Signs of Insulin Resistance in Women (And Why They Get Missed)

I'm a fifty-six-year-old man writing about symptoms in women, so let me be straight about why. Most of the people who message me are women, usually in their forties or fifties, and they nearly all open the same way: "I've been told my bloods are fine, but I know something isn't right." I recognise that sentence, because I said a version of it for years.

What follows is the pattern I hear over and over. I'm not a doctor — this is a prompt to get the right tests done, not a diagnosis.

Why the signs get missed in women

Almost every symptom of insulin resistance has a ready-made alternative explanation for a woman in midlife. Tired? Busy life. Weight around the middle? Menopause. Cravings? Stress. Poor sleep? Hormones. Each of those can be true, and each of them lets the underlying pattern carry on unnoticed for another few years.

Add to that the fact that a "normal" HbA1c covers a wide range. You can drift upward inside normal for a decade before anyone uses the word prediabetes.

The ten signs worth taking seriously

1. Weight around the middle. Especially if the rest of you hasn't changed much.
2. The afternoon crash. Reliable, around 3pm, and usually fixed with something sweet.
3. Cravings after eating. Not hunger — the specific pull toward sugar or bread after a meal.
4. Hungry again in two hours. A meal that should hold you doesn't.
5. Brain fog. Losing words, rereading the same paragraph, feeling one step behind.
6. Waking tired. Eight hours in bed and no benefit from it.
7. Irregular periods or PCOS. Strongly associated with insulin resistance.
8. Skin changes. Skin tags, or velvety dark patches on the neck, armpits or groin.
9. Blood pressure and cholesterol creeping up. Particularly raised triglycerides with low HDL.
10. Dieting stops working. You do everything you used to do and the weight doesn't move.

Three or four of these together is a pattern. You can walk through the full list on the insulin resistance self-check.

What to ask your GP for

HbA1c, fasting glucose, a full lipid panel with triglycerides and HDL, blood pressure, and fasting insulin if you can get it. Ask for the actual numbers rather than "fine" — the trend across a few years tells you far more than a single result inside range.

What actually shifts it

The same things that shifted mine, and none of them are dramatic: steady the blood sugar at every meal with fibre and protein, stop grazing between meals, keep a sensible eating window most days, protect your muscle, and stay consistent for ninety days before you judge anything. I've written up the whole approach in insulin resistance explained and the food side in what to eat for insulin resistance.

For me the drink was what made the habits survivable. When you aren't fighting hunger all afternoon, eating sensibly stops requiring willpower — and that's the difference between a diet and a change.

A word if you're on a jab

Plenty of women message me while on Wegovy, Ozempic or Mounjaro, worried about what happens when they stop. That's a fair worry, and it's worth planning for early rather than late — see coming off Mounjaro. Never change a prescription because of something you read online, including this. That conversation belongs with your prescriber.