5 min readNew DelhiAug 27, 2026 06:00 AM IST
Insulin does not behave in exactly the same way in everyone who develops problems with blood sugar regulation. In some people, the body’s tissues become less responsive to insulin, so the pancreas must produce more of the hormone to keep glucose under control. In others, the pancreas gradually loses its ability to produce enough insulin.
This difference is important because insulin resistance and declining insulin production can overlap, but they are not identical processes. The balance between the two can also change over time, which may help explain why people with apparently similar blood sugar levels can have very different underlying metabolic problems.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
So, what determines whether a person primarily develops insulin resistance or progressively loses insulin-producing capacity? We spoke to an expert to understand the biological factors behind these different patterns, whether genetics, body composition and lifestyle play a role, and what this means for blood sugar control over time.
Why do some people develop insulin resistance while others lose insulin production?
Kanikka Malhotra, Consultant Dietician and Diabetes Educator, tells indianexpress.com, “This comes down to where the body’s weak link sits, either at the receptor end or the production end. Insulin resistance develops when muscle, liver and fat cells stop responding well to insulin, often driven by excess visceral fat releasing inflammatory signals that block insulin’s action. Beta cell decline is a different story, where the insulin-producing cells themselves lose function or gradually die off, frequently influenced by genetics and long-term cellular stress.”
She adds that most people actually have some of both, but genetics tends to set which pathway dominates. Think of it like two different failures in the same supply chain. One is a factory producing less; the other is customers refusing delivery. Someone with strong beta-cell reserve can compensate for resistance for years by simply producing more insulin, while someone with limited reserve shows problems earlier, even without much resistance at all.
How do genetics and lifestyle affect insulin-producing beta cells?
Beta cells are remarkably sensitive to their surroundings, and each factor pulls in its own direction. Genetics can determine how many beta cells a person starts with and how resilient they are under stress.
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“Age naturally reduces beta cell efficiency, while visceral fat around the abdomen, more common in South Asian body types even at lower BMI, creates a toxic environment through fat byproducts that directly impair beta cell function. Food high in refined carbohydrates forces repeated insulin surges, gradually exhausting these cells, while regular physical activity improves insulin sensitivity and reduces this demand. This is why two people eating similar thalis can have very different outcomes. One may have beta-cell reserve built through genetics and muscle mass, while the other is already running closer to capacity. It is this combination of inherited resilience and lifestyle load that decides who tips into diabetes sooner,” states Malhotra
Can insulin resistance progress to loss of insulin-producing capacity?
Quick Quiz
See if you can answer this:
What can happen to insulin production as insulin resistance progresses over time?
A. The pancreas permanently produces more insulin without any decline in function.
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B. Insulin production can eventually decline as pancreatic beta cells lose their ability to compensate for prolonged insulin resistance and high glucose.
C. Insulin resistance always reverses before insulin production is affected.
D. Blood sugar remains normal because the pancreas can compensate indefinitely.
Reveal the answer
✅ Correct answer: B
In the early stages of insulin resistance, Malhotra says, the pancreas may compensate by producing more insulin, helping keep blood sugar relatively normal. Over time, prolonged insulin resistance and persistently elevated glucose can contribute to declining beta-cell function. As insulin production falls, blood sugar may become consistently elevated rather than rising only after meals.
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This can change treatment needs. Malhotra suggests that lifestyle measures and medicines that improve insulin sensitivity may eventually need to be supplemented or replaced by other treatments, including insulin therapy in some people. Monitoring changes in glucose and, when clinically appropriate, measures such as C-peptide can help doctors assess how insulin production is changing and adjust treatment accordingly.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.