Your blood sugar looks fine. Your insulin doesn't.

A QUESTION WE HEAR MOST WEEKS

"My labs came back normal, so why do I still feel off?"

You've done the work. You asked for a metabolic panel, got the results, and your doctor said everything looks fine. Glucose normal, cholesterol acceptable, nothing flagged. And yet something still doesn't feel right.

We hear this a lot in both Cape Town and Bucharest. The panel looks clean. But we run fasting insulin alongside it, and that number tells a different story.

Fasting insulin is not a standard part of most metabolic panels. It costs very little to add, but most clinics don't include it unless someone is already diabetic or pre-diabetic. So patients walk away reassured, without knowing that their insulin has been elevated for years, quietly driving inflammation, fat accumulation around the organs, and the kind of cellular aging that doesn't show up until it's harder to reverse.

Fasting glucose is a late signal. By the time it rises, insulin has often been compensating for a decade, working to keep blood sugar looking normal. A fasting insulin above around 10 uIU/mL is worth paying attention to, even when everything else appears fine. The HOMA-IR score (which combines fasting insulin and fasting glucose into a single ratio) gives a cleaner picture of where someone actually sits on the insulin resistance spectrum. Most people have never had it calculated.

We think this is a preventable gap in routine care, and also fixable, if you catch it early enough.

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WHAT YOU CAN DO NEXT

• Ask your doctor to add fasting insulin to your next blood draw. If they won't, most private labs will run it for a small fee. Request HOMA-IR as well, or calculate it yourself once you have both numbers (the formula is widely available).
• Look at your lifestyle inputs alongside the number. Elevated fasting insulin responds well to consistent resistance training, reducing refined carbohydrates, and improving sleep quality. None of these require a prescription.
• If your fasting insulin is above 10 and your doctor says not to worry because your glucose is normal, get a second opinion from someone who works in preventive or functional medicine. The two numbers together tell a story that neither one tells alone.

P.S. Have you ever had fasting insulin tested? Hit reply and let me know. I'm curious how many people reading this have seen that number at all.

— Emilian