Your last blood work came back and your doctor said everything looks fine. Your fasting glucose was normal. Your A1c was in range. You were told to keep doing what you are doing.
But you are still exhausted after a full night of sleep. You crave something sweet an hour after eating. You have noticed darkening skin along the back of your neck or in your armpits. You have gained weight steadily around your middle even though your eating habits have not changed.
Here is what most doctors are not telling you: your blood sugar can be perfectly “normal” for years while insulin resistance is quietly progressing in your body. And for Black women specifically, the standard screening approach may be missing the problem entirely.
“Insulin resistance can cause significant metabolic damage for years before blood sugar levels rise enough to trigger a prediabetes or diabetes diagnosis. By the time the numbers change, the process has usually been underway for a long time.” — Nellie W.K., MSN, AGACNP-BC, iBlackBeauty Founder
What Is Insulin Resistance — In Plain Language
Insulin is a hormone made by your pancreas. Every time you eat, your blood sugar rises, and insulin is released to escort that glucose out of your bloodstream and into your cells, where it is used for energy. Think of insulin as the key and your cells as the lock.
Insulin resistance happens when your cells stop responding properly to that key. The door does not open as easily. Your pancreas compensates by producing more and more insulin, trying to force the glucose through. For a while, this works — your blood sugar stays in the normal range. But the cost is that your body is flooding itself with insulin all the time.
Over time, elevated insulin drives a cascade of problems: it promotes fat storage (particularly around the abdomen), raises inflammation, disrupts hormones, strains the cardiovascular system, and stresses the pancreas. Eventually, if the pancreas cannot keep up, blood sugar starts to rise — first into the prediabetes range, then into type 2 diabetes.
The critical point: all of that damage can be happening while your glucose and A1c are still reading as normal.
Why This Hits Black Women Differently
Insulin resistance is not equally distributed. Research consistently shows Black women carry a disproportionate burden — and the disparity exists even at healthy body weights.
What the Research Shows
- Black women with a normal BMI (under 25) had roughly double the rate of insulin resistance compared with similarly lean white and Hispanic women, according to findings from the multicenter Insulin Resistance Atherosclerosis Study presented at the Endocrine Society annual meeting.
Source: Wake Forest University / Insulin Resistance Atherosclerosis Study - Black adults have a 17% higher prevalence of prediabetes compared with white adults after adjusting for age, sex, education, income, physical activity, diet, and body size, per a 2023 study published in Frontiers in Public Health.
Source: Frontiers in Public Health, 2023 (NHANES data) - At ages 50–59, 23% of African American women have diagnosed diabetes, compared with 9.7% of white women — a rate roughly 2.4 times higher, per CDC data cited by the CDC monograph on diabetes and women’s health.
Source: CDC, Diabetes & Women’s Health Across the Life Stages - Black adults with prediabetes had only a 17% awareness rate in a national sample — meaning approximately 83% did not know they had it, per the same 2023 Frontiers in Public Health analysis.
Source: Frontiers in Public Health, 2023 - Among Black/African American adults, 12.4% have diagnosed diabetes compared with 10.0% for the total U.S. adult population, per HHS Office of Minority Health, 2024.
Source: HHS Office of Minority Health, 2024 (CDC/NCHS data)
What these numbers mean in practice: Black women are developing insulin resistance at higher rates and younger ages, often in bodies that do not look “sick” by the metrics medicine typically uses. Standard weight-based screening misses many of them entirely.
Researchers from the Insulin Resistance Atherosclerosis Study concluded that the definition of obesity may need revision for Black women — and that they may need evaluation and treatment for insulin resistance even at weights not typically considered a clinical concern.
Why Standard Testing Misses It
When you go to your annual physical, your doctor most likely orders a fasting glucose and possibly an A1c. These are the standard screening tools for prediabetes and diabetes. They are useful — but they measure the outcome, not the underlying process.
Here is the problem: glucose and A1c reflect what your blood sugar is doing right now. They do not tell you how hard your pancreas is working to keep that number normal. A woman can have a fasting glucose of 92 mg/dL — squarely in the “normal” range — while her fasting insulin is already dangerously elevated, her pancreas is compensating heavily, and insulin resistance has been progressing for years.
What Standard Testing Shows vs. What It Misses
- Fasting glucose — measures blood sugar after 8–12 hours without food. Normal is under 100 mg/dL. Does not measure insulin levels at all.
- A1c (glycated hemoglobin) — reflects your average blood sugar over approximately 3 months. Normal is below 5.7%. A useful long-term marker, but it also does not detect insulin overproduction.
- Fasting insulin — measures how much insulin is circulating after an overnight fast. This is the test most doctors do not order. Elevated fasting insulin with normal glucose is a classic early sign of insulin resistance — and it is invisible on standard panels.
- HOMA-IR — a calculated estimate combining fasting insulin and fasting glucose. The formula is: fasting insulin (µU/mL) × fasting glucose (mg/dL) ÷ 405. A score near 1.0 is typical in a healthy young adult. Research cutoffs for insulin resistance range from approximately 1.9 to 3.0 depending on the study population.
Fasting insulin is not part of standard U.S. preventive care guidelines. Many primary care providers do not order it at all. You may need to ask for it specifically.
What Insulin Resistance Can Look Like in Your Body
Because insulin resistance often has no dramatic early symptoms, it is easy to dismiss what your body is telling you as stress, aging, or just being tired. Some of the signs that may point toward insulin resistance include:
Signs That May Warrant a Conversation With Your Provider
- Fatigue that does not resolve with sleep — when your cells cannot use glucose efficiently, energy production suffers, and exhaustion becomes a baseline state rather than a temporary condition
- Intense carbohydrate or sugar cravings — particularly in the afternoon or an hour or two after eating, which can reflect blood sugar fluctuation driven by high insulin
- Difficulty losing weight despite eating well and exercising — chronically elevated insulin actively promotes fat storage, particularly in the abdominal area
- Brain fog or difficulty concentrating — the brain is highly dependent on stable glucose, and insulin resistance can disrupt the supply
- Darkening of the skin on the neck, armpits, groin, or under the breasts (acanthosis nigricans) — this velvety skin darkening is a recognized clinical marker of hyperinsulinemia. Research has shown it appears in a significant proportion of women with documented insulin resistance, and it may be more visible and more common in women with darker skin tones
- Skin tags in the same areas — small, soft growths that frequently co-occur with acanthosis nigricans and elevated insulin
- Irregular periods or PCOS diagnosis — insulin resistance is a central driver of polycystic ovary syndrome and affects hormone production and menstrual regularity
- High triglycerides and low HDL cholesterol — a lipid pattern strongly associated with insulin resistance, even when total cholesterol looks normal
It is important to note that none of these symptoms alone confirms insulin resistance. They are signals worth taking to your provider as part of a fuller clinical conversation — not a self-diagnosis.
The Long Game: Why Catching This Early Matters
Insulin resistance does not stay quiet forever. Left unaddressed, it progresses along a well-documented path:
Chronically elevated insulin drives visceral fat accumulation — the fat stored around organs in the abdominal cavity, which is metabolically active and inflammatory. It raises blood pressure by increasing sodium retention and constricting blood vessels. It disrupts lipid metabolism, raising triglycerides and lowering protective HDL cholesterol. It fuels systemic inflammation. It stresses the cardiovascular system over years, long before a diabetes diagnosis is ever made.
This matters enormously for Black women, who already face higher rates of hypertension, heart disease, kidney disease, and diabetes than white women. Insulin resistance is not a separate problem from those conditions — it is frequently the upstream driver of all of them.
The good news: insulin resistance is one of the most modifiable metabolic conditions that exists. Unlike some genetic risk factors, it responds significantly to lifestyle interventions — and catching it early, before the pancreas begins to fail, gives you the most leverage.
What to Ask Your Doctor — Word for Word
You may sit down with a provider who has never ordered a fasting insulin test in a routine visit. That does not mean you cannot ask for it. Here is exactly how to frame the conversation:
Script: What to Say at Your Next Appointment
“I’ve been reading about insulin resistance and how it can be present even when fasting glucose and A1c are normal. Given that I’m a Black woman — and research shows Black women have higher rates of insulin resistance even at normal weight — I’d like to know if a fasting insulin level would be appropriate to add to my labs. I’m also experiencing [name your symptoms: fatigue, cravings, weight changes, skin changes, irregular cycles]. Would a fasting insulin and HOMA-IR calculation give us useful information?”
The Full Lab Panel Worth Discussing With Your Provider
- Fasting insulin (ordered with an overnight fast; not part of standard panels)
- Fasting glucose (likely already being ordered)
- Hemoglobin A1c (likely already being ordered)
- Fasting lipid panel — specifically triglycerides and HDL; a ratio of triglycerides to HDL above 3.0 is associated with insulin resistance
- Fasting insulin + fasting glucose together — your provider or you can calculate HOMA-IR: (fasting insulin × fasting glucose) ÷ 405. A value above approximately 2.0–2.5 is worth discussing, though no universal cutoff exists
A few practical notes: The fasting insulin test requires an overnight fast of 8 to 12 hours. It is inexpensive and widely available, though it is not always covered by insurance as a routine screening tool. You can ask your provider to include it with labs you are already having drawn. If your results come back “normal” by the lab’s reference range but your symptoms persist, ask your provider to interpret the result in the context of your full clinical picture — reference ranges for fasting insulin vary significantly between labs.
The Bottom Line
Research shows Black women develop insulin resistance at higher rates than white women, often at healthy body weights, and often years before blood sugar numbers change. Standard glucose and A1c testing does not detect insulin resistance in its early stages. Asking your provider for a fasting insulin level and understanding your HOMA-IR is a concrete step you can take at your next appointment. The earlier insulin resistance is identified, the more options you have to reverse its course.
Expert Guidance Built for You
iBlackBeauty was created by a Board-Certified Acute Care NP for Black and Latina women who are done settling for generic health advice that was never designed for their bodies.
Sources
- Wake Forest University / Insulin Resistance Atherosclerosis Study. “Race May Be Risk Factor for Insulin Resistance, Research Shows.” Wake Forest Baptist Medical Center News, 2006.
- Malone JI, et al. “Prediabetes prevalence and awareness by race and ethnicity in the United States.” Frontiers in Public Health, December 2023.
- HHS Office of Minority Health. “Diabetes and Black/African Americans.” Updated 2024. (Citing CDC/NCHS Interactive Summary Health Statistics for Adults, 2025.)
- CDC Monograph: Diabetes & Women’s Health Across the Life Stages: A Public Health Perspective. Summarized in: Minority Nurse, “D is for Diabetes and Disparities.”
- Acibademinternational.com. “Fasting Insulin and Insulin Resistance Tests: What HOMA-IR Means and Who Should Ask for It.” Clinical overview.
- Osei K, et al. “Insulin resistance, secretion, and clearance in African American women.” PMC/PubMed.
This article is written for educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized medical guidance.
Nellie W.K. is the founder of iBlackBeauty.com, a clinical health platform created specifically for Black and Latina women navigating chronic disease risk. She brings years of acute care and chronic disease management experience to content that meets women where they are — with clinical accuracy, not generic advice.
