute walks after meals significantly reduce blood sugar spikes.

The goal is to maintain strong, active muscle across decades. This protects long term insulin sensitivity and overall metabolic health.

2. Fix Your Sleep

Chronic poor sleep raises stress hormones, increases hunger, and worsens insulin resistance.

Large studies show a U shaped relationship between sleep duration and diabetes risk. The lowest risk is around 7 to 8 hours of sleep per night. Both short sleep and very long sleep increase risk.

A 2025 study of women with past gestational diabetes found that 7 to 8 hours of sleep was associated with the lowest future diabetes risk, even after adjusting for diet and activity.

Action steps

• Aim for 7 to 8 hours of real sleep most nights.
• Keep a consistent sleep schedule and avoid very late bedtimes. Staying up well past midnight is linked to worse blood sugar control.
• Ask to be evaluated for obstructive sleep apnea if you snore, stop breathing at night, or feel excessively tired.

Better sleep makes it easier to control appetite, maintain healthy weight, and keep insulin levels in a healthier range.

3. Reduce Abdominal and Visceral Fat

Visceral fat is the fat stored deep inside the abdomen around the liver, pancreas, and intestines. This is different from the softer fat just under the skin that you can pinch. Research consistently shows that visceral fat has a far stronger relationship with insulin resistance, fatty liver, and cardiovascular disease than total body weight alone. A person can have a normal body mass index but still carry high amounts of visceral fat and have high metabolic risk.

Abdominal fat that sits under the skin in the belly area is also relevant. When abdominal fat is high, it is very often accompanied by an unhealthy amount of visceral fat deeper inside the abdomen. Together, these create a more inflammatory environment, raise free fatty acids in the blood, and make it harder for insulin to move glucose into the cells. This is why a growing waistline is an important early warning sign even if the scale has not changed much.

A dual energy X ray absorptiometry body composition scan (DXA scan) provides a low radiation way to measure visceral fat. DXA measured visceral fat corresponds well with computed tomography and magnetic resonance imaging and strongly predicts insulin resistance and overall cardiometabolic risk.

A practical way to interpret visceral fat from DXA scans:

Ideal visceral fat

• Less than about 0.5 kilograms (1.1 pounds).
• Typically falls in a low risk category and often below the twenty fifth percentile for adults.

Acceptable visceral fat

• About 0.5 to 1.0 kilograms (1.1 to 2.2 pounds).
• Above about 1.0 kilogram, studies show a noticeably higher rate of metabolic syndrome, insulin resistance, and fatty liver.

Higher risk visceral fat

• More than 1.0 kilogram (over 2.2 pounds).
• Associated with significantly higher rates of insulin resistance, abnormal blood sugar patterns, and fat buildup in the liver.

These are guidelines, not rigid thresholds. Genetics, ethnicity, age, sex, and fitness modify risk at any given level. From a longevity standpoint, maintaining visceral fat in the ideal or low acceptable range for decades is one of the most effective ways to prevent insulin resistance.

4. Upgrade What You Eat and How Much You Eat

There is no single best diet, but certain patterns consistently improve insulin resistance when calorie intake is appropriate.

Energy balance matters most. Eating more calories than you burn will be stored as fat, especially in the abdominal and visceral areas.

Beyond calories, food quality plays a major role.

Mediterranean style eating pattern

Large studies and randomized trials show that people who follow a Mediterranean diet have a lower risk of type 2 diabetes. This diet improves insulin resistance, cholesterol patterns, and inflammation.

The PREDIMED studies found that:

• A Mediterranean diet rich in olive oil, nuts, vegetables, whole grains, and legumes reduced new cases of diabetes by 23 to 52 percent, especially when combined with activity and modest calorie reduction.

Lower refined carbohydrate and lower glycemic patterns

Studies comparing lower carbohydrate or lower glycemic diets with traditional high carbohydrate diets show:

• Smaller rises in blood sugar and insulin after meals.
• Modest improvements in insulin resistance and hemoglobin A1c when calories are matched.

Practical nutrition principles

• Eat mostly whole, minimally processed foods: vegetables, fruits, beans, lentils, intact whole grains, nuts, and seeds.
• Include high quality protein at each meal, often 1.2 to 1.6 grams per kilogram per day when building or maintaining muscle.
• Choose olive oil and other unsaturated fats as your main added fats.
• Strongly limit sugary drinks, refined grains, trans fats, and ultra processed snacks.
• Avoid large, late night, carbohydrate heavy meals, which worsen overnight blood sugar and insulin levels.

5. Time Your Meals Wisely

When you eat affects insulin sensitivity, not just what you eat.

Early time restricted eating

A study in men with prediabetes tested a 6 hour eating window with dinner before 3 p.m. versus a typical 12 hour window. The early pattern improved insulin sensitivity, blood pressure, oxidative stress, and hunger even without weight loss.

Other studies in people with overweight or type 2 diabetes using 8 to 10 hour eating windows show:

• Modest weight loss
• Better fasting blood sugar and improved insulin sensitivity in many, but not all, studies.

Some trials show no additional benefit when weight loss is the same. This suggests meal timing works best when it supports an overall healthy diet.

Practical approach

• Finish most calories 3 or more hours before bedtime.
• Consider an 8 to 12 hour eating window starting within a few hours of waking.
• Focus on food quality first. Use time restriction as a structure, not a strict rule that creates stress.

6. Tame Stress, Quit Smoking, and Cut Back on Alcohol

Chronic stress raises cortisol and encourages fat gain around the abdomen, disrupts sleep, and increases cravings. All of these worsen insulin resistance.

Smoking

Smoking increases insulin resistance and raises the risk of type 2 diabetes by 30 to 40 percent. The more a person smokes, the higher the risk. Research also shows that smokers have higher insulin resistance on blood tests than non smokers.

Alcohol

From a preventive health perspective:

• Heavy and binge drinking clearly worsen insulin resistance and increase the risk of type 2 diabetes.
• Alcohol disrupts sleep, which further worsens insulin sensitivity.
• Many alcoholic drinks contain sugar and rapidly absorbed carbohydrates.

Avoiding smoking entirely and minimizing or avoiding alcohol are the safest long term choices.

7. Use Medications When Lifestyle Is Not Enough

Lifestyle change is foundational, but medications can add powerful benefits in the right settings.

Metformin

• Reduced progression from prediabetes to diabetes by 31 percent in the Diabetes Prevention Program.

GLP-1 receptor agonists (semaglutide, tirzeptaide)

• Can lead to 10 to 20 percent weight loss, reduce visceral fat, improve insulin sensitivity, and reduce major cardiovascular events.

Sodium glucose cotransporter 2 inhibitors (SGLT2-inhibitors)

• Improve blood sugar, protect the kidneys and heart, and modestly improve weight and insulin sensitivity.

Thiazolidinediones (for example pioglitazone)

• Improve insulin sensitivity but have potential side effects including weight gain, ankle swelling, and increased fracture risk.

These medicines should be used in partnership with a clinician and are most effective when built on strong nutrition, movement, and sleep foundations.

References

This page is for educational purposes only and is not a substitute for personalized medical advice. Decisions about testing and treatment should be made with your own clinician.