Introduction
If you've landed here, something is probably already telling you that your body isn't working the way it used to. Weight that won't shift no matter what you try. Energy that crashes after meals. Cravings you can't seem to control. A nagging sense that something metabolic is off - even though you've been told your blood tests are "normal."
You're asking the right question. And you're in good company: research suggests around one in four adults has insulin resistance, and the large majority don't know it. It is often called "silent" precisely because it can be advancing for years while standard testing looks reassuring.
This article will help you do three things: recognise the signs of insulin resistance specific to women, understand why your GP's blood tests may have missed it, and know exactly which markers to ask for if you want a clear answer.
What insulin resistance actually is (in plain terms)
Insulin is the hormone that moves sugar (glucose) out of your bloodstream and into your cells to be used for energy. When everything is working well, a small amount of insulin does the job efficiently.
Insulin resistance is when your cells stop responding properly to insulin. Glucose struggles to get into the cells, so your blood sugar starts to rise. Your pancreas responds by producing more insulin to force the job through. For a while, this works - your blood sugar stays in the normal range because your body is quietly producing far more insulin than it should need.
This is the crucial part, and it's the part standard testing misses: your blood sugar can look completely normal while your insulin levels are high and climbing. The problem is present and progressing, but the usual tests - which measure sugar, not insulin - don't see it.
We cover the full mechanism in PCOS and insulin resistance: what's really driving your symptoms, but that single insight - high insulin hiding behind normal blood sugar - is the reason so many women are told they're fine when they aren't.
Insight
"Normal blood sugar" and "normal insulin" are not the same thing. In the early years of insulin resistance, your body keeps blood sugar normal by pumping out extra insulin. A test that only measures blood sugar will look fine. A test that measures insulin would tell a very different story.
The signs of insulin resistance in women
Insulin resistance shows up differently in women than in the diabetes-focused checklists you'll find on most health sites. Here are the signs that matter, grouped by how they tend to appear.
Weight and body composition
- Weight gain around the middle that's new or stubborn, even without changes to your diet
- Difficulty losing weight despite eating well and exercising - this is one of the most common and most frustrating signs, and we explain exactly why it happens in why you're not losing weight even when doing everything right
- Weight that returns quickly after you lose it
Energy and cravings
- Energy crashes after meals, particularly after carbohydrates - feeling like you need to nap after lunch
- Strong cravings for sugar and carbohydrates, especially in the afternoon
- Feeling shaky, irritable, or "hangry" if you go too long without eating
- Needing to eat frequently to feel stable
Hormonal and reproductive signs
- Irregular, absent, or unpredictable periods
- Symptoms of PCOS - acne, excess facial or body hair, scalp hair thinning
- Worsening perimenopause symptoms - insulin resistance often increases in your 40s as oestrogen declines, which we cover in why your blood sugar changes in your 40s
Physical signs you can see
- Skin tags, particularly around the neck and armpits
- Darkened, velvety patches of skin (called acanthosis nigricans) on the back of the neck, armpits, or groin
- More facial or body hair than before
How you feel
- Persistent fatigue that doesn't improve with rest
- Brain fog or difficulty concentrating
- Increased hunger even after eating
You don't need all of these to be insulin resistant. Many women have just a handful - most commonly the stubborn weight, the post-meal energy crash, and the cravings. If several of these feel familiar, insulin resistance is worth taking seriously. For a deeper look at the subtler signs, see the signs of "silent" insulin resistance women most often miss.
The afternoon energy crash plus sugar cravings around 3pm is one of the most telling everyday patterns. If you regularly feel like you hit a wall mid-afternoon and reach for something sweet to get through it, that's your blood sugar and insulin talking - not a lack of willpower.
Why your GP may have told you everything's normal
This is where many women get stuck, and it's worth understanding clearly so you can advocate for yourself.
When you ask your GP to check for blood sugar problems, they will almost always order one or both of these:
- Fasting glucose - measures the sugar in your blood after an overnight fast
- HbA1c - measures your average blood sugar over the past three months
Both of these measure sugar. Neither measures insulin.
As we covered above, in the early and middle stages of insulin resistance, your body keeps your blood sugar normal by producing extra insulin. So your fasting glucose and HbA1c can both come back squarely in the normal range - while your insulin is high and your metabolism is under strain. Your GP sees normal results and, reasonably, tells you you're fine.
This isn't negligence. Standard screening is designed to catch diabetes and pre-diabetes - conditions defined by blood sugar. It is not designed to catch insulin resistance in its earlier, reversible stages. The result is that many women spend years being told they're fine while gaining weight, losing energy, and feeling increasingly unwell.
Insight
If you've been told your bloods are "normal" but you still feel unwell, you are not imagining it and you are not being difficult. The standard tests were simply never designed to detect what you're experiencing. The question to ask is not "is my blood sugar normal" - it's "what is my insulin doing."
The markers to actually ask for
If you want a real answer, these are the markers worth requesting. You can ask your GP, though not all are routinely available through standard bulk-billed testing, and interpretation matters as much as the numbers themselves.
Fasting insulin. This is the single most useful marker and the one almost never tested by default. It measures how much insulin your body is producing at rest. A fasting insulin that sits in the upper part of the "normal" range - or above it - is a strong early indicator of insulin resistance, even when blood sugar is normal.
Fasting glucose. Useful in combination with fasting insulin, not on its own.
HOMA-IR. This is a calculation that combines your fasting insulin and fasting glucose into a single score that estimates insulin resistance. It's far more revealing than glucose alone, but it requires fasting insulin to be tested - which is exactly the marker that usually gets left off.
Triglyceride-to-HDL ratio. From a standard lipid panel, the ratio of your triglycerides to your HDL ("good") cholesterol is a useful indirect marker. A high ratio is associated with insulin resistance.
HbA1c. Worth having for the bigger picture, but remember it can stay normal well into insulin resistance.
The challenge most women run into is twofold: getting fasting insulin tested in the first place, and then getting someone to interpret the full picture rather than just checking whether each number falls inside a broad "normal" range. A marker can be technically "normal" and still be telling you something is wrong - and that interpretation is where standard care often falls short.
This is exactly the gap that functional blood chemistry analysis is designed to fill. Rather than asking only "is this number outside the reference range," it asks "is this number optimal, and what is the full pattern telling us" - which is how insulin resistance gets caught early, while it's still very much reversible.
So... am I insulin resistant?
Here's the honest answer. You can't diagnose yourself from an article, and you shouldn't try to. But you can get a strong sense of whether it's likely, and whether it's worth investigating properly.
If you recognise several of the signs above - particularly stubborn weight around the middle, post-meal energy crashes, sugar cravings, and a history of "normal" bloods despite feeling unwell - then insulin resistance is a genuine possibility and worth pursuing with the right testing.
The good news, and it's significant: insulin resistance is one of the most reversible metabolic conditions there is. Caught early, it responds remarkably well to the right dietary and lifestyle changes - far better than most women expect. We've written a complete, evidence-based guide to how to reverse insulin resistance naturally, which is the natural next step if this article has confirmed your suspicions.
What matters most is not panicking, and not ignoring it either. It's getting a clear picture and acting on it while the condition is still highly responsive.
Clinical Insight
Insulin resistance is among the most prevalent and least detected metabolic conditions in women, and the gap between its prevalence and its diagnosis is largely explained by the limitations of standard screening. Conventional testing relies on fasting glucose and HbA1c - both measures of glycaemia rather than insulin - which remain within normal range throughout the compensatory hyperinsulinaemic phase, the period during which the pancreas maintains normoglycaemia by progressively increasing insulin output. During this phase, which can persist for years, insulin resistance is present, progressing, and clinically significant, yet entirely invisible to the markers most commonly ordered. Fasting insulin, HOMA-IR, and the triglyceride-to-HDL ratio offer substantially earlier detection but are infrequently requested in routine practice, and where they are tested, results are often assessed against broad reference ranges rather than optimal ranges, allowing meaningful dysfunction to be reported as normal. In women, the picture is further complicated by hormonal context: PCOS, declining or dysregulated oestrogen in perimenopause, and cortisol dysregulation all independently reduce insulin sensitivity, meaning insulin resistance frequently presents alongside hormonal symptoms that are themselves misattributed or dismissed. The clinical reality is that a woman experiencing the characteristic cluster - central weight gain, post-prandial fatigue, carbohydrate craving, and hormonal disruption - alongside "normal" standard bloods is not reassured by those results so much as failed by them. A comprehensive assessment that measures insulin directly, interprets markers against optimal rather than merely normal ranges, and accounts for the hormonal context almost always clarifies a picture that standard screening leaves frustratingly opaque - and because insulin resistance is highly responsive to targeted nutritional intervention in its earlier stages, that clarity is genuinely actionable.
Working With "Normal" Results When You Know Something Isn't Right?
The signs in this article point toward insulin resistance - but the only way to know for certain is to look at the right markers, interpreted against optimal ranges and in the context of your full hormonal picture. For women who want that clarity, my metabolic health programmes begin with a comprehensive analysis of your individual blood chemistry, going well beyond the standard glucose-and-HbA1c screening to identify what is actually happening with your insulin and metabolism.
From there, the work becomes personalised: a nutrition protocol designed around your individual blood test results, identifying the foods that suit your body and directly addressing the metabolic factors driving your symptoms - rather than the generic advice that so often fails women with insulin resistance.
Many women describe this as the first time anyone has actually explained what their body has been doing - and the first approach that has actually worked.
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