The First Domino

In my opinion, the primary marker for your health is the HBA1C test. A hemoglobin A1C (HbA1C) test is a blood test that shows your average level of blood glucose, over the past two to three months. All food is broken down into glucose and in order for it to be sent into your blood, insulin is produced which is like a passkey for glucose to go into your cells.

On a high carbohydrate diet (typical Indian diet), insulin is produced constantly to send glucose that is in your blood to go into your cells. However, your cells reject that glucose because they don’t need it. They don’t need it because the existing glucose in them isn’t utilized if you live a sedentary lifestyle or you don’t exercise as much as you think you do. But our pancreas thinks that maybe if more insulin is produced the cells will accept the glucose. But cells continue to reject it and this is where you develop insulin resistance.

This is where the first domino falls with respect to your health. The human body does not develop insulin resistance overnight. This is developed over weeks and months of poor eating habits. The excess food that you are now consuming which is not used by the cells will now be turned into fat and stored in the body.

Initially fat is deposited under your skin. This is where you end up with chubby cheeks, thigh fat or fat in your upper arms and even your upper-back. This fat is called subcutaneous fat – although this is going to cause just aesthetic issues it does not necessarily cause any health issues yet. You can see in this picture of me from 2012, I have very little belly fat but quite a bit of chest fat and chubby cheeks.

It is when the body runs out of places under the skin and starts depositing fat in the belly area. This is called visceral Fat and visceral fat is known to cause health problems. There is a direct correlation between visceral fat and type-2 diabetes. In a study (PMID: 40432378) among 6,575 adults aged 40+ followed for an average of 3.19 years, 11.4% developed diabetes. The study showed that every visceral fat independently and significantly predicted diabetes risk, confirming visceral fat and type 2 diabetes have a direct correlation.

Test… Check 1, 2, 3

There are 3 tests including the HBA1C which everyone must get done regularly especially. A score of anything below 5.7% means you are not at risk of pre-diabetes (insulin resistance), 5.8% – 6.4% means you have pre-diabetes.Anything above 6.4% means that you have type 2 diabetes. Unlike other blood tests like fasting blood sugar, HBA1C accounts for the past data in your blood to give the results. This is the most accurate assessment of your health.

The other two tests are your lipid profile tests (cholesterol) and tests to check if you have fatty liver. Because an indication of belly fat will likely mean that your bad cholesterol is on the higher side and belly fat can even seep into your liver or coat your liver and reduce its functioning.

Early Warning Signs

One of the early warning signs that you are insulin resistant is when your skin starts to darken. You notice patches of dark skin near the neck, elbow crease and on the forehead. This condition is called ‘Acanthosis Nigricans’. I remember having this and you can see in this picture despite the well lit outdoors, my skin is quite dark around the neck.

What Now and How Often?

If you are diagnosed with pre-diabetes or type 2 diabetes you need to reduce the amount of carbohydrates you consume. Eyeball it and reduce some items by 40%. Minimize consumption of processed foods – limit to two instances a month. Yes. That is right, no more than two instances in a month. Get your HBA1C tested often – at least once every 3 months. Places like Thyrocare are able to provide these tests for Rs. 200/- (as of May 2026).

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