The Invisible Drivers of Insulin Resistance

If you’ve ever felt like you’re “doing everything right” — eating well, staying active, keeping your weight in a healthy range — and your blood sugar numbers still creep up… you’re not alone.

I’m writing this because it happened to me.

For most of my adult life, I ate a mostly plant-based, minimally processed diet. I worked out daily. My BMI never went above 20. My waist circumference, waist-to-hip ratio, and waist-to-height ratio were all firmly in the “healthy” range. No obvious red flags.

And still: prediabetes.

That experience forced me to widen my lens. Because if food, exercise, and weight loss were the only levers that mattered, this shouldn’t have happened — not to me, and not to the many people who do all the “right” things and still struggle.

Prediabetes is sometimes brushed off as an unavoidable part of getting older. But it shouldn’t be. The numbers alone tell us that something bigger is going on.

In the U.S., more than 34% of adults — roughly 115 million people — have prediabetes, and an estimated 80% don’t know it (CDC). Even here in Boulder County — a place known for movement, health consciousness, and outdoor life — about 20% of residents are estimated to have prediabetes, representing more than 65,000 people.

This isn’t a problem that only exists “somewhere else” for “someone else.” It’s right here, among us.

So what’s going on?

The problem with a food-and-fitness-only story

Food quality and movement matter. A lot.

But when the entire diabetes conversation collapses into “eat less + move more,” two things happen:

1. We miss the real drivers of blood sugar dysregulation.
2. People internalize blame when the simple formula doesn’t work — even though their bodies are responding to far more than calories.

It’s also simply not true that insulin resistance only affects people in larger bodies. Many people in smaller, leaner bodies — myself included — develop prediabetes without fitting the usual stereotype.

That’s why I think of insulin resistance not as a personal failure, but as a multi-system signal.

Your blood sugar doesn’t just respond to food or exercise.

It responds to your whole life.

A multi-system framework: six “invisible drivers” of insulin resistance

When I work with clients — and when I look at my own story — I use a broader framework that looks at insulin resistance as a multi-system signal that something is out of balance in your body. The signals indicate quiet, often overlooked factors that can push blood sugar up even when meals and workouts look great on paper.

Here are six interconnected systems that quietly push blood sugar up — even when your meals and workouts look great on paper:

1) Sleep

The underrated glucose regulator

Even a few nights of short or disrupted sleep can reduce insulin sensitivity, disrupt appetite hormones, and raise stress hormones. Over time, it adds up.

Sleep disruption has also been linked to changes in abdominal fat distribution and metabolic risk — another reason weight alone doesn’t tell the full story.

Try this:

• Anchor your wake-up time (within 1–2 hours, even on weekends). This is even more important than bedtime and helps reduce “social jetlag.”
• Support your circadian rhythm with bright mornings and dim evenings.
• Set screen boundaries (computer, phone, tv) you can realistically maintain. Small, consistent wins beat perfect routines.

2) Stress

The cortisol–glucose loop

Chronic stress doesn’t just live in your mind. It changes physiology. Cortisol and adrenaline raise blood sugar, increase glucose production by the liver, and make recovery harder — especially if you’re also under-sleeping.

Try this:

• Build short micro-recovery breaks into your day (2–5 minutes, several times a day).
• Use simple breathing practices (box breathing or 4-7-8) to consciously calm your nervous system.
• Create “downshift cues”: breath, walking, music, a short call with a calming person. Set reminders on your phone or computer.
• Notice patterns: do your glucose numbers worsen during high-demand periods or after emotionally charged conversations?

3) Hormones

All of them

Insulin is a hormone, constantly interacting with others: cortisol, thyroid hormones, estrogen, progesterone, testosterone, leptin, ghrelin, and more. Life stages like perimenopause, menopause, PCOS, thyroid dysfunction, medication changes, or chronic stress can all change the insulin story.

This is why two people can eat the same way — and see very different outcomes.

Try this:

• Track glucose responses alongside other symptoms: sleep, cycle changes, hot flashes, energy dips, cravings, mood.
• If something feels “off,” ask for labs that match your life stage and symptoms — not just a standard panel.

4) Food

Yes — but wider than “carbs”

Food matters, but the “just cut carbs” approach misses the big picture.

Two people can eat equally “healthy” diets and have very different glucose outcomes depending on:

• meal timing
• protein adequacy
• fiber amount and type
• fat composition
• microbiome health
• how stressed or sleep-deprived they are when they eat

Try this:

• Meal sequencing: starting meals with fiber, protein, or fat before carbohydrates can significantly reduce post-meal glucose spikes.
• Watch what happens when you shift the timing of your meals. Earlier dinner is often a quiet superpower.
• Track food for two weeks, noting not just what you eat, but how you feel afterward (energy, mood, hunger, sleep)
• Consider short-term glucose monitoring (CGM) to understand your responses. This isn’t about perfection — it’s about gathering information.

5) Exercise

The right dose matters

Movement is one of the best tools we have — but more isn’t always better.

High training volume combined with low recovery, under-fueling, or chronic stress can increase oxidative stress and impair glucose tolerance. At the same time, someone can be very active, working out in the healthy range, and still have insulin resistance if sleep, stress, hormones, or visceral fat distribution are working against them. Context matters!

Try this:

• Prioritize moderate endurance training with at least two strength training sessions per week (muscle is excellent glucose storage)
• Add short after-meal walks — simple and surprisingly effective.
• Treat recovery as part of the plan, not a reward.
• Listen to your heart. If exercise consistently wears you out and leaves you tired and exhausted, scale back.

6) Microbiome

Your metabolic ecosystem

The gut microbiome influences inflammation, glucose metabolism, appetite signaling, and how you process different fibers and carbs. It’s not magic — and it’s not a supplement plan — but it is part of the system.

Try this:

• Increase plant diversity (think variety, not volume).
• Eat the colors of the rainbow and add high-fiber beans & legumes to your meals.
• Add 1–2 fermented foods you genuinely enjoy and tolerate.
• Listen to your gut. If foods consistently leave you feeling off, that’s useful data — not something to ignore.

Why this matters in real life

Because the “invisible drivers” are often the real bottlenecks.

People often blame themselves for not being disciplined enough, when what they actually need is:

• better sleep and nervous system support
• strength training and recovery time, not just strenuous cardio workouts
• a hormone-aware plan
• food structure that fits real life
• gut support that starts with basics
• and a view of health that isn’t reduced to weight

For anyone in a smaller body who’s been told, “You’re fine — you’re not overweight,” this framework is especially important. Prediabetes can go unnoticed for years when we equate metabolic risk with body size alone.

A grounded next step

If you want something practical to do this week, start here:

1. Get your baseline data: A1C, fasting glucose, fasting insulin (if available for you), lipids, blood pressure.
2. Pick one invisible driver that resonates with you, or feels clearly out of balance right now — sleep, stress, recovery — and support that first.
3. Run small experiments for 2 weeks. No forever rules. Just curiosity.

This is exactly how I work with clients: we put on our detective hats, look beyond one-size-fits-all advice, and figure out what your glucose is responding to — and why. From there, we build changes that are realistic, supportive, and sustainable.

If you’d like help untangling your own glucose story, get in touch. Let’s figure this out together.