Before chasing high cholesterol, ask: is it insulin resistance?

Elevated cholesterol is often managed with statins. These medications reliably lower both ApoB and LDL cholesterol, two well-established drivers of cardiovascular risk. But sometimes, high ApoB reflects an underlying problem: insulin resistance.

Insulin resistance causes a metabolic shift that affects how the body handles energy, redistributes fat, alters cholesterol-carrying particles, and silently raises heart disease risk over time.

Statins remain an indispensable strategy, especially for people with genetic lipid disorders or established cardiovascular disease. But when high ApoB stems from insulin resistance, the first step is to address the root issue. Targeted changes in nutrition, exercise, weight loss, and medications like metformin can improve metabolic health and often lower ApoB as a secondary effect. This may reduce the need for statins, though not necessarily eliminate them.

Could You Have Insulin Resistance?

Most doctors rely on fasting glucose and HbA1c to assess overall metabolic health. Unfortunately, these are lagging indicators, only rising after insulin resistance has been present for years.

Earlier indicators can include:

• Extra belly fat
• Weight that won't budge, even with effort
• Elevated blood pressure
• Elevated ApoB or triglycerides
• Sugar cravings or crashes after meals

If any of these sound familiar, it's time to take a deeper look. Testing for insulin resistance directly (see below) can help you catch problems earlier, before blood sugar becomes an issue.

What Insulin Resistance Is

Insulin is a hormone that signals cells that glucose (sugar) is available in the bloodstream and can be taken for energy production, storage, or to power intracellular mechanisms. When everything is working properly, your body needs only a small amount of insulin.

Insulin resistance occurs when muscle, liver, and fat cells stop responding efficiently to insulin's signal. To compensate, the pancreas produces more insulin to maintain normal blood sugar. For a while, this works. Glucose stays in range, but insulin levels rise behind the scenes.

This early shift in insulin dynamics is the first sign that something is off. Over time, the imbalance spreads. The liver keeps making glucose when it is not needed. Fat cells release more fatty acids. Muscles take in less glucose. These changes lead to increased fat storage, chronic inflammation, and rising levels of ApoB-containing particles, raising your risk of heart disease, type 2 diabetes, and other chronic conditions.

By the time your fasting blood sugar is high, the system has already been under stress for years.

What Happens If You Ignore It

If insulin resistance is not addressed early, the system eventually breaks down. The pancreas struggles to keep up with the rising insulin demand, and blood sugar begins to increase, first slightly, then persistently, leading to prediabetes and eventually type 2 diabetes.

But the consequences extend beyond blood sugar. Chronically high insulin and glucose contribute to blood vessel damage, accelerate atherosclerosis, and increase the risk of heart attacks and strokes. Nerve and kidney function decline, fat accumulates in the liver, the immune system weakens, and cognitive performance deteriorates.

How to Catch It Early

Because glucose and HbA1c rise late in the process, standard labs often miss insulin resistance in its earlier stages when it is most reversible.

The Early Insulin Resistance Panel provides a more sensitive approach. It combines multiple biomarkers that reveal metabolic stress before it becomes obvious. It includes:

• CardioIQ IR Score: A validated score from 0 to 100 estimating the probability of insulin resistance. Based on intact insulin and C-peptide, shown to outperform traditional indices in early detection.
• Intact insulin: Reflects how much bioactive insulin your body is producing. This provides a clearer picture than standard insulin tests, which often include fragments that distort the result.
• C-peptide: Co-released with insulin in a 1:1 ratio but not cleared by the liver, making it a more stable marker of total insulin output. Especially helpful when insulin levels are distorted by clearance differences or medications.
• HOMA-IR: A classic index using fasting glucose and insulin to estimate how hard your body is working to maintain normal glucose. Still useful but less sensitive than the IR Score alone.
• TyG Index: A calculation from triglycerides and glucose that correlates with insulin sensitivity, especially in the liver. Useful when other signs are ambiguous.
• Glucose: Often normal in early insulin resistance but still essential; helps put other values in context and contributes to trend analysis over time.
• Insulin: A widely used measure that helps estimate how hard your pancreas is working to maintain normal glucose; also used in standard indices.
• Triglycerides: Elevated levels are common in insulin resistance and often reflect poor fat metabolism; they are also an early warning sign for heart disease.
• ALT and AST: These liver enzymes often rise when fat begins to accumulate in the liver. Even small elevations can be an early clue that your metabolism is struggling.

This panel helps you spot insulin resistance while it is still quiet, when you can do something about it, before it turns into diabetes or heart disease. Most labs detect damage; this one detects the drift.

If You Have Insulin Resistance, Fix It Early

Insulin resistance is reversible, especially if you catch it early. Core levers that move the needle include:

• Nutrition: Cut refined carbs like bread, pasta, and sugar. Start with 100-150 grams of total carbs per day and adjust based on your glucose response. A continuous glucose monitor (CGM) can help identify what spikes your levels. Favor complex carbs with fiber like lentils, oats, and vegetables to slow absorption and improve insulin sensitivity.
• Movement: Do at least 150 minutes per week of Zone 2 cardio such as brisk walking or cycling. Add resistance training twice weekly to build muscle and improve glucose disposal. Short walks 10-15 minutes after meals help reduce post-meal glucose spikes.
• Sleep: Get 7 to 9 hours of consistent, high-quality sleep each night. Poor or irregular sleep increases cortisol, a stress hormone that interferes with insulin signaling and worsens metabolic control.
• Supplements: Key nutrients such as omega-3s, magnesium, berberine, and vitamin D can enhance insulin sensitivity and support metabolic function.
• Medications: Metformin lowers hepatic glucose production and improves insulin sensitivity. GLP-1 receptor agonists reduce appetite and promote weight loss. SGLT2 inhibitors lower blood glucose through urinary excretion and may offer cardiovascular and renal benefits.

What tools work best depends on your lab results, your history, and how aggressively you want to intervene. That's where Instalab comes in. Once you've taken the Early Insulin Resistance Panel, we can help you make sense of the data and identify your biggest levers.

What tools work best depends on your lab results, your history, and how aggressively you want to intervene. That's where Instalab comes in. Once you've taken the Early Insulin Resistance Panel, we can help you make sense of the data and identify your biggest levers.