The Silent Driver of Disease: Why Fasting Glucose Isn’t Enough

Insulin resistance is increasingly understood not merely as a precursor to diabetes, but as the foundational metabolic dysfunction driving the majority of modern chronic diseases, including cardiovascular disease, hypertension, and neurodegenerative disorders. While traditional medicine often focuses on managing symptoms—such as lowering blood pressure or cholesterol—these are frequently downstream effects of a system flooded with insulin. When cells become numb to insulin’s signals, the pancreas compensates by overproducing this hormone to keep blood sugar stable. This state of hyperinsulinemia can ravage the vascular system and promote inflammation long before a standard blood test raises any red flags.

The danger lies in the “glucose-centric” approach of standard physicals. A patient can maintain normal fasting glucose levels for years, or even decades, by churning out massive amounts of insulin to force that sugar into cells. By the time fasting glucose finally creeps out of the normal range, the pancreas has likely been overcompensating for 10 to 15 years, and significant beta-cell dysfunction has already occurred. This is why waiting for an elevated A1C or fasting glucose is often too late for true prevention; it detects the crash after the brakes have already failed.

To catch this metabolic derangement in its infancy, we must look beyond glucose to the relationship between sugar and insulin. The HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) calculation utilizes both fasting insulin and fasting glucose to provide a clear picture of insulin sensitivity. A HOMA-IR score can reveal hidden resistance while blood sugar is still “perfect,” offering a precious window of opportunity. Identifying and reversing insulin resistance at this early stage—through dietary changes, intermittent fasting, and lifestyle interventions—is the single most effective strategy for preventing the progression to overt Type 2 diabetes and preserving long-term cardiovascular health.

References

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3. Di Pino, A., & DeFronzo, R. A. (2019). Insulin Resistance and Atherosclerosis: The Missing Link. Arteriosclerosis, Thrombosis, and Vascular Biology, 39(6), 1018–1020.