By Dr. Joshua Nderitu, MBChB  |  Family Physician & Oncology Trainee  |  Overall Health Channel

Health Insights 360 | Wellness Health Services Medical Center,

 

 

Imagine a thief who enters your house every single day — not through a broken window or a forced door — but through the front door you left open for him. He takes a little from you each time: your energy, your focus, your metabolism, your health. And because he is quiet and patient, you do not even notice him until the damage is already done.

 

That is insulin resistance. And millions of Kenyans are living with it right now without knowing it.

 

Insulin resistance is one of the most underdiagnosed, underappreciated, and most dangerous metabolic conditions in the world today. It sits silently at the root of Type 2 diabetes, obesity, heart disease, fatty liver, hormonal imbalances, some cancers, and even cognitive decline. Yet most people have never heard of it — and even those who have, rarely understand just how personal and urgent this threat really is.

 

Today, we are pulling back the curtain. By the end of this article, you will understand exactly what insulin resistance is, why it is likely already affecting someone in your household, and most importantly, what you can do right now to take back control.

 

“Your body whispers before it screams. Listen early.” — Dr. Joshua Nderitu

 

 

1. What Is Insulin — And Why Does It Matter?

Before we talk about insulin resistance, we need to understand insulin itself.

 

Insulin is a hormone produced by your pancreas — that small gland tucked behind your stomach. Its primary job is to act like a key: when you eat food and your blood sugar rises, insulin is released to “unlock” the cells of your body so glucose (sugar) can enter and be used for energy.

 

Think of it this way: imagine your cells are houses, and glucose is a delivery truck full of fuel. Insulin is the person who opens the front door and lets the fuel inside. Without insulin working properly, that truck parks outside your house all day, the fuel stays in the blood, and your cells starve for energy even while you are drowning in sugar.

 

Insulin also plays critical roles in:

• Storing excess energy as fat
• Regulating other hormones including cortisol and testosterone
• Suppressing the liver’s glucose production
• Supporting muscle growth and repair
• Protecting the lining of your blood vessels

 

In a healthy body, this system is beautifully balanced. But in our modern world, this balance is being disrupted every single day — often without our knowledge.

 

2. What Is Insulin Resistance?

Insulin resistance is what happens when the cells of your body stop responding properly to insulin’s signal.

 

Going back to our house analogy: imagine you have been ringing the doorbell of the same house 20 times a day, every day, for years. Eventually, the person inside stops coming to the door. They become desensitized to the ringing. That is insulin resistance — your cells stop “opening the door” no matter how many times insulin knocks.

 

In response, your pancreas panics. It thinks, “The signal is not working. Let me shout louder.” So it produces MORE and MORE insulin trying to force the cells to respond. For a while, this works. Blood sugar stays normal. You feel fine. Nothing unusual on routine tests.

 

But this silent overwork eventually catches up:

• The pancreas gets exhausted from overproduction
• Blood sugar starts rising — first after meals, then fasting
• You develop prediabetes, then Type 2 diabetes
• Elevated insulin quietly damages your heart, liver, brain, and hormones

 

And here is the most frightening part: by the time most people receive a diabetes diagnosis, they have often been insulin resistant for 10 to 15 years.

 

KEY FACT

Insulin resistance is not diabetes — it is the silent bridge that leads to diabetes, heart disease, cancer, and more.

Most people remain undiagnosed for a decade or longer.

Standard blood tests often miss it until significant damage has already occurred.

It is largely reversible — especially when caught early.

 

 

3. Why Is This a Critical Issue in Kenya?

You might be tempted to think of insulin resistance as a “western problem” — something that affects people in high-income countries eating fast food all day. But that assumption is costing lives here in Nairobi, in Kisumu, in Mombasa, in rural Kenya.

 

Here is the reality we face:

 

• The International Diabetes Federation estimates that over 500,000 Kenyans have been diagnosed with Type 2 diabetes — but this figure vastly underrepresents the true burden, as millions more are undiagnosed.
• Non-communicable diseases (NCDs) including Type 2 diabetes, hypertension, and heart disease now account for more than one third of all deaths in Kenya.
• Urbanisation is accelerating the risk. As more Kenyans move to cities, sedentary jobs, ultra-processed foods, stress, and poor sleep are creating the perfect storm for insulin resistance.
• African genetics may actually increase susceptibility. Research suggests that people of African descent often develop Type 2 diabetes at lower body weights and BMIs compared to Caucasian populations — meaning the traditional “only if you are obese” narrative is dangerously misleading for us.

 

And at the centre of all of this? Insulin resistance. Quietly, consistently, stealing health years before a single symptom appears.

 

“Prevention is not expensive. Neglect is.” — Dr. Joshua Nderitu

 

 

4. The Warning Signs: Are You Already Affected?

Because insulin resistance develops gradually and standard blood tests often miss it until late stages, most people have no idea they are affected. However, your body does send signals. Here are the most common warning signs:

 

Physical Signs

• Weight gain around the abdomen (the notorious “belly fat” — this is not cosmetic, it is metabolic)
• Skin darkening in body folds (neck creases, armpits, groin) — called acanthosis nigricans
• Skin tags (small flesh-coloured growths around the neck and armpits)
• Polycystic Ovarian Syndrome (PCOS) in women, including irregular periods and excess facial hair
• Fatty liver disease (often discovered incidentally on ultrasound)

 

Energy and Cognitive Signs

• Persistent fatigue, especially after meals
• Constant hunger even after eating — especially craving sugar and carbohydrates
• Brain fog, poor concentration, difficulty staying sharp
• Energy crashes in the mid-afternoon
• Difficulty sleeping or non-refreshing sleep

 

Metabolic and Lab Signs

• High fasting triglycerides (above 1.7 mmol/L)
• Low HDL cholesterol (the “good” cholesterol) — below 1.0 in men, below 1.3 in women
• Elevated fasting blood glucose (above 5.6 mmol/L) or HbA1c in the prediabetes range
• High blood pressure (above 130/85)
• Elevated uric acid or gout

 

Having three or more of these signs is strongly suggestive of metabolic syndrome — the clinical name for the cluster of problems driven largely by insulin resistance.

 

SELF-CHECK: 5 QUICK WARNING SIGNS

1.  Do you carry weight around your belly even if the rest of you is slim?

2.  Do you feel tired or foggy after eating, especially carbohydrate-rich meals?

3.  Are you constantly craving sugar or feeling hungry soon after eating?

4.  Have you noticed dark patches forming in your neck folds or armpits?

5.  Do your blood results show rising sugar, triglycerides, or falling HDL?

 

If you answered yes to two or more of these questions, it is time to speak to a health professional. Not tomorrow. This week.

 

 

5. What Causes Insulin Resistance?

Insulin resistance is not just about eating too much sugar. The drivers are multi-factorial — and many of them are embedded in everyday modern life:

 

Lifestyle Risk Factors ✓  Ultra-processed foods (white bread, soda, biscuits, instant noodles) ✓  Sedentary lifestyle — sitting for 6-10+ hours per day ✓  Chronic stress — cortisol raises blood sugar ✓  Poor sleep — even 4-5 nights of bad sleep induces resistance ✓  Visceral fat — fat inside the abdomen releases inflammatory signals ✓  Smoking and alcohol ✓  Certain medications (steroids, antipsychotics)

Biological Risk Factors ✓  Genetics and family history ✓  African/Asian ancestry — higher susceptibility at lower BMI ✓  Age-related muscle loss (sarcopenia) ✓  Hormonal imbalances (PCOS, hypothyroidism, Cushing’s) ✓  Gut microbiome disruption ✓  Polycystic ovary syndrome ✓  Previous gestational diabetes

 

Notice that many lifestyle risk factors are reversible. This is the most important takeaway from this section: insulin resistance, in most cases, is not a permanent sentence. It is a signal. And you have the power to respond to it.

 

 

6. The Downstream Damage: What Insulin Resistance Is Quietly Doing to Your Body

If you are living with unaddressed insulin resistance, here is what is likely happening beneath the surface — long before any major diagnosis appears:

 

Your Heart

Elevated insulin damages the inner lining of blood vessels (endothelium), accelerates plaque formation (atherosclerosis), raises blood pressure, and increases the risk of heart attack and stroke. Insulin resistance is now considered a major driver of cardiovascular disease — independent of cholesterol levels.

 

Your Liver

Excess insulin drives the conversion of glucose to fat inside the liver. This leads to Non-Alcoholic Fatty Liver Disease (NAFLD), which is now the most common liver disease globally. Left unchecked, NAFLD can progress to non-alcoholic steatohepatitis (NASH) and even cirrhosis.

 

Your Brain

Emerging research is calling Alzheimer’s disease “Type 3 diabetes” — a condition driven in part by insulin resistance in the brain. The brain depends on insulin signalling for memory, learning, and clearing metabolic waste. When that signalling breaks down, neurodegeneration accelerates.

 

Your Hormones

In women, elevated insulin stimulates the ovaries to produce excess androgens (male hormones), directly causing PCOS, irregular cycles, infertility, acne, and unwanted hair growth. In men, insulin resistance suppresses testosterone, leading to fatigue, reduced libido, and muscle loss.

 

Your Cancer Risk

As an oncology trainee, this one is close to my heart. Elevated insulin is a potent growth factor. It activates pathways (including IGF-1 signalling) that encourage cell proliferation and suppress apoptosis (programmed cell death). This contributes to increased risk of colon, breast, endometrial, and pancreatic cancers. Insulin resistance and obesity are now the second leading preventable causes of cancer, after tobacco.

 

THE INSULIN RESISTANCE DISEASE WEB

→  Type 2 Diabetes

→  Hypertension (High Blood Pressure)

→  Cardiovascular Disease & Heart Attack

→  Non-Alcoholic Fatty Liver Disease (NAFLD)

→  Polycystic Ovarian Syndrome (PCOS)

→  Cognitive Decline & Alzheimer’s Disease

→  Increased Cancer Risk (colon, breast, endometrial, pancreatic)

→  Gout & Kidney Disease

→  Sleep Apnoea

 

 

7. How Is Insulin Resistance Diagnosed?

This is where medicine sometimes fails patients. The standard blood test used to assess diabetes risk — fasting blood glucose or HbA1c — can appear completely normal even in someone who has had significant insulin resistance for years.

 

Why? Because in early insulin resistance, the pancreas compensates by producing MORE insulin. Blood sugar stays normal — but only because the pancreas is working overtime. The person looks “healthy” on paper while their metabolic system burns out underneath.

 

More sensitive approaches include:

 

1. Fasting Insulin Level — A fasting insulin above 10-15 mIU/L suggests resistance even with normal blood sugar.
2. HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) — A calculated score using fasting glucose and fasting insulin. A score above 2.0-2.5 suggests insulin resistance.
3. Triglyceride-to-HDL Ratio — A simple ratio you can calculate from a standard lipid panel. A ratio above 3.0 (in mg/dL units) is a strong proxy for insulin resistance.
4. Oral Glucose Tolerance Test (OGTT) with Insulin Levels — The gold standard for catching early insulin resistance before glucose becomes abnormal.
5. Clinical Assessment — Waist circumference, blood pressure, skin signs (acanthosis nigricans), and symptom history all contribute to clinical diagnosis.

 

My strong recommendation: if you have two or more of the warning signs listed earlier, ask your doctor specifically for a fasting insulin level and HOMA-IR. Do not wait for a diabetes diagnosis. By that point, the door has been open for years.

 

 

8. Can Insulin Resistance Be Reversed?

Yes. And this is the most empowering message in this entire article.

 

Insulin resistance — especially in its early and middle stages — is largely reversible through lifestyle intervention. No expensive medication required. No surgery. Just consistent, informed daily action.

 

The research is unambiguous: lifestyle changes outperform metformin and other medications in preventing the progression from prediabetes to Type 2 diabetes. The landmark Diabetes Prevention Program study showed a 58% reduction in progression to diabetes through structured lifestyle change — compared to just 31% with metformin.

 

Here is what works:

 

Nutrition: Eat to Heal Your Cells

• Reduce ultra-processed carbohydrates: white rice, white bread, soda, biscuits, cakes, instant noodles, chips
• Embrace high-fibre whole foods: whole githeri, brown ugali, leafy greens, legumes, traditional vegetables
• Include quality proteins at every meal: eggs, fish, lean meat, lentils, beans — protein blunts the insulin spike
• Healthy fats are your friends: avocado, nuts, olive oil, fatty fish — these improve insulin sensitivity
• Watch liquid calories: sodas, juices, sweetened teas, and alcohol are insulin-spiking culprits
• Time your eating: finishing your last meal 2-3 hours before bed supports overnight insulin recovery

 

Movement: The Most Powerful Insulin Sensitiser

• Resistance training (weights, bodyweight exercises) increases muscle mass — and muscle is the body’s largest glucose sink
• Aerobic exercise (brisk walking, cycling, dancing) directly improves insulin sensitivity for 24-48 hours after a session
• Breaking up prolonged sitting: even a 5-10 minute walk after meals significantly blunts post-meal blood sugar spikes
• Aim for at least 150 minutes of moderate activity per week — broken into sessions you enjoy and can sustain

 

Sleep: The Ignored Metabolic Lever

• Adults need 7-9 hours of quality sleep per night
• Even one week of sleeping 5-6 hours induces measurable insulin resistance in healthy adults
• Prioritise consistent sleep and wake times, a dark and cool bedroom, and limiting screen time before bed

 

Stress Management: Cortisol Is the Co-Driver

• Chronic stress keeps cortisol elevated, which continuously raises blood sugar and blocks insulin’s action
• Daily stress reduction practices — prayer, reflection, nature walks, deep breathing, journalling — are not luxuries; they are metabolic medicine

 

When Medication Is Needed

• Metformin is the most established pharmacological option and may be appropriate in moderate-to-severe insulin resistance
• Newer classes of diabetes medications (SGLT2 inhibitors, GLP-1 agonists) have shown remarkable benefits beyond blood sugar control
• Always work with your doctor — medication should complement lifestyle change, not replace it

 

 

9. A Word for Families: “Your Habits Are Your Medicine”

Insulin resistance is rarely an individual disease. It runs in families — through shared genes, yes, but more powerfully through shared habits. The family that eats together, moves together, and prioritises health together, heals together.

 

If you are a parent reading this, your children are watching what you eat, how you spend your evenings, whether you prioritise sleep, and how you respond to stress. The metabolic patterns you are modelling today are the patterns they will carry into adulthood.

 

Your family is your pharmacy. And the prescription is in your daily habits.

 

“Your habits are your medicine — and your family is your pharmacy.” — Dr. Joshua Nderitu

 

 

10. Your Next Step: Don’t Wait for the Diagnosis

Insulin resistance is the silent thief that no one warned you about. It enters quietly, works patiently, and takes from you incrementally: your energy, your metabolism, your hormones, your heart, and ultimately your years.

 

But unlike most thieves, this one cannot operate in the dark once you turn on the lights.

 

Knowledge is the first weapon. And today, you are better armed.

 

If this article has resonated with you — if you recognised yourself or someone you love in these warning signs — do not sit with that knowledge passively. Take the next step. Book a consultation. Request the right blood tests. Start the Health Insights 360 programme. Build the habits that protect your future.

 

Because the best treatment for insulin resistance is the one that happens before the disease takes root.

 

And that window is right now.

 

 

References & Further Reading

1. American Diabetes Association. Standards of Medical Care in Diabetes — 2024. Diabetes Care. 2024;47(Suppl 1).
2. Knowler WC, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
3. International Diabetes Federation. IDF Diabetes Atlas, 10th Edition. 2021. https://diabetesatlas.org
4. Eckel RH, et al. The metabolic syndrome. Lancet. 2010;375(9710):181-183.
5. Lauby-Secretan B, et al. Body Fatness and Cancer — Viewpoint of the IARC Working Group. N Engl J Med. 2016;375:794-798.
6. Sesti G. Pathophysiology of insulin resistance. Best Pract Res Clin Endocrinol Metab. 2006;20(5):665-679.
7. Otten J, et al. Exercise training adds to the effect of dietary treatment in reducing total and cardiovascular mortality and cardiovascular events in overweight/obese individuals with type 2 diabetes. Eur J Prev Cardiol. 2019;26(11):1194-1204.

 

 

TAKE ACTION: JOIN HEALTH INSIGHTS 360

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Health Insights 360 is a 12-week structured digital preventive health coaching programme designed specifically for busy African professionals managing lifestyle health conditions.

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Prevention is not expensive. Neglect is.

 

 

Dr. Joshua Nderitu, MBChB  |  Family Physician & Oncology Trainee  |  Health Insights 360

Wellness Health Services Medical Center, Nairobi, Kenya