Functional Medicine Approach to Insulin Resistance

Functional Medicine Approach to Insulin Resistance in India. Insulin resistance develops when cells in tissues such as muscle, liver and fat become less responsive to insulin, requiring the body to compensate with greater insulin secretion to maintain glucose regulation. Over time, this pattern can be associated with prediabetes, type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, abnormal triglycerides and other cardiometabolic problems. NIDDK

At RH+, we do not look at insulin resistance simply as a problem of eating too much sugar.

We assess the individual’s dietary patterns, meal frequency, sleep, stress, physical activity, body composition, medical history and relevant metabolic markers together.

With Prashantt J Wadhaawan, Functional Medicine Practitioner and Founder of RH+, the aim is to understand the wider metabolic environment and identify which factors deserve attention first.

Online functional medicine consultations are available across India.

Insulin Resistance Can Develop Before Blood Sugar Looks Abnormal

One of the reasons insulin resistance can be missed is that glucose does not always tell the whole story.

In the earlier stages, the pancreas may compensate for reduced insulin sensitivity by producing more insulin.

As a result, a person may have apparently acceptable glucose values while other metabolic patterns are already developing.

This is why I do not look at a single fasting-glucose value in isolation.

I look at the broader picture.

“I do not assess insulin resistance from one glucose value. I look at the broader metabolic picture and how the person is functioning.” — Prashantt J Wadhaawan

It is also important to distinguish insulin resistance assessment from the formal diagnosis of prediabetes or diabetes. Standard diagnostic tests for prediabetes include fasting plasma glucose, HbA1c and the oral glucose tolerance test. Measures such as fasting insulin or HOMA indices may provide additional metabolic context but are not the standard diagnostic criteria for diabetes. NIDDK

How I Assess Insulin Resistance

My starting point is the same structured assessment process I use for other complex health concerns.

Health Risk Assessment for Insulin Resistance

A detailed questionnaire helps me understand symptoms across multiple physiological systems rather than beginning with one laboratory marker.

Medical History for Insulin Resistance

I review:

• family history
• existing metabolic conditions
• medications
• previous diagnoses
• weight history
• liver-health history
• hormonal conditions such as PCOS where relevant
• previous laboratory findings

Diet & Lifestyle Assessment in Insulin Resistance

I then look closely at:

• meal frequency
• meal timing
• food quality
• portion patterns
• cravings
• sleep
• physical activity
• training history
• stress
• sedentary behaviour
• body-weight changes

Review Existing Reports

If relevant reports are already available, I review them before recommending additional testing.

The objective is to understand the person first and then interpret the numbers within that context.

Metabolic Markers I May Review in Insulin Resistance

Depending on the individual’s history and existing reports, I may look at markers such as:

• fasting blood glucose
• fasting insulin
• C-peptide
• HbA1c
• fructosamine
• HOMA2-IR where appropriate
• triglycerides
• HDL and broader lipid profile
• liver enzymes
• body composition
• waist or visceral-fat patterns
• other metabolic or nutritional markers where relevant

Not everyone needs every test.

And these tests should not be confused with the recognised diagnostic criteria for diabetes and prediabetes.

For formal diagnosis, established blood-glucose-based testing remains important. NIDDK

Common Patterns I See in Insulin Resistance

In my clinical work, insulin resistance is rarely just a matter of someone eating desserts or adding sugar to tea.

I frequently see a broader lifestyle pattern involving some combination of:

• frequent eating
• constant snacking
• poor-quality food choices
• irregular meal timing
• very late meals
• inadequate sleep
• chronic stress
• low physical activity
• visceral fat accumulation
• family history
• and, in some cases, eating too little for prolonged periods

The combination differs from person to person.

A sedentary individual with visceral obesity and poor sleep requires a different strategy from a younger person who already trains regularly but has poor meal structure and a strong family history.

This is why I do not begin with a universal insulin-resistance diet.

“Insulin resistance is not always a sugar problem. It is often a pattern created by how the person eats, sleeps, moves, recovers and carries body fat over time.”

Frequent Eating, Cravings & Meal Structure

One area I pay particular attention to is how often the person feels they need to eat.

Some people find themselves moving continuously between meals, snacks, tea, coffee, sweet foods or other sources of energy throughout the day.

They may describe:

• frequent hunger
• cravings
• energy crashes
• difficulty going several hours without eating
• feeling sleepy after meals
• needing something sweet later in the day

These symptoms are not specific enough to diagnose insulin resistance on their own.

But together with the person’s metabolic profile, diet and lifestyle, they can provide useful context.

One practical objective in many of my programmes is helping the individual become comfortable with well-structured, satisfying meals rather than continuously chasing hunger and energy fluctuations.

Body Composition & Visceral Fat

Body weight alone does not tell us enough.

Where possible, I am more interested in body composition and visceral-fat patterns.

Visceral adiposity is strongly associated with metabolic dysfunction, and abdominal obesity is a recognised risk factor for insulin resistance and prediabetes. NIDDK

This also explains why two people of the same body weight may have very different metabolic profiles.

For someone carrying substantial visceral fat, reducing excess body fat while preserving or developing muscle can become an important part of the strategy

Insulin Resistance, Triglycerides & Fatty Liver

Insulin resistance often exists alongside other metabolic abnormalities.

These may include:

• elevated triglycerides
• fatty liver / MASLD
• central obesity
• high blood pressure
• impaired glucose regulation
• metabolic syndrome

NIDDK specifically recognises abnormal triglycerides, obesity, metabolic syndrome and MASLD among conditions associated with insulin resistance and prediabetes. NIDDK

For this reason, I do not separate insulin resistance from the person’s broader metabolic and liver-health profile.

Explore Metabolic Health →

Common Mistakes I See in Insulin Resistance Clients

Looking Only at Glucose & HbA1c

Glucose and HbA1c are important.

But focusing only on these values can sometimes cause people to ignore the rest of their metabolic picture.

Depending on the individual, fasting insulin, triglycerides, liver markers, body composition and lifestyle patterns may provide useful additional information.

Staying on Extreme Diets Too Long

Another common mistake is assuming that because one diet initially produced weight loss or lower glucose readings, it must remain the right strategy indefinitely.

For example, some people remain on very restrictive ketogenic or high-fat diets for long periods without reassessing:

• overall energy intake
• food quality
• lipid profile
• liver health
• body composition
• nutritional adequacy
• sustainability

Low-carbohydrate eating patterns can be one evidence-based option for some people with prediabetes, but current diabetes guidance supports individualised eating patterns rather than one mandatory diet for everyone. Diabetes Journals

Eating Too Little

Some people respond to weight gain or poor glucose control by progressively reducing food intake.

But an unsustainable diet can make it difficult to maintain adequate nutrition, physical activity, training performance and long-term adherence.

The objective should be to create an appropriate nutritional strategy — not simply to eat as little as possible.

Ignoring Nutritional Status

Iron, vitamin B12, vitamin D and other nutritional factors may not directly explain insulin resistance, but deficiencies can influence how a person feels, exercises, sleeps and adheres to lifestyle changes.

Doing Only Cardio

Cardiovascular exercise is valuable.

But I do not want people to think that hours of cardio are the only way to improve metabolic health.

Muscle and resistance exercise deserve an important place in the strategy.

Ignoring Sleep & Stress

Sleep and chronic stress are often treated as secondary considerations.

In my approach, they are part of the metabolic assessment from the beginning.

Exercise Should Match the Person In Insulin Resistance

Exercise recommendations need to reflect the person’s actual starting point.

Someone who is young, relatively fit and already experienced with resistance training can follow a very different programme from someone who has severe obesity and has never exercised.

For the latter individual, beginning with an aggressive exercise programme may be unrealistic.

I may instead start with something as basic as increasing daily steps progressively over weeks or months.

The goal is to move from:

sedentary → more daily movement → greater exercise tolerance → structured exercise

rather than expecting an immediate transformation.

As weight, mobility and confidence improve, resistance training can gradually be introduced.

For many individuals, this may eventually involve 2–3 appropriately supervised resistance-training sessions per week, according to capability and medical circumstances.

Public-health and diabetes guidance similarly emphasises gradual increases in physical activity, with a general target of around 150 minutes per week of moderate activity for many adults where appropriate. Diabetes Journals

“The best exercise plan is not the hardest one. It is the one the person can safely progress with and sustain.”

Why Muscle Matters

Skeletal muscle is a major site of glucose disposal.

For this reason, muscle health and physical activity are particularly relevant to metabolic health.

The goal is not necessarily bodybuilding.

Depending on the individual, it may simply mean:

• preserving existing muscle
• gradually improving strength
• reducing sedentary time
• walking more
• increasing overall physical capacity
• eventually introducing appropriate resistance training

This is one reason I do not evaluate weight loss using the weighing scale alone.

Body composition matters.

Nutrition for Insulin Resistance

There is no one insulin-resistance diet that everyone needs to follow.

The strategy should consider:

• total energy needs
• body composition
• metabolic health
• physical activity
• training
• food preferences
• cultural eating habits
• triglycerides
• liver health
• nutrient requirements
• sustainability

Current diabetes guidelines support several evidence-based dietary patterns and emphasise food quality, appropriate calorie intake and individual metabolic goals rather than a single universally required macronutrient distribution. Diabetes Journals

For many people, improving the quality and structure of eating is more useful than simply labelling foods as carbohydrates or fats.

Gut Health & Insulin Resistance

Gut health is not automatically the cause of insulin resistance.

However, when significant gastrointestinal symptoms, dietary restriction or nutritional problems are present, I include them in the wider assessment.

The question is not:

“Does everybody with insulin resistance have a gut problem?”

The question is:

“Is digestive health interfering with this person’s nutrition, health or ability to implement an effective metabolic strategy?”

Explore Gut & Digestive Health →

Insulin Resistance & PCOS

Insulin resistance is particularly relevant in many people with PCOS.

The relationship between insulin, reproductive hormones, body composition and metabolic health means that PCOS should not always be viewed as an isolated reproductive-hormone problem.

The significance of insulin resistance varies between individuals, which is why appropriate assessment remains important.

Explore Hormonal Health →

Sleep, Stress & Metabolic Health

Insulin resistance is not managed through food alone.

I routinely look at:

• sleep duration
• sleep timing
• poor-quality sleep
• stress exposure
• recovery
• physical activity
• daily routine
• daylight exposure

For someone living with chronic sleep deprivation and high stress, simply giving them a more restrictive diet may not solve the wider problem.

Sometimes the first intervention needs to be restoring basic physiological routine.

What Are We Actually Trying to Improve in Insulin Resistance?

My objective is not simply to make one laboratory number look better.

Depending on the individual, I look for improvement in areas such as:

• fasting insulin when elevated
• triglycerides
• body weight
• visceral fat
• body composition
• cravings
• meal-to-meal satiety
• energy stability
• glucose regulation
• physical capacity
• sleep and overall metabolic health

A particularly meaningful practical change is when someone can eat an appropriate balanced meal, feel satisfied, and remain comfortable until their next meal without repeatedly experiencing cravings or energy crashes.

“The goal is not only better glucose. It is better metabolic control throughout the day.”

Our Functional Medicine Approach to Insulin Resistance

1. Assess the Person

Health-risk questionnaire, symptoms, medical history, lifestyle and diet.

2. Review the Metabolic Picture

Existing glucose, insulin, lipid, liver and body-composition data are considered together.

3. Identify the Main Drivers

These may involve:

meal structure → food quality → excess visceral fat → inadequate movement → poor sleep → stress → other metabolic factors

with different priorities for different people.

4. Build a Sustainable Nutrition Strategy

Rather than automatically prescribing extreme carbohydrate restriction, the diet is designed according to individual requirements.

5. Increase Movement Progressively

Sedentary individuals may begin with achievable daily movement targets before more structured exercise is introduced.

6. Build or Preserve Muscle

Resistance exercise is gradually incorporated where appropriate.

7. Correct Relevant Deficiencies & Health Issues

Nutritional, gastrointestinal or other relevant factors are addressed according to assessment findings.

8. Reassess

We monitor symptoms, adherence, body composition and relevant metabolic markers over time.

Functional Medicine for Insulin Resistance Across India

Online consultations allow the broader metabolic picture to be assessed without requiring someone to travel to RH+.

Depending on the individual, we may review:

• fasting glucose
• fasting insulin
• HbA1c
• lipid profile
• triglycerides
• liver markers
• existing medical reports
• body composition
• dietary patterns
• cravings and meal structure
• sleep
• stress
• exercise history
• lifestyle

with Prashantt J Wadhaawan, Functional Medicine Practitioner.

Insulin Resistance FAQs

Can you have insulin resistance with normal fasting glucose?

It is possible for metabolic dysfunction to develop before fasting glucose becomes overtly abnormal because the pancreas may compensate by producing more insulin. However, fasting insulin is not itself one of the standard diagnostic tests for prediabetes or diabetes.

Is fasting insulin more important than HbA1c?

They answer different questions.

HbA1c is an established test for diagnosing and monitoring abnormal glucose regulation. Fasting insulin can sometimes provide additional metabolic context, but it should not replace established diagnostic testing.

What is HOMA-IR?

HOMA is a mathematical model that uses glucose and insulin-related measurements to estimate insulin resistance or beta-cell function. It can provide metabolic context, but it is not the standard test used to diagnose diabetes or prediabetes.

Can insulin resistance be improved?

Lifestyle interventions involving appropriate weight management, nutrition, physical activity and sleep can substantially improve metabolic risk, and in some individuals insulin sensitivity can improve considerably. NIDDK

Do I need to stop carbohydrates?

No.

Some people may benefit from reducing refined carbohydrates or adopting a lower-carbohydrate dietary pattern, but there is no requirement for everyone with insulin resistance to follow a ketogenic diet. Current guidance supports several individualised eating patterns. Diabetes Journals

Is insulin resistance only seen in overweight people?

No.

Excess body fat, particularly visceral fat, increases risk, but family history, activity levels, medications and other factors can also matter. Body weight alone does not determine metabolic health. NIDDK

Can insulin resistance cause high triglycerides?

Insulin resistance commonly occurs alongside abnormal triglycerides and other forms of dyslipidaemia. Elevated triglycerides should be assessed within the person’s overall cardiovascular and metabolic-risk profile. NIDDK

Is walking enough?

For someone who is very sedentary, walking can be an excellent place to begin. As exercise tolerance improves, a broader programme including resistance training may be appropriate.

Can I consult online for insulin resistance?

Yes. RH+ provides online functional medicine consultations across India where remote support is appropriate.

Work With Prashantt J Wadhaawan

If your glucose appears acceptable but you are dealing with high fasting insulin, elevated triglycerides, visceral fat, cravings, weight gain or other metabolic concerns, a broader assessment may help clarify where to begin.

The objective is not to put everyone on the same diet.

It is to understand your metabolic pattern, correct the fundamentals and build a strategy that can be sustained.

Prashantt J Wadhaawan
Functional Medicine Practitioner | Founder, RH+

Online consultations available across India.