Can You Reverse Insulin Resistance Before You Develop Diabetes?

Last month, someone sat across from me and said, "Ryan, my doctor told me that I’m insulin resistant. But my sugar levels are totally normal. So, I don’t really need to worry, am I right?"

I thought for a second before answering and it got me thinking. Because that one sentence told me exactly where the confusion is coming from.

Insulin resistance is not exactly diabetes.

But it is also not nothing.

It is the years before diabetes, when your body is quietly working much harder than it should just to keep your blood sugar looking normal on paper.

Let me explain to you what happens here.

Insulin is a hormone that instructs your cells, basically the muscle, liver, and the fat cells, to take up glucose from blood. When you aren't responsive or resistant to insulin anymore cells, the pancreas responds by releasing more insulin. This effect may last for a while but after that, your fasting glucose stays in range. Your reports look fine. Your doctor may not flag anything.

But behind that normal number, your pancreas is shouting where it used to whisper.

This is why I don’t like it when someone says, "My sugar is normal, so I am fine." Normal glucose with high insulin is not the same as metabolic health. It usually means you are still compensating. And compensation has a shelf life.

So can this actually be reversed before it becomes diabetes?

Yes. And we now have real data to support that, not just theory.

A 2025 retrospective study from an Indian tertiary care setting followed prediabetic patients through a structured, multidisciplinary lifestyle programme. Close to half the patients achieved remission back to normal glucose status. The strongest predictors of remission were not surprising once you think about it. People who lost more than 10 percent of their body weight were nearly four times more likely to reverse their prediabetes. People who brought their HOMA IR, a marker of insulin resistance. Below 2.5 also did significantly better. Age mattered too. Acting before 50 improved the odds considerably.

That last point deserves your attention. Time is not a neutral factor here. The more time you carry insulin resistance, the tougher job your pancreas has done, and the less capacity it probably has left.

It's simply to make sure you know that insulin resistance isn't something to joke about, even though we're not trying to scare you with it. It is meant to tell you that the best time to act is now, not after your HbA1c crosses into diabetic range.

We also have the Diabetes Prevention Program, one of the most cited trials in this space. Structured lifestyle change, mainly modest weight loss and regular physical activity, reduced progression to type 2 diabetes more effectively than metformin. And the benefits held up over long term follow up, not just in the first year.

Why do Indians need to take this more seriously?

Now, if you are Indian, there is a layer to this conversation that I think does not get enough attention.

Many of my patients are not overweight by BMI standards. Some are what I call the "lean but at risk" profile. Research comparing South Asians with European populations has repeatedly shown that we tend to carry more visceral fat, the fat around our organs, and more fat inside the liver and muscle, even at a lower BMI. This is sometimes called the thin fat phenotype. It means an Indian adult with a BMI of 23 can carry the same metabolic risk as a European adult with a BMI of 27 or higher.

This is exactly why I ask about waist circumference, not just weight. A flat scale reading can still hide a rising risk.

What actually moves the needle?

So what actually moves the needle? Based on the evidence, and what I see working in the clinic, it comes down to a few things done consistently, not one dramatic change done once.

• Weight, if you have excess to lose. You do not need to lose a large amount. Even 5 to 7 percent of body weight has been shown to meaningfully improve insulin sensitivity in trial after trial. Losing more than 10 percent improves the odds of remission further.

• Resistance training, not just walking. Your skeletal muscle is responsible for the majority of glucose disposal in your body. A recent meta-analysis in older adults with type 2 diabetes found that resistance training improved HOMA IR, fasting glucose and HbA1c, while also increasing muscle mass. More muscle simply means more storage space for glucose, and a better response to the insulin you already have.

• Protein at each meal. This supports the muscle that resistance training is trying to build, and it also slows the glucose spike from a meal. I have written before about how much protein a person actually needs, and the honest answer is that it depends on your body weight, activity and goals, not a number you copy from Instagram.

• Sleep. This aspect is often overlooked. In fact, evidence points to the fact that even a couple of nights of sleeplessness can greatly decrease the insulin sensitivity of a normal person. For example, you may be following an excellent diet regimen on one hand and neglecting five hours of restless sleep, which basically means you aren't on your side. 

• Reducing refined carbohydrate load at breakfast specifically, since that is usually where Indian diets carry the most glycemic burden, through poha, upma, white rice or sugary tea, all before the body has moved much that day.

• 
  

I want to be honest about something else. Reversal does not mean cure in a permanent sense. It means your metabolic markers have moved back into a normal range through the changes you made. If those changes disappear, the risk can return. This is not a failure of willpower. It reflects how insulin resistance actually works. It responds to what you consistently do, not what you did for eight weeks last year.

That’s why I tell my patients do not chase the scale alone, Be open. Ask a broader set of questions.

• What happened to your waist shape?

• What happened to your fasting insulin, not only your fasting glucose?

• What happened to your strength and muscle mass?

• What happened to your energy after meals?

These tell you far more about your trajectory than one glucose reading taken on one morning.

If you have been told you are insulin resistant or prediabetic. Please do not file that away as something to deal with later. The data is fairly clear that earlier action changes outcomes. Waiting until your HbA1c crosses 6.5 means waiting until the harder to reverse stage.

A qualified dietitian or nutritionist can look at your health, lifestyle, food preferences, sleep goals and nutritional needs and help build a plan around you, rather than asking you to fit into a generic diet.

Start Your Personalised Diet Plan: click here

Because the honest goal here is not just a better lab report next year. It is making sure this window, the one where reversal is still very much possible, does not quietly close while you assume normal sugar means you are safe.