When most people hear the word "insulin,” they immediately think of diabetes. But insulin’s role in the body goes far beyond blood sugar control — it’s one of the most powerful fat storage hormones we have. This means insulin has a direct influence on weight gain, appetite, cravings, energy levels, and even mood.

Feeling “hangry”? That’s often an insulin-driven response. Craving sweets or salty snacks? Insulin can play a role there, too. Even conditions like PCOS (polycystic ovary syndrome) — one of the most common hormonal diagnoses in women — are strongly linked to insulin resistance.

And here’s one of the most overlooked facts: menopause is a state of increased insulin resistance. No, women are not “crazy” when they say they are eating the same as always yet gaining weight, particularly around the midsection, after 40. The culprit is not simply a “slowed metabolism” — it’s the hormonal changes of perimenopause and menopause, which shift the body toward greater insulin resistance. This makes fat storage, especially visceral fat, more likely even without major changes in diet or activity.

Unfortunately, the importance of insulin is often downplayed in our healthcare system. Instead of identifying and treating high insulin early, most patients are prescribed medications for high blood pressure, cholesterol, or blood sugar — all of which can be downstream effects of insulin resistance. This “wait and watch” approach leaves many people on track to eventually develop diabetes or heart disease, when prevention was possible all along.

Insulin is made by the pancreas and secreted in response to sugar in the blood — most often after eating carbohydrates. Your carbohydrate threshold — the amount you can eat before insulin spikes too high — is different from the next person’s.

If you consistently exceed your threshold, insulin levels may remain high. This leads to insulin resistance, where your cells stop responding properly to insulin’s signals. The result? Your body pumps out even more insulin, which further promotes fat storage and disrupts appetite control.

It’s important to stress: the solution is not “cut all carbs forever” or simply “stop eating bread and pasta.” Instead, it’s about understanding the gram amount of carbohydrates your body can handle daily and consistently — then making adjustments based on your symptoms and lab results.

A simple blood test can measure your fasting insulin. Ideally, we like to see it below 8 mIU/L when looked at by itself. This is one of the most revealing markers for understanding your metabolism and weight challenges.

Insulin clearance rates differ from person to person. That’s why two people can eat the same meal, but one feels fine while the other is battling cravings and fatigue an hour later.

No single lab value tells the whole story. That’s where the HOMA-IR index  comes in:

> HOMA-IR = (Fasting Insulin x Fasting Glucose) ÷ 405

A score above 2 suggests some degree of insulin resistance — the higher the number, the more significant the problem.

One of the most revealing ways to understand your insulin response is the carbohydrate (or glucose) challenge — consuming a measured sugar load, then checking insulin every 30 minutes over two hours.

This test shows not just how high your insulin rises, but how quickly your body can reduce and clear it. Some people discover they are highly efficient — insulin spikes briefly, then drops back down in a reasonable time frame. Others learn that their insulin stays elevated for hours before starting to decline.

The higher the spike and the longer it takes to clear, the more it suggests that carbohydrate intake should be reduced to a level your body can handle without prolonged high insulin. This insight can help tailor your approach — whether that means adjusting carb levels, exploring intermittent fasting, or considering medications or supplements that improve insulin sensitivity.

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Fasting glucose above 100 mg/dL is considered prediabetic.

A1C of 5.7% or higher is also considered prediabetic.

Looking at fasting glucose + A1C + fasting insulin together gives the clearest picture.

Lifestyle and nutrition are the foundation for lowering insulin, but medications can play a role. Metformin can improve insulin sensitivity and support weight loss, though it may cause temporary bloating or GI discomfort. Newer injectable medications can also influence insulin signaling to reduce appetite and promote weight loss. (We’ll explore these in another post.)

High insulin signals your body to store fat — and if that signal is constant, health problems follow. Metabolic syndrome is a common example, diagnosed when a person has 3 of the following 5:

1. High blood pressure

2. Elevated triglycerides

3. Low HDL cholesterol

4. High fasting glucose

5. Increased waist circumference

This pattern is alarmingly common, yet the root cause — insulin resistance — is often ignored.

Insulin is not just a “diabetes hormone." It drives appetite, cravings, fat storage, and many chronic health issues. Menopause and perimenopause naturally increase insulin resistance — midsection weight gain is hormonal, not imagined. The glucose challenge test can reveal how efficiently your body clears insulin and guide personalized nutrition strategies. You can improve insulin sensitivity by finding your carb threshold, tracking key labs, and making consistent nutrition and lifestyle changes. Addressing insulin resistance early can prevent a cascade of long-term health problems.