Not Everyone With Insulin Resistance Needs Medication

By Tina Chagoury, Clinical Dietitian · 5 min read · 2026-09-14

Insulin resistance has become a diagnosis that leads straight to a prescription. There is a great deal that works before that point.

Not everyone with insulin resistance needs to be told to take metformin or start a GLP-1 injection.

That is not an argument against medication. There are situations where it is entirely appropriate, and that decision belongs with your doctor. It is an argument against skipping everything that comes before it, because a great deal of it works.

What genuinely improves insulin sensitivity

Here is the order I work in, roughly by how much difference each makes.

1. Build and use muscle

This is the single most powerful lever and the most consistently ignored.

Muscle is where glucose goes. When you contract and load a muscle, it draws glucose out of the blood and holds it there, and it does this through a pathway that does not require insulin at all.

A woman with very little muscle has very little capacity to handle carbohydrate, no matter how carefully she eats. Resistance training, two or three times a week, changes this measurably.

2. Stabilise blood sugar through meal structure

• Protein within the first hour of waking
• Protein at every meal
• Three structured meals, no all day grazing
• Carbohydrate eaten alongside protein, fat and fibre rather than alone

Constant snacking keeps insulin permanently elevated, and permanently elevated insulin is the environment insulin resistance develops in.

3. Walk after eating

Ten minutes. It sounds trivial. It produces a measurable reduction in the post meal glucose rise, because working muscle is pulling glucose out of the blood exactly when there is a surplus.

4. Reduce the inflammatory load

Inflammation interferes with insulin signalling directly. Processed food, refined and fried oils, processed sugar and artificial sweeteners all contribute.

5. Sleep

A short night measurably reduces insulin sensitivity the following day. This is one of the better established findings in the field, and it is free.

6. Manage the stress load

Cortisol raises blood glucose by design. Chronic elevation therefore works directly against everything above.

7. Correct deficiencies

Vitamin D, magnesium and others all participate in glucose handling. You cannot out train a deficiency.

An important nuance

Not everyone with disordered blood sugar has insulin resistance.

Sometimes the diet is simply wrong. Sometimes movement is far too low. Sometimes stress is high and cortisol is disordered, which affects glucose directly.

This is why we investigate before we intervene, rather than applying the same label and the same solution to everyone.

How to know where you stand

Ask for fasting glucose and fasting insulin together. Fasting insulin is the one most commonly left off, and without it you cannot calculate HOMA-IR, which is what tells us whether insulin resistance is actually present.

Add HbA1c for the longer term picture. A continuous glucose monitor, worn for a few weeks, teaches you more about your own responses than any single blood test can.

The realistic expectation

These changes are not fast and they are not dramatic week to week. They are, however, the changes that hold, and they are the ones that keep working after any medication stops.

This article is nutrition education, not medical advice. Decisions about metformin or any prescription belong with your doctor.

Tina Chagoury is a licensed clinical dietitian specialising in women's hormonal health and metabolism, and the creator of the Hormone Reset Method™. Learn more and start here.