Insulin resistance is the root cause of type 2 diabetes, PCOS, and metabolic syndrome in many patients. Early specialist assessment and targeted treatment can prevent serious long-term complications.
What Is Insulin Resistance?
Dr Syed Kazmi, Consultant Endocrinologist at Naas Cardiology & Endocrinology Clinic in Naas, Co. Kildare (IMC 213626), provides specialist assessment and management of this condition. Appointments are available on Saturdays & Sundays at Suite 5, Vista Primary Care Clinic, Ballymore Road, Naas. To book, call 089 656 7597.
When cells become resistant to insulin, the pancreas compensates by producing more - but eventually cannot keep up, leading to rising blood glucose and, ultimately, type 2 diabetes.
Insulin resistance underlies the majority of type 2 diabetes cases, drives PCOS in many women, causes fatty liver disease (MASLD), and significantly increases cardiovascular risk. It is often silent for years before blood glucose rises to diabetic levels.
Who Should Be Assessed?
Assessment & Treatment
Assessment includes:
Treatment options:
The Mechanism
Insulin moves glucose from the blood into muscle, liver and fat cells. In insulin resistance those tissues respond poorly, so the pancreas compensates by producing more insulin. For years blood glucose can stay normal on the back of these high insulin levels, which is why insulin resistance is often present long before any abnormal glucose test. Over time the pancreas cannot keep up, glucose starts to rise into the pre-diabetes range (HbA1c 42–47 mmol/mol, or fasting glucose 6.1–6.9 mmol/L), and eventually into the type 2 diabetes range.
Insulin resistance rarely travels alone. It clusters with central weight gain, raised blood pressure, high triglycerides, low HDL cholesterol and fatty liver — the pattern described as the metabolic syndrome — and it is the central mechanism in type 2 diabetes, in polycystic ovary syndrome, and in non-alcoholic fatty liver disease. Assessing it is therefore not just about glucose: it is about the whole cardiometabolic picture and the chance to intervene while the changes are still reversible.
Testing & Management
The Work-Up
What Improves It
Book Now
Dr Kazmi, Consultant Endocrinologist (IMC 213626). Saturday & Sunday appointments. Self-referral accepted.
Insulin resistance is a condition where body cells do not respond normally to insulin, causing the pancreas to overproduce it. Over time this leads to pre-diabetes and type 2 diabetes.
In many cases, yes. With lifestyle changes, weight loss (especially with GLP-1 therapy), and targeted medication such as metformin, insulin resistance can be significantly improved or reversed before type 2 diabetes develops.
There is no single routine blood test that labels someone as “insulin resistant”. Dr Kazmi makes the assessment from the whole picture: body shape and waist measurement, blood pressure, an HbA1c or fasting glucose that is normal or in the pre-diabetes range, a lipid profile showing high triglycerides and low HDL, and often evidence of fatty liver. A fasting insulin measured alongside glucose can be used to calculate HOMA-IR, which supports the assessment, but it is not needed in every case and is interpreted with caution. The practical output is a risk category and a plan, not just a label.
Frequently, yes — especially before type 2 diabetes has developed. Losing 5 to 10 per cent of body weight, becoming more active (resistance training as well as aerobic exercise), improving diet quality and cutting excess alcohol can substantially restore insulin sensitivity, and the Diabetes Prevention Program showed that structured lifestyle change reduced progression to diabetes by more than half. Where the risk of progression is high, or where PCOS or significant obesity is present, metformin or GLP-1 based therapy is added. Even where it cannot be fully reversed, improving it lowers the risk of diabetes, heart disease and fatty liver progression.
They are stages of the same process. Insulin resistance is the underlying defect — cells respond poorly to insulin — and blood glucose can still be normal because the pancreas compensates. Pre-diabetes is the stage where glucose has started to rise but has not reached the diabetes threshold (HbA1c 42–47 mmol/mol). Type 2 diabetes is diagnosed at an HbA1c of 48 mmol/mol or above, or a fasting glucose of 7.0 mmol/L or above, on the appropriate confirmatory testing. The earlier in this sequence you intervene, the more of the risk is preventable.
No referral is required — self-referral is accepted, though a GP letter with recent bloods is useful. An insulin-resistance assessment overlaps with a diabetes review but is broader and preventive in focus: it is aimed at people who do not yet have diabetes but have the metabolic pattern that leads to it, or who have PCOS or fatty liver driven by the same mechanism. If testing shows you already meet the criteria for diabetes, the consultation simply becomes a full diabetes assessment on the day.