Modern Metabolic Health with Dr. Lindsay Ogle, MD

Understanding Insulin Resistance And Why It Matters

• Lindsay Ogle, MD

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***CORRECTION*** A1c of 6.5% or greater is diagnostic of Type 2 Diabetes (Dr. Ogle misspoke @6:45)

Diabetes Prevention: https://drlindsayogle.ck.page/diabetes


Ever wondered why carb cravings feel relentless or why weight feels harder to manage than it used to? We dig into the real mechanics of insulin resistance and map the path from normal glucose to prediabetes and type 2 diabetes, making sense of the numbers your doctor orders and the signals your body sends. With clear language and practical examples, we turn confusing lab ranges into meaningful next steps.

We break down fasting glucose and A1C—what they measure, the exact cutoffs, and when each test makes the most sense—so you can walk into your next appointment informed and confident. You’ll learn who should get screened earlier, from those with family history or gestational diabetes to anyone noticing skin tags, acanthosis nigricans, irregular cycles tied to PCOS, or surging hunger and carb cravings. Most importantly, we explain why catching elevated glucose early protects your heart, kidneys, nerves, eyes, and brain over the long haul.

Treatment has evolved. Not everyone with type 2 diabetes needs insulin, and newer options can lower blood sugar, support weight management, and reduce cardiovascular and renal risk. We connect these therapies to everyday habits that move the needle—protein-forward meals, short walks after eating, strength training, better sleep, and cutting sugary drinks—so you can build a plan that fits real life. If you’re worried about your risk or already in the prediabetes range, you’ll leave with actionable steps and a path to healthier numbers.

If this conversation helps you or someone you care about, subscribe, share it, and leave a quick review. Your support helps more people find reliable guidance and take charge of their metabolic health.

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Dr. Lindsay Ogle:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. That's about one in 10 adults have type 2 diabetes. And the numbers are even higher for prediabetes. It is estimated that 98 million US adults are living with pre-diabetes. That's about one in three adults have prediabetes, which places these people at much higher risk of developing type 2 diabetes later on in life. And then there's a portion of people who have insulin resistance that's happening even before a diagnosis of prediabetes. So that's even more of the population that is having some metabolic disturbance that is affecting their health and how they feel on a day-to-day basis. What do I mean when I say insulin resistance? So insulin is a hormone that is released from the pancreas, and the pancreas is an organ that is in the upper midsection of our abdomen of our belly, kind of right under the middle of our rib cage. And that hormone gets secreted, and the role of insulin is to tell our cells or to help our cells collect the sugar that's in the blood, so then the cells can use that sugar for energy and can function as they need to to help our body function properly. So what happens with insulin resistance is that for some reason and um as science progresses, we are really fine-tuning exactly what that underlying cause is. And right now we know that it's multifactorial, so it's a combination of genetic factors, environmental factors, lifestyle factors, um, and many more that we are probably unaware of at the moment, but many factors together can cause insulin resistance, and what that means is there is something that is happening that is preventing the insulin from working effectively on the cell to allow it to collect that blood sugar, that glucose. And so that cells have the energy that they need. So, what happens over time is that we are needing more and more insulin to be released from the pancreas, and at some point our pancreas cannot keep up with that higher levels of insulin production, and when that happens, the insulin resistance um kind of wins, and then we are not able to bring that sugar into the cells, and our blood sugar rises. And when the blood sugar rises, that is when you end up eventually getting diagnosed with either prediabetes or diabetes, depending on how high the blood sugar levels are. Like I said in the beginning, insulin resistance, prediabetes, and diabetes is really a continuum, it's a spectrum of a condition or a disease. And we have these arbitrary cutoffs that have been created so we can categorize where someone is on that spectrum. And what we have uh decided as a medical community and a scientific community is that fasting blood sugar, so you have not um ate or drank anything with calories in it for eight hours. Um, after that fasting period, you check your blood sugar. If it's below 100, that's considered a normal blood sugar. If the blood sugar is between 100 and 125, that's in the prediabetes range. And if it's 126 or higher, that's in the diabetes range. There's another way that we can screen or test for prediabetes or diabetes, and that's with a blood test called a hemoglobin A1C. Now, what's nice about this test is that you don't need to be fasting, so you can get it done at any time of the day. So if you have an afternoon doctor's appointment and you had lunch, you can get this blood test done and be screened for diabetes. What it's doing is it's it's a it's a way that we can estimate what your average blood sugar has been over the past three months. And I could go into the details, but it doesn't particularly matter about how this test works. Um, but the cutoffs for the A1C is an A1C of 5.6 or below is in the normal range, and then 5.7 to 6.4 is in the prediabetes range, and then um 5.7 or above is in the diabetes range. Anyone 35 or above should be screened for type 2 diabetes. There are reasons that you may be at increased risk for type 2 diabetes, that could be a family history of diabetes, personal history of elevated blood sugar, gestational diabetes. If you've had high blood sugar during a pregnancy, um, if you have autoimmune disease, either personally or family history, if you have something called polycystic ovarian syndrome or PCOS, which often presents as irregular menstrual cycles, um, sometimes people have um thicker chin hairs or are losing some hair in this area. If you have something called acanthosis Niagara cans, which is thickening and darkening of the skin, specifically in the neck or armpits or groin area, um, skin tags, multiple skin tags can be um evidence of insulin resistance. People who have insulin resistance also have increased hunger, um, increased cravings for carbohydrates. They also often struggle with weight management. Um, their weight can often fluctuate or they can have difficulty losing weight when maybe in the past that wasn't the case. If any of this sounds like you, I definitely recommend talking to your doctor and getting screened for diabetes or prediabetes. So, why is this so important? Why is it important to know if you have prediabetes or if you have diabetes? It's a couple of reasons. One, if we do not control our blood sugar and lower our insulin levels, we're at higher risk for complications of diabetes. And there are many. Complications can include increased risk of heart disease, heart attack, or stroke, um, higher chance of kidney disease, um, type 2 diabetes, and uncontrolled blood pressure are the number one and number two causes of someone needing to be on dialysis. So it's really important to get that diabetes under control to lower those risks. Other complications of diabetes include poor wound healing, which can lead to amputations, increased risk of infection, increased risk of dementia, it can affect um sexual function, it can affect our nerves and cause pain and numbness and tingling, it can cause gum disease, it can affect our vision and even cause blindness. It can cause something called gastroparesis, which is slowing of the stomach and can cause nausea and upset stomach. Lots of different complications. And not everyone who has diabetes develops these, but they are at higher risk for these conditions later on in their life. And again, why it's so important to screen yourself for diabetes, and if you do have it, to be on effective treatment. And that kind of leads into the other reason why it's so important to know if you have diabetes because there is really great treatment available now, um, and it is much, much more and much better than what we've had in the past. Um, not everybody who has diabetes needs to be on insulin, and this is really important to know. If you have type 2 diabetes, you have so many options available to you for treatment, and like I said, a lot of them are extremely effective and actually help you feel better now and decrease your risk of complications in the future. So, my next video, I'm going to talk about what those treatment options are. But if you are worried about your diabetes risks, or if you know you have prediabetes or have a family history of diabetes, and you want to know what you can do now to decrease your chances of developing diabetes in the future, then please check out my tips on how to prevent diabetes in the link below. There are seven tips here that are easily implemented, and many of them you can start today. And so you can find that link below, seven evidence-based ways to prevent diabetes. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.