Prediabetes and insulin resistance are closely connected, as both indicate that the body is struggling to regulate blood sugar effectively. Recognising their shared causes and risk factors is key to understanding how early intervention can help prevent progression to type 2 diabetes, obesity, and other metabolic diseases.

Medical and nutritional treatments often overlap, particularly in conditions like insulin resistance, hypertension, and heart disease. While both aim to improve health, they operate through different mechanisms: medical care typically focuses on controlling physical symptoms and stabilising the condition through prescribed medications, whereas nutritional care emphasises lifestyle changes, especially diet to help restore systemic balance and address underlying causes. Medications may offer short-term relief, but they don’t always resolve the root issue. In contrast, nutrition-based strategies support long-term recovery and prevention by targeting the body’s metabolic and biochemical foundations.

Prediabetes

Prediabetes marks the early stages of insulin resistance, where glucose begins to accumulate in the bloodstream but hasn’t yet reached diabetic levels. While it increases the risk of developing type 2 diabetes, progression is not inevitable. With sustained lifestyle changes, particularly a targeted diet and regular physical activity, prediabetes can often be reversed.

Since most blood glucose comes from food, nutrition plays a central role in managing prediabetes. Diets low in refined carbohydrates and added sugars help stabilise glucose levels, while fibre-rich whole foods support metabolic health. However, growing evidence shows that ultra-processed foods (UPFs) even when calorie-controlled can disrupt glucose regulation. Their additives, emulsifiers, and altered food structures may impair gut health and hormonal balance, contributing to insulin resistance.

Medical and Nutritional Approaches

Medical treatment often mirrors nutritional strategies, focusing on weight management, blood pressure control, and cholesterol reduction. In some cases, doctors prescribe metformin, a medication that reduces glucose production in the liver and improves insulin sensitivity. Newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors are being explored for high-risk individuals with prediabetes, though lifestyle change remains the foundation of care.

Supplementation may also support metabolic health. Vitamin D deficiency has been linked to obesity, high blood pressure, and impaired glucose regulation. Emerging research suggests that restoring vitamin D levels may improve insulin sensitivity and support pancreatic function. Meanwhile, gut microbiome research is uncovering links between gut bacteria and glucose metabolism. Diets rich in fibre and fermented foods may help regulate insulin production and reduce inflammation.

Exercise remains a cornerstone of both medical and nutritional management. Physical activity activates GLUT-4 receptors, which help move glucose from the bloodstream into muscle cells, lowering blood sugar levels independently of insulin. Regular movement also improves mitochondrial function, reduces inflammation, and supports weight loss.

Increasingly, digital health tools such as continuous glucose monitors, wearable trackers, and personalised nutrition apps are helping individuals monitor and respond to glucose fluctuations in real time, empowering more precise and proactive self-care.

Other factors

Ethnicity also influences risk: South Asian populations, including Asian Indians, show higher rates of insulin resistance and type 2 diabetes. The impact of migration, acculturation, and lifestyle changes on this risk is still being explored.

Sleep and stress are now recognised as additional risk factors. Poor sleep quality, chronic stress, and disrupted circadian rhythms can impair insulin sensitivity and increase the likelihood of metabolic dysfunction.

Insulin Resistance

Insulin resistance is a metabolic condition and significant factor in many diseases including type 2 diabetes, hypertension, non-fatty liver disease and some cancers. It occurs when the body’s cells become less responsive to insulin, making it harder for glucose to enter cells and be used for energy. To compensate, the pancreas produces more insulin than necessary, leading to elevated insulin and blood glucose levels often before prediabetes is diagnosed.

Common signs include obesity, high visceral fat, elevated blood pressure, and raised fasting glucose levels. Visceral fat, particularly around the abdomen, is metabolically active and contributes to inflammation by releasing hormones and cytokines that disrupt insulin signalling. However, insulin resistance can also occur in individuals with normal weight, especially those with a family history of type 2 diabetes or certain ethnic backgrounds.

Medical and Nutritional Approaches

Both medical and nutritional strategies focus on increasing physical activity, improving diet quality, and ensuring adequate sleep. One study found that overweight individuals who lost just 10% of their body weight experienced an 80% improvement in insulin sensitivity.

While there is no medication approved solely for insulin resistance, drugs like metformin, GLP-1s and thiazolidinediones (TZDs) may be prescribed to help lower blood glucose and improve insulin response. Nutritional professionals often provide more detailed dietary guidance, but both medical and nutrition experts typically recommend:

• Lean protein sources such as poultry, fish, and legumes

• Healthy fats like olive oil, nuts, and seeds

• Wholegrains, legumes, and non-starchy vegetables

• Low glycaemic index carbohydrates to control glucose spikes

Portion control and calorie restriction are essential for weight loss, while managing simple carbohydrate foods like white bread, pastries and white rice, helps maintain stable blood glucose levels.

GLP-1 Medication

GLP-1 receptor agonists like Ozempic, mimic the action of the gut hormone glucagon-like peptide-1, which enhances insulin secretion, suppresses glucagon release, slows gastric emptying, and promotes satiety. These effects help lower blood glucose levels and support weight loss, two key goals in managing insulin resistance and type 2 diabetes.

They are especially effective in individuals with obesity-related insulin resistance and have shown cardiovascular benefits in high-risk populations. However, they are not a cure: their effects depend on continued use, and they work best when combined with lifestyle changes like diet and exercise. In some individuals, particularly those with advanced beta-cell dysfunction or non-obesity-related insulin resistance, the response may be limited.

Prediabetes and Insulin Resistance

• Both conditions involve the body’s reduced ability to respond to insulin. In insulin resistance, cells do not respond properly to insulin, forcing the pancreas to produce more. Prediabetes develops when the body can no longer keep blood sugar in check and blood glucose levels start to rise.

• Both occur in early stages of type 2 diabetes. Insulin resistance typically comes first, and if left unmanaged, it can lead to prediabetes and eventually diabetes.

• Both conditions often develop without obvious symptoms. Many people are unaware they have insulin resistance or prediabetes until routine blood tests reveal elevated glucose or insulin levels.

• Diet, exercise, weight loss, and sleep improvement is central to managing them both. These changes can improve insulin sensitivity and lower blood glucose, potentially reversing both conditions.

• In some cases, medications like metformin are used to treat both, especially in individuals with high risk or additional metabolic complications.

Shared Risk Factors:

• Obesity, especially excess abdominal fat

• Sedentary lifestyle

• Family history of type 2 diabetes

• Poor sleep and chronic stress

• Certain ethnic backgrounds (e.g. South Asian, African-Caribbean)

• Hormonal conditions like PCOS

Takeaway

Early recognition and treatment of insulin resistance and prediabetes are critical to preventing progression to type 2 diabetes, cardiovascular disease, and other metabolic conditions. By combining medical care with sustained lifestyle changes, individuals can take charge of their metabolic health and reduce long-term risks.

This proactive, dual approach not only enhances quality of life but also eases pressure on healthcare systems. Personalised strategies tailored to each individual’s biology, habits, and environment are essential for lasting prevention.

Medical interventions may offer rapid symptom relief, while nutritional strategies work gradually to restore balance and address root causes. Together, they shift the focus from symptom management to true recovery.

However, identifying the underlying cause of illness can be challenging, especially when symptoms overlap or multiple conditions coexist. Misdiagnosis or delayed treatment becomes more likely. That’s why it’s vital to interpret the body’s biochemical signals and select interventions that align with each person’s unique metabolic profile.