Metabolic · 5 min
Metabolic health, explained
When strict metabolic health criteria are applied — normal blood pressure, glucose, lipids, waist circumference, and no medications — only a minority of adults across Europe qualify. In the United States, only about 12% of adults meet these criteria. Metabolic dysfunction is now the rule, not the exception, and it begins decades before a diagnosis appears in your notes.
Insulin resistance is the upstream story
Most type 2 diabetes does not begin with high glucose. It begins with rising insulin, secreted in larger and larger doses to keep glucose in range. For 10–20 years the pancreas compensates and the standard fasting glucose looks normal. By the time fasting glucose is abnormal, the underlying disease is well established.
This is why fasting insulin and HOMA-IR — not just glucose or HbA1c — are the markers that catch the problem early.
What to actually measure
A metabolic panel worth running: fasting insulin (target <6 µIU/mL), fasting glucose, HbA1c (<5.3%), triglycerides, HDL, ALT, and waist circumference. The triglyceride-to-HDL ratio is a remarkably good surrogate for insulin resistance — under 1.5 (in mg/dL) is reassuring; over 3 is not.
HOMA-IR — calculated from fasting insulin and glucose — gives a single number. Below 1.5 is healthy; 1.5–3 suggests early resistance; above 3 is overt.
The four levers that move it
Insulin resistance responds to four things, in roughly this order of impact: skeletal muscle (more of it, more often used), sleep, nutrition (calorie balance, fibre, protein, refined-carb load), and stress. Resistance training and Zone 2 cardio together do more for insulin sensitivity than any drug short of metformin or GLP-1 agonists.
A single week of poor sleep can drop insulin sensitivity by 25%. A 5–7% loss of body fat can reverse it.
What to do this week
- Ask for fasting insulin, HbA1c, triglycerides and HDL on your next blood draw.
- Take a 10-minute walk after your largest meal — it blunts the glucose spike meaningfully.
- Add two short resistance sessions; muscle is your largest glucose sink.
- Anchor each meal with 30g of protein and a fibre source.