Blood sugar
How the body manages glucose.
Health education · Metabolic healthSaint‑Hyacinthe
Insulin resistance and metabolic health: understanding what happens before diabetes
Blood sugar, insulin, triglycerides, blood pressure and liver health: metabolic health is not just about sugar levels.
Metabolic health describes how the body manages and uses energy, glucose and lipids. The pancreas, liver, muscles, adipose tissue, hormones and blood vessels are all involved, and insulin plays a central role.
When cells respond less well to insulin, this is called insulin resistance. The body can compensate for a time by producing more insulin, so blood sugar sometimes remains normal. At Clinique IPS du Palais, the assessment therefore looks at the whole picture rather than a single result.
Four areas
What a metabolic assessment looks at
Insulin
The hormone that helps cells use glucose.
Lipids
Triglycerides, HDL, LDL and cardiovascular risk.
Liver
A central organ of metabolic health.
Insulin resistance is not diagnosed simply because fasting insulin is high. The assessment is based on the overall metabolic profile and the clinical context.
Understanding
Insulin and insulin resistance
Insulin is a hormone produced by the pancreas. After a meal, it helps glucose enter certain cells, especially those of the muscles and adipose tissue, and is involved in storing and using energy, particularly in the liver.
The term insulin resistance is used when the tissues respond less well to the same amount of insulin. The pancreas first compensates by producing more insulin. When this compensation decreases, blood sugar can rise and lead to prediabetes, then, in some people, to type 2 diabetes.
Is it the same thing as prediabetes?
No.
Insulin resistance: a physiological mechanism.
Prediabetes: a condition defined by specific values: fasting blood sugar of 6.1 to 6.9 mmol/L, HbA1c of 6.0 to 6.4% or 7.8 to 11.0 mmol/L two hours after a 75 g OGTT.2
The tests
Can it be diagnosed with a simple blood test?
Not as simply as prediabetes or diabetes.
Diabetes Canada's tools for screening and diagnosing blood sugar disorders use fasting blood sugar, HbA1c and the OGTT. Fasting insulin is not one of them.2
Insulin levels vary depending on when the sample is taken, diet, blood sugar and certain medications. HOMA-IR, calculated from fasting blood sugar and fasting insulin, is used mainly in research: there is no universal Canadian clinical threshold for making a diagnosis with this index.
- Fasting blood sugar
- HbA1c
- OGTT if needed
Metabolic syndrome
Five criteria, at least three for a diagnosis
Metabolic syndrome is not a single disease: it is a cluster of factors that often occur together and signal an increased risk of type 2 diabetes and cardiovascular disease. According to the harmonized definition used by Diabetes Canada, at least 3 of the following 5 criteria are required:1
CriterionThreshold
High waist circumferenceDepends on the population (in Québec: 102 cm or more in men, 88 cm or more in women3)
Triglycerides≥ 1.7 mmol/L or treatment
Low HDL< 1.0 mmol/L (men), < 1.3 mmol/L (women)
Blood pressure≥ 130 systolic and/or ≥ 85 diastolic, or treatment
Fasting blood sugar≥ 5.6 mmol/L or treatment
The 130/85 threshold is used here to define metabolic syndrome: it is not the threshold used to diagnose and treat hypertension according to the 2025 Canadian guidelines. Likewise, a fasting blood sugar of 5.6 does not mean diabetes.
What contributes to insulin resistance?
Several factors can contribute: genetic predisposition, a family history of type 2 diabetes, age, low physical activity, abdominal fat, insufficient or disrupted sleep, obstructive sleep apnea, certain medications or certain hormonal conditions.
Diabetes Canada’s risk factors for type 2 diabetes include polycystic ovary syndrome, obstructive sleep apnea, acanthosis nigricans (darker patches of skin, often on the neck or in the armpits), glucocorticoids and atypical antipsychotics.2;4
Can a thin person be affected?
Yes.
Weight alone is not enough to assess metabolic health. A person of so-called normal weight can have prediabetes, high triglycerides, hypertension or fat in the liver. Conversely, not all people with excess weight have the same abnormalities.
Visceral fat, which accumulates around the organs, is more closely linked to metabolic abnormalities: that is why waist circumference adds information to weight.
The liver
Metabolic liver disease (MASLD)
What was formerly called “non-alcoholic fatty liver disease” (NAFLD) has been renamed MASLD, for metabolic dysfunction-associated steatotic liver disease.5 It is closely linked to prediabetes, type 2 diabetes and other metabolic factors, and can remain silent for years.
Why be concerned about it?
In some people, fat in the liver can progress to inflammation, fibrosis or more advanced liver disease.
Diabetes Canada recommends considering screening for MASLD-related fibrosis in all people living with prediabetes or type 2 diabetes.5
FIB-4
This calculation uses age, AST, ALT and platelets. It is the first-line tool recommended by Diabetes Canada.5
Below 1.3: low risk of advanced fibrosis. Between 1.3 and 2.67: indeterminate result requiring further testing. 2.67 or higher: high risk and referral to a specialist.5
Are normal enzymes enough?
No. According to Diabetes Canada, transaminases (ALT, AST) can remain normal in up to 15% of people with advanced fibrosis.5
Screening is therefore done based on the context, even if enzymes are normal.
What symptoms?
Often none. No set of symptoms can be used to diagnose insulin resistance.
Sugar cravings, fatigue after meals, hunger pangs or energy “crashes,” often presented on social media as sure signs, have many possible causes.
What about sleep apnea?
Diabetes is reported about 2.5 times more often in adults diagnosed with sleep apnea.6 Snoring, pauses in breathing, unrefreshing sleep or sleepiness warrant an assessment.
What about PCOS?
Polycystic ovary syndrome is one of the risk factors for type 2 diabetes recognized by Diabetes Canada.4 A metabolic assessment may therefore be relevant in this context.
The assessment
Which tests are useful?
The assessment depends on the clinical context. Insulin testing is not universal screening: its usefulness depends on a specific clinical question.
Blood sugar and HbA1c
Fasting blood sugar, HbA1c and OGTT when a more precise assessment is needed.
Lipid panel
LDL, HDL, triglycerides, non-HDL cholesterol, and sometimes ApoB or Lp(a).
Blood pressure
A major component of cardiometabolic risk.
Liver and kidneys
Liver panel (and FIB-4 if needed) and kidney function depending on risk factors.
Taking action
How can you improve insulin sensitivity?
Physical activity
According to Obesity Canada, regular physical activity, with or without weight loss, can improve hyperglycemia and insulin sensitivity, blood pressure and dyslipidemia.7
Muscles use a lot of glucose: combining aerobic and strength training, in an appropriate way, can be beneficial.
Weight, but not only weight
Obesity Canada specifies that weight loss should not be the only criterion for judging the success of physical activity.7
In cases of MASLD, Diabetes Canada recommends sustained weight loss of at least 5 to 10%, with more than 10% being preferable to help reverse fibrosis.5
Diet
There is no single mandatory diet. For MASLD, Diabetes Canada favours a Mediterranean-style diet.5
There is no need to eliminate carbohydrates: their quality, fibre and meal composition matter more. Limiting sugary drinks, ultra-processed foods and alcohol is generally helpful.
Sleep
Poor-quality sleep makes physical activity, regular eating and energy management more difficult. Sleep apnea should be investigated when it is suspected.
Medications?
An isolated insulin value is not treated: medications are chosen based on the conditions actually present (high-risk prediabetes, diabetes, obesity, PCOS, dyslipidemia, hypertension, MASLD) and the level of risk.
No supplement should be presented as a universal solution.
Measuring progress
Progress isn’t measured by weight alone: blood sugar, HbA1c, blood pressure, triglycerides, HDL, LDL, physical fitness, waist circumference, liver parameters, sleep and quality of life. A stable weight can go hand in hand with a clear improvement.
Metabolic health in Saint-Hyacinthe
At Clinique IPS du Palais, a metabolic health assessment can look at several dimensions at once: blood sugar, HbA1c, lipid profile, blood pressure, kidney function, liver health, medications, sleep, physical activity, diet, family history, cardiovascular factors, and weight and body composition when relevant.
When several abnormalities are present, the goal is to set realistic priorities rather than correct each number separately.
Frequently asked questions
Frequently asked questions
Are insulin resistance and prediabetes the same thing?
No. Insulin resistance is a mechanism: the tissues respond less well to insulin. Prediabetes is defined by specific blood sugar or HbA1c values.
Can you be insulin resistant with normal blood sugar?
Yes, especially when the pancreas is still able to compensate by producing more insulin. However, normal blood sugar alone is not enough to conclude that insulin resistance is present.
Should I have my insulin measured?
Not necessarily. Diabetes Canada's tools for screening and diagnosing prediabetes and diabetes are based on fasting blood sugar, HbA1c and the OGTT, not on fasting insulin.
Is HOMA-IR a diagnosis?
No. It is an index calculated from fasting blood sugar and fasting insulin, used mainly in research. There is no universal Canadian clinical threshold for making a diagnosis with this index.
Should I stop eating carbohydrates?
No. Metabolic health depends on much more than the total amount of carbohydrates: their quality, fibre, meal composition and physical activity also matter.
Can a thin person have poor metabolic health?
Yes. Weight alone is not enough to determine metabolic risk.
Should I lose weight?
It depends on your situation. When weight loss is indicated, it can improve several parameters. However, according to Obesity Canada, weight loss should not be the only measure of success of physical activity.
Does insulin resistance always lead to diabetes?
No. It increases the risk in certain situations, but progression to diabetes is not automatic.
Is fatty liver linked to metabolic health?
Yes. Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to prediabetes, type 2 diabetes and other metabolic factors.
Key takeaways
Insulin resistance is a mechanism in which tissues respond less well to insulin. It cannot be reduced to a blood sugar level, a weight, an insulin level or a symptom.
The goal is not to seek a diagnosis of “insulin resistance” at all costs, but to identify modifiable cardiometabolic factors early in order to reduce the risk of type 2 diabetes, cardiovascular disease and other complications.
Sources
- Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome (Diabetes Canada guidelines, chapter 3). 2018, accessed October 5, 2026. diabetes.ca
- Diabetes Canada. Screening for and Diagnosing Diabetes (tool for professionals). Accessed October 5, 2026. diabetes.ca
- Government of Quebec. Dyslipidémie (cholestérol). Updated January 30, 2025, accessed October 5, 2026. quebec.ca
- Diabetes Canada. Assess Your Risk of Developing Diabetes. Accessed October 5, 2026. diabetes.ca
- Kim J et al. Diabetes and Metabolic Dysfunction-associated Steatotic Liver Disease in Adults (Diabetes Canada guidelines, chapter 42). Accessed October 5, 2026. diabetes.ca
- Public Health Agency of Canada. Quel est l’impact de l’apnée du sommeil sur les Canadiens? Accessed October 5, 2026. canada.ca
- Obesity Canada. Canadian Adult Obesity Clinical Practice Guideline — Physical Activity in Obesity Management. 2025, accessed October 5, 2026. obesitycanada.ca (PDF)
The information on this page is provided for informational purposes and does not replace an assessment by a health professional.