What Insulin Resistance Means (Beyond Just Diabetes)
Episode Summary
Dr. Sasha Rose, a naturopathic doctor and lead provider at Med Matrix with over 20 years in metabolic health, joins co-owner Brian Leggott to explain why insulin resistance matters long before anyone is diagnosed with diabetes. She describes insulin as a key that opens cells so glucose can enter, and explains how years of high insulin wear that system down until cells stop responding. The central point is that insulin can stay elevated for years or decades while blood sugar still looks normal, quietly driving fatigue, stubborn midsection weight, brain fog, inflammation, fatty liver, hormone problems, and conditions like PMOS (formerly PCOS) and metabolic syndrome. Because insulin is rarely tested on standard annual blood work, the problem usually goes unnoticed until something else forces a visit. Rose explains why insulin promotes fat storage, why stress and poor sleep feed the cycle, and why conventional primary care often runs out of time to investigate root causes. She walks through the functional medicine approach: a comprehensive lab panel, an in-body scan that tracks waist circumference, and personalized plans built around sleep, stress, nutrition, movement, and targeted support. She closes with three practical first steps anyone can take today.
Key Topics
- 1
What insulin resistance actually is, using the lock-and-key analogy for how insulin moves glucose into cells
- 2
Why insulin can stay elevated for years or decades while blood sugar still reads normal
- 3
Conditions linked to insulin resistance beyond diabetes: PMOS (formerly PCOS), fatty liver, cardiovascular disease, and metabolic syndrome
- 4
Subtle early signs such as cravings, postprandial energy crashes, midsection weight gain, brain fog, and mood changes
- 5
Why elevated insulin promotes fat storage and makes weight loss so difficult
- 6
Visceral fat, waist circumference, and the role of cortisol and chronic stress
- 7
Lifestyle drivers: ultra-processed food, poor sleep, sedentary habits, and circadian rhythm disruption from shift work
- 8
How conventional primary care assesses blood sugar versus the functional medicine root-cause approach
- 9
Bio-individuality and why two patients with similar labs get different treatment plans
- 10
Three practical first steps: improving sleep quality, finding hidden sources of sugar, and reducing dietary inflammation
Quotable Moments
“Insulin levels can be elevated for a long time before your blood sugar actually becomes high or abnormal.”
“I don't think of it as that insulin resistance causes all of the things I just listed, but that all of those conditions are very complex and insulin resistance is often a pretty crucial component of them.”
“If you have an elevated level of insulin, that is promoting fat storage. It's not really going to promote fat loss.”
“It's based on our biology, it's not based on our current reality.”
“Aggressively or drastically modifying lifestyle behaviors is probably the most important thing you can do to reverse insulin resistance.”
Treatments Mentioned
FAQ
Metabolic Health FAQ
Yes. Dr. Rose explains that insulin levels can stay elevated for years or even decades before blood sugar ever becomes high or abnormal. Type 2 diabetes is often the end result of a process that has been developing quietly the whole time, so many people are insulin resistant long before any diabetes diagnosis.
Insulin is not part of standard annual blood work, so it is rarely measured. Standard labs usually look at fasting glucose and hemoglobin A1C, which assess blood sugar rather than insulin itself. Because the early signs are subtle and easy to dismiss, insulin resistance often goes unnoticed in a short conventional visit.
Insulin is a storage hormone, so when levels are elevated the body is prompted to store fat and limit fat burning. Rose describes the body acting as if it is preparing for a famine, holding on to fat and increasing hunger and cravings. Over time this reduces metabolic flexibility, so people can eat well and exercise yet still feel stuck.
Many people are largely asymptomatic, but possible early signs include increased cravings and hunger, energy crashes after meals (especially in the afternoon), midsection weight gain, difficulty concentrating, and mood changes. Some people may notice skin tags or darkening of the skin around the neck or underarms. None of these are definitive on their own, but together they can point toward the beginnings of insulin resistance.
Rather than looking at blood sugar alone, the providers examine the years of factors that led to this point, including stress resilience, movement, nutrition, hormonal status, inflammation, and gut health. Med Matrix uses a comprehensive lab panel and an in-body scan that tracks waist circumference over time. Because every person's history and biology differ, treatment plans are individualized rather than one-size-fits-all.
Dr. Rose suggests taking an honest look at sleep quality and sleep hygiene first, since it is low cost and ties into cortisol and stress resilience. Second, find hidden sources of sugar, such as sweetened coffee drinks and energy drinks. Third, reduce pro-inflammatory foods like fast food, refined carbs, and high-salt items, and consider a high-quality omega-3 fatty acid supplement, with Rose noting she often aims for close to 2,000 mg per day.
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