How to Accurately Assess Your Level of Insulin Resistance

Article written and reviewed by Cyrus Khambatta, PhD
Published August 12, 2019

Understanding insulin resistance can be somewhat challenging. After all, there are a lot of questions! Is my blood glucose different from my blood sugar? Do I have serum insulin, or is the insulin in the serum I inject? Does every person with diabetes need insulin? People talk about fats, proteins, and carbohydrates, does that matter to me? And on and on and on... it can be a headache!

But it doesn't have to be that way. At Mastering Diabetes, our mission is to provide you with a clear understanding of what causes insulin resistance, and provide you with the tools to reverse it using your food as medicine, so that you can maximize your metabolic health safely and effectively.

Our team hears the following statement all the time: “My A1c is now in the non-diabetic range. Does that mean that I reversed insulin resistance completely? If not, what am I supposed to do now?”

The “what now?” part of the question is important, because if you’ve fully adopted a low-fat, plant-based, whole-food lifestyle, then your habits will continue to improve your insulin sensitivity over time.

Your A1c Value is an Incomplete Marker of Insulin Resistance

Your A1c is used as a biometric marker of your average blood glucose control, and is typically used to diagnose type 1 diabetes, type 1.5 diabetes, prediabetes or type 2 diabetes.

Technically speaking, when your A1c drops below 5.7% your diabetes diagnosis can be removed from your medical record. At Mastering Diabetes, we recommend maintaining an A1c value less than 5.7% without the use of oral medications or insulin for 365 days to claim that you have reversed either prediabetes or type 2 diabetes.

It’s very important to understand that your A1c value is simply an indicator of your blood glucose control, and only provides you with information about your level of insulin resistance when interpreted in the context of other biomarkers.

Understanding your level of insulin resistance can be challenging because it requires examining multiple biomarkers, each of which is a continuum. Since the amount of stored fat (triglyceride) inside your muscle and liver cannot adequately be measured at any given time, other laboratory biomarkers are necessary to provide context.

PILAF: How to Measure Insulin Resistance

Insulin resistance is the root cause of many chronic diseases. Often, being diagnosed with diabetes precedes the diagnosis of other chronic conditions, including coronary artery disease, metabolic syndrome, high cholesterol, hypertension, Alzheimer’s disease, cancer, stroke, and chronic inflammation.

When reversing insulin resistance using your diet, the goal is to become as insulin sensitive as possible, to prevent against the development of these chronic diseases.

In order to help you understand your level of insulin resistance, we’ve developed a convenient checklist (downloadable PDF available below) to help you understand how to become as insulin sensitive as possible. We won't just teach you how to test for insulin resistance. We'll teach you how to reverse insulin resistance entirely.

Download the Insulin Resistance Checklist Today

Insulin Resistance Checklist

Click on the button below to download the Insulin Resistance Checklist and track your level of insulin resistance over time...

And the best part is you don't need to go in for a ton of blood tests to measure your endogenous insulin and fret over some sort of 'fasting insulin levels chart'. You don't even have to go in for an oral glucose tolerance test (though this is another helpful method).

Instead, you can get a really accurate sense of your insulin resistance just based on the mnemonic PILAF, as described below:

P:    Pressure
I:     Ideal bodyweight
L:     Lipids
A:    A1c

F:     Fasting blood glucose

We'll walk you through them now, but please note: with each of these biomarkers, being free of oral medication to achieve these results is a key piece in understanding how insulin resistant you are. On the checklist, you’ll see “free of oral medication” as a checklist item, and one goal is to check that box for every biomarker.

Let’s dive in to each of these letters individually:

P Stands for Pressure (Blood Pressure)

Your blood pressure is a measurement of the effort it takes for your heart to circulate blood throughout your cardiovascular system. The higher your blood pressure, the harder your heart must work to push blood throughout your body.

In most cases, hypertension (high blood pressure) is caused by the hardening of blood vessels, which creates resistance against your heart. Over time, hypertension can become life-threatening, because it increases your risk for a heart attack or stroke (1–5).

Most doctors prescribe medication to treat hypertension, unaware that simple dietary changes are more powerful and free of dangerous side effects (6,7).

The evidence-based research shows that hypertension is an independent risk factor for insulin resistance (2). Reducing your blood pressure to less than 120/80 (systolic/diastolic) without medication is essential in helping you reverse insulin resistance.

Recommended Blood Pressure Range
Systolic pressure = 100-120 mmHg
Diastolic pressure = 60-80 mmHg

I Stands for Ideal Bodyweight

Being overweight elevates your risk for most chronic diseases, and is caused by the accumulation of fat in your adipose tissue as well as in tissues that are not designed to store fat, like your muscles and liver.

By losing excess weight, you burn stored fat in adipose tissue as well as fat stored inside your muscles and liver.

You can monitor your bodyweight on an inexpensive bathroom scale to measure your progress at achieving your ideal bodyweight and reversing insulin resistance. Here is how you calculate your ideal weight:

How to Calculate Your Ideal Bodyweight for Women

Measure your height in inches. The first 5 feet of height is equal to 105 pounds, and every inch thereafter is equal to approximately 4 pounds.

Ideal Bodyweight for Women = 105 + 4x

(x = every inch over 5 feet of height)

How to Calculate Your Ideal Bodyweight for Men

Measure your height in inches. The first 5 feet of height is equal to 115 pounds, and every inch thereafter is equal to approximately 5 pounds.

Ideal Bodyweight for Men = 115 + 5x

(x = every inch over 5 feet of height)

L Stands for Lipids

When your lipid panel (total cholesterol, LDL, HDL, and triglycerides) is elevated, this often indicates an insulin resistant liver, or fatty liver. Fatty liver is usually diagnosed via imaging or elevated liver enzymes, resulting in an enlarged liver that is engorged with excess fat. As you gain insulin sensitivity, your cholesterol panel is likely to normalize.

In order to significantly reduce your risk for a heart attack, we recommend achieving the following fasting lipid panel:

Total Cholesterol: < 150 mg/dL

LDL Cholesterol: < 100 mg/dL

Triglycerides: < 150 mg/dL

HDL Cholesterol: > 50 mg/dL (for women)

HDL Cholesterol: > 40 mg/dL (for men)

A Stands for A1c

As we discussed earlier, your hemoglobin A1c is often the first indicator that that you are living with any form of diabetes. The evidence-based research indicates that the lower your A1c value, the better your blood glucose control, and the lower your risk for long-term complications.

When following a low-fat, plant-based, whole-food lifestyle, a lower A1c is a strong indicator of reduced insulin resistance. In fact, a low-fat, plant-based, whole-food diet is one of the most effective ways to reduce your A1c value and improve your glycemic control.

Now, here’s where it gets confusing. When following a low-carbohydrate or ketogenic diet, a lower A1c does not indicate a lower level of insulin resistance. In fact, those eating low-carbohydrate and ketogenic diets are the most insulin resistant, as we have explained in previous articles.

Your A1c is an indicator of your level of insulin resistance if and only if you are eating a low-fat diet, and not if you are eating a high-fat diet.

The A1c guidelines set forth by the American Diabetes Association are as follows:

Type 2 Diabetes: > 6.4%

Prediabetes: 5.7–6.4%

Non-Diabetic: < 5.7%

F Stands for Fasting Blood Glucose

Your fasting blood glucose value is a key indicator of your level of insulin resistance, and is important to monitor daily when living with any form of diabetes. As you become more insulin sensitive, your fasting blood glucose is likely to decrease.

Monitoring your daily fasting blood glucose is a simple way to measure how your diet is affecting your glycemic control. The goal is to achieve a consistent fasting blood glucose between 80-100 mg/dL.

As you transition to a low-fat, plant-based, whole-food diet, you are likely to experience fluctuations in your fasting blood glucose, but an overall downward trend is a great indicator of increased insulin sensitivity.

Fasting Blood Glucose Target: 80-100 mg/dL

Here’s the Good News

Eating a low-fat, plant-based, whole-food diet containing between 10-15% of your calories from fat is the single most effective way to reverse insulin resistance ever discovered by the scientific community.

If one or more of your biomarkers explained above are out of range, then this could indicate that you are living with some form of insulin resistance, and that’s why this checklist is helpful to understand where you are on the continuum.

Adopting a low-fat, plant-based, whole-food diet, performing regular exercise and intermittent fasts, and doing so in a constructive community of other people will maximize your insulin sensitivity and minimize your risk for chronic disease.

Download the Insulin Resistance Checklist below and post it in a visible location to help you achieve your most insulin sensitive self. Use the checklist as a way to help guide your path toward insulin sensitivity. 

As you check off the boxes, continue to use the tools that we provide in our program to work your way towards the best health you’ve ever had, and enjoy the fruits of your labor all along the way!

Do you want to learn even more about insulin resistance? Have a look at this article to gain further knowledge.

Download the Insulin Resistance Checklist Today

Insulin Resistance Checklist

Click on the button below to download the Insulin Resistance Checklist and track your level of insulin resistance over time...


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About the author 

Cyrus Khambatta, PhD

Cyrus Khambatta, PhD is a New York Times bestselling co-author of Mastering Diabetes: The Revolutionary Method to Reverse Insulin Resistance Permanently in Type 1, Type 1.5, Type 2, Prediabetes, and Gestational Diabetes.

He is the co-founder of Mastering Diabetes and Amla Green, and is an internationally recognized nutrition and fitness coach who has been living with type 1 diabetes since 2002. He co-created the Mastering Diabetes Method to reverse insulin resistance in all forms of diabetes, and has helped more than 10,000 people improve their metabolic health using low-fat, plant-based, whole-food nutrition, intermittent fasting, and exercise.

Cyrus earned a Bachelor of Science in Mechanical Engineering from Stanford University in 2003, then earned a PhD in Nutritional Biochemistry from the University of California at Berkeley in 2012. He is the co-author of many peer-reviewed scientific publications.

He is the co-host of the annual Mastering Diabetes Online Summit, a featured speaker at the Plant-Based Nutrition and Healthcare Conference (PBNHC), the American College of Lifestyle Medicine Conference (ACLM), Plant Stock, the Torrance Memorial Medical Center, and has been featured on The Doctors, NPR, KQED, Forks Over Knives, Healthline, Fast Company, Diet Fiction, and the wildly popular podcasts the Rich Roll Podcast, Plant Proof, MindBodyGreen, and Nutrition Rounds.

Scientific Publications:

Sarver, Jordan, Cyrus Khambatta, Robby Barbaro, Bhakti Chavan, and David Drozek. “Retrospective Evaluation of an Online Diabetes Health Coaching Program: A Pilot Study.” American Journal of Lifestyle Medicine, October 15, 2019, 1559827619879106. https://doi.org/10.1177/1559827619879106

Shrivastav, Maneesh, William Gibson, Rajendra Shrivastav, Katie Elzea, Cyrus Khambatta, Rohan Sonawane, Joseph A. Sierra, and Robert Vigersky. “Type 2 Diabetes Management in Primary Care: The Role of Retrospective, Professional Continuous Glucose Monitoring.” Diabetes Spectrum: A Publication of the American Diabetes Association 31, no. 3 (August 2018): 279–87. https://doi.org/10.2337/ds17-0024

Thompson, Airlia C. S., Matthew D. Bruss, John C. Price, Cyrus F. Khambatta, William E. Holmes, Marc Colangelo, Marcy Dalidd, et al. “Reduced in Vivo Hepatic Proteome Replacement Rates but Not Cell Proliferation Rates Predict Maximum Lifespan Extension in Mice.” Aging Cell 15, no. 1 (February 2016): 118–27. https://doi.org/10.1111/acel.12414

Roohk, Donald J., Smita Mascharak, Cyrus Khambatta, Ho Leung, Marc Hellerstein, and Charles Harris. “Dexamethasone-Mediated Changes in Adipose Triacylglycerol Metabolism Are Exaggerated, Not Diminished, in the Absence of a Functional GR Dimerization Domain.” Endocrinology 154, no. 4 (April 2013): 1528–39. https://doi.org/10.1210/en.2011-1047

Price, John C., Cyrus F. Khambatta, Kelvin W. Li, Matthew D. Bruss, Mahalakshmi Shankaran, Marcy Dalidd, Nicholas A. Floreani, et al. “The Effect of Long Term Calorie Restriction on in Vivo Hepatic Proteostatis: A Novel Combination of Dynamic and Quantitative Proteomics.” Molecular & Cellular Proteomics: MCP 11, no. 12 (December 2012): 1801–14.

Bruss, Matthew D., Airlia C. S. Thompson, Ishita Aggarwal, Cyrus F. Khambatta, and Marc K. Hellerstein. “The Effects of Physiological Adaptations to Calorie Restriction on Global Cell Proliferation Rates.” American Journal of Physiology. Endocrinology and Metabolism 300, no. 4 (April 2011): E735-745. https://doi.org/10.1152/ajpendo.00661.2010

Bruss, Matthew D., Cyrus F. Khambatta, Maxwell A. Ruby, Ishita Aggarwal, and Marc K. Hellerstein. “Calorie Restriction Increases Fatty Acid Synthesis and Whole Body Fat Oxidation Rates.” American Journal of Physiology. Endocrinology and Metabolism 298, no. 1 (January 2010): E108-116.