You could be slim and healthy but still at risk! Know all about blood sugar levels

You look fine. You feel fine. Your weight is normal, your energy is decent, and nobody at your last health check raised an eyebrow. Yet inside your body, a slow and damaging process may already be underway, one that carries no visible warning label and announces itself only when the damage is done. This is the reality of dysglycemia, or chronically dysregulated blood sugar, in people who appear outwardly healthy. It is not a rare case.

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Researchers now estimate that hundreds of millions of people worldwide are living with prediabetes or early insulin resistance without knowing it. Many are slim. Many are young. Many are eating what they consider a reasonable diet.

“Standard blood sugar testing has a significant blind spot. Fasting glucose below 100 mg/dL is considered normal. But this single snapshot misses how blood sugar behaves after meals, and it is those post-meal spikes that do much of the damage,” Dr Tushar Tayal, Internal Medicine Specialist, CK Birla Hospital, Gurugram, tells Health Shots. Continuous glucose monitoring studies in people without diagnosed diabetes have found striking variability, as reported in Nature. Some individuals spike well into prediabetic ranges after eating a bowl of white rice or a slice of toast, then return to normal fasting levels by morning. Their annual blood test would never flag them.

What does it mean when insulin levels are elevated?

Elevated insulin levels, a sign that the pancreas is working hard to compensate, often precede elevated glucose levels by years. Testing for fasting insulin alongside glucose gives a far earlier warning, yet it remains uncommon in routine check-ups. The conventional picture of someone at risk for type 2 diabetes is heavy, sedentary, and middle-aged. That picture is dangerously incomplete.

How does visceral fat affect insulin resistance?

Visceral fat impairs the ability of cells to respond to insulin. This hormone escorts glucose from the bloodstream into tissues for energy. When cells stop responding to insulin’s signal, the pancreas compensates by producing more insulin. Blood glucose may stay technically normal for years, but only because the pancreas is working overtime. Eventually, that compensation breaks down. By the time a fasting glucose test catches the problem, the metabolic machinery has often been struggling for a decade.

A condition called TOFI (Thin Outside, Fat Inside) describes people with a healthy body mass index who nonetheless carry significant visceral fat around their liver, pancreas, and other organs. This fat is metabolically active in all the wrong ways. It quietly drives insulin resistance, without ever showing up around the waistline.

What happens when blood sugar is too high?

High blood sugar, even at subclinical levels, is not passive. It damages the walls of blood vessels through a process called glycation, stiffens arteries, promotes inflammation, and accelerates a form of cellular ageing, raising the risk of heart disease, kidney disease, nerve damage, and cognitive decline. None of this produces obvious symptoms in the short term.

What can you do?

Awareness is the first tool:

• Ask your doctor about fasting insulin, HbA1c, and a two-hour glucose challenge test if you have risk factors such as family history, a high-carbohydrate diet, poor sleep, chronic stress, or a sedentary lifestyle, even if your weight seems fine.
• Beyond testing, the most powerful levers are lifestyle: resistance training dramatically improves insulin sensitivity, short walks after meals blunt glucose spikes, and replacing refined carbohydrates with fibre-rich whole foods flattens the daily glucose curve.