How to know if you have it
Normal fasting glucose does not rule it out. That is the central misunderstanding. For years the pancreas compensates by producing more insulin and glucose stays in range: the system works, at an increasing cost. By the time glucose finally rises, the process has been established for a long time.
What does reveal it:
- Fasting insulin alongside glucose, with HOMA-IR calculated from both.
- High triglycerides with low HDL, and above all a ratio between them above 2.
- Raised visceral fat, even at normal weight.
- Acanthosis nigricans: velvety darkening of skin on neck, armpits or knuckles.
- Marked sleepiness after meals, hunger two hours later, difficulty losing abdominal fat.
No single sign confirms anything. Diagnosis is made by your doctor integrating the whole.
Why it appears
The cause is not “eating sugar”. It is closer to a chronic excess of available energy against a limited capacity to store and use it. When subcutaneous adipose tissue saturates, fat deposits where it should not: viscera and liver. That ectopic fat interferes with insulin signalling.
Which is why sedentary living and muscle loss weigh so heavily: less muscle means less glycogen storage capacity and less glucose demand. The same breakfast lands differently in two people of the same age and weight but ten kilos apart in skeletal muscle mass.
The piece almost nobody mentions
Skeletal muscle takes up between 70 and 80 % of circulating glucose after a meal. It is by far the main destination of the carbohydrate you eat.
That has a hard practical consequence: if you lose weight by losing muscle, you worsen your insulin resistance even though the scale drops. Very restrictive diets without adequate protein or strength stimulus achieve exactly that, and explain why so many people regain weight with a worse metabolism than they started with.
It is why I work with measured body composition rather than weight. The question is not how much you lost, but where it came from.
How to structure eating
- Enough protein at every meal. The requirement is based on your habits and spread evenly across the day.
- Carbohydrates with fibre and accompanied. Not eliminating them: changing their form. A carbohydrate eaten with protein, fat and fibre produces a very different glycaemic response than the same carbohydrate alone.
- Distribution matched to your activity. Concentrate more carbohydrate around training, when muscle is most receptive.
- Cut free sugars and sweetened drinks. In Panama that means looking hard at natural juices with added sugar, sodas and coffee with condensed milk. Reading the nutrition label on products matters.
- Unsaturated fats as the base. Olive oil, avocado, nuts, oily fish.
And most important: strength training two or three times a week. No diet compensates for the absence of muscular stimulus in this condition.
Which foods worsen it
- Sweetened drinks, including fruit juices and “natural” drinks with added sugar.
- Large amounts of refined flours eaten alone, without protein or fibre alongside.
- Regular alcohol, which also raises triglycerides.
- Very large, widely spaced meals producing big spikes.
- Aggressive calorie deficits without adequate protein, for the reason above.