Why Your Metabolism Could Be Broken For Years Before Anyone Notices
- precisionpcw
- Jun 4
- 5 min read
I want to tell you about a patient I saw recently.
He was 44 years old, felt reasonably well, exercised
a few times a week, and had just come from his annual
physical at another practice. Everything was normal,
he told me. His doctor had said so. Cholesterol fine.
Blood pressure fine. Blood sugar fine.
I ran a HOMA-IR on him — a simple calculation using
fasting insulin and fasting glucose that measures how
well his cells were actually responding to insulin.
His score was 4.8. Anything above 2.0 suggests insulin
resistance. Above 3.5 is significant. At 4.8, his
metabolism had been struggling for a long time.
He had no idea. His doctor had no idea. And yet his
body had been sending signals for years — he just
didn't know how to read them, and nobody had run
the right test.
What Insulin Resistance Actually Is
Your cells run on glucose — it's their primary fuel.
But glucose can't enter most cells on its own. It
needs insulin, a hormone produced by your pancreas,
to unlock the door.
Insulin resistance happens when that lock gets stiff.
The key still fits, but it doesn't turn as easily. So
your pancreas compensates by making more insulin —
more keys, trying harder to open the same doors.
For a while, this works. Blood sugar stays normal.
Your A1C looks fine. Your fasting glucose is
unremarkable. By every standard measure your doctor
checks, you look metabolically healthy.
But here's what's happening underneath: your insulin
levels are elevated. And chronically elevated insulin
drives fat storage — particularly around the abdomen
and organs. It promotes inflammation. It raises
triglycerides. It contributes to high blood pressure.
It increases cardiovascular risk. And eventually,
after years of your pancreas working overtime, it
starts to fall behind — and that's when blood sugar
begins to rise, and the pre-diabetes diagnosis arrives.
"By the time blood sugar becomes abnormal, insulin
resistance has typically been present for 10 to 15
years. Standard screening catches the end of the
story. HOMA-IR catches the beginning."
Why Standard Screening Misses It Completely
The standard metabolic screening in a typical annual
physical includes fasting glucose and sometimes HbA1c;
a three-month average of blood sugar levels. Both
are useful tools. But both measure blood sugar, not
insulin. And in early and intermediate insulin
resistance, blood sugar is still normal.
Think of it this way: if you want to know how hard
an engine is working, you don't just measure speed.
You check the fuel consumption, the temperature, the
pressure. Measuring glucose alone is like only
checking speed — it tells you where things are now,
not how hard the system is working to maintain them.
HOMA-IR requires one additional test: fasting insulin.
Most standard panels don't include it. It costs very
little. It takes no extra blood draw. It just isn't
ordered, because most physicians aren't looking for
insulin resistance until it's already become diabetes.
The Numbers That Should Concern Every Adult
88 million Americans currently have pre-diabetes.
84% of them have no idea. The condition has been
building for an average of 10 to 15 years before
a diagnosis is made. And the additional test that
would have caught it earlier — fasting insulin —
costs nothing extra to add to a standard blood panel.
That's not a gap in medicine. That's a gap in
attention.
The Signs Your Body Is Already Sending
Insulin resistance isn't silent — it speaks, just
not in language most people recognize as metabolic.
Here are the signals I see most often in patients
who turn out to have elevated HOMA-IR:
Fatigue that doesn't improve with sleep
Difficulty losing weight despite diet and exercise
Sugar and carbohydrate cravings — especially after meals
Energy crashes 1–2 hours after eating
Abdominal fat that feels stubborn regardless of effort
Brain fog and difficulty concentrating
Skin tags or darkened skin in neck folds
Elevated triglycerides on standard labs
None of these symptoms are specific to insulin
resistance — which is part of why it goes
undiagnosed. They're easy to attribute to stress,
poor sleep, aging, or just being busy. But when
I see three or four of them together in a patient,
I run a HOMA-IR before I do anything else.
What the Numbers Mean
Here's how I interpret HOMA-IR scores in practice
and what each level means for your health:
HOMA-IR Score | What It Suggests | What We Do |
Below 1.5 | Optimal insulin sensitivity | Monitor annually, maintain current lifestyle |
1.5 – 2.0 |  Normal range — monitor closely | Lifestyle review, dietary assessment |
2.0 – 3.5 |  Mild to moderate insulin resistance | Targeted dietary changes, movement protocol, recheck at 90 days |
Above 3.5 | Significant insulin resistance | Comprehensive metabolic intervention — nutrition, lifestyle, possible medication |
The Good News — This Is Reversible
Insulin resistance is not a life sentence. It is
one of the most modifiable conditions in medicine.
Caught early — before blood sugar becomes abnormal,
before the damage accumulates — it responds
remarkably well to the right interventions.
In my practice, the most effective approaches combine three things:
Carbohydrate quality, not elimination. Reducing refined carbohydrates and added sugars — not all carbohydrates — meaningfully improves insulin sensitivity within weeks.
Resistance training. Muscle tissue is the primary site of insulin-mediated glucose uptake. Even two sessions per week creates measurable improvement.
Sleep and stress management. Cortisol directly impairs insulin sensitivity. Chronic sleep deprivation of even one hour per night can raise HOMA-IR significantly.
I recheck HOMA-IR at 90 days after any significant
intervention. In most cases the numbers move.
Sometimes dramatically. Seeing that change on paper
is one of the most motivating things a patient can
experience — it proves the effort is working before
any scale number or clothing size changes.
What I Want You to Take Away
If you've had a recent physical and been told
everything is normal — ask specifically about your
fasting insulin level. If it wasn't checked, it
doesn't mean your metabolism is fine. It means
nobody looked.
If you recognize yourself in the symptom list above
— fatigue, stubborn weight, energy crashes,
carbohydrate cravings — don't assume it's just
stress or aging. These are metabolic signals. They
deserve a metabolic investigation.
If you want to know your HOMA-IR — we check it at
Precision Primary Care as part of our standard new
patient evaluation. It's one of five markers I
consider essential for anyone serious about their
long-term health. The other four are coming in the
next posts in this series.
Your metabolism is telling you something. The
question is whether anyone is listening.
Ready to know your numbers? Book a free 30-minute
consultation with Dr. Milien at Precision Primary
Care & Wellness in Fishers, Indiana — or download
our free guide, "The 5 Systems That Determine How
Long and How Well You Live."
About the Author
Dr. Seneque Milien, MD is the founder of Precision
Primary Care & Wellness in Fishers, Indiana.
Board-certified in Family Medicine and Obesity
Medicine, he brings over 10 years of experience
as a hospitalist and medical director to outpatient
care. He built Precision specifically to practice
the kind of prevention-focused, data-driven medicine
that standard care rarely has time for. This blog
is where he shares what he wishes every patient
already knew.
