Case Study: Management of Insulin Resistance and Improvement of Metabolic Health in an Active Woman

Client Profile: Female, 36 Years Old, Active
Author: Kostadin Tsvetkov, Nutritionist and Dietitian
Published: January 22, 2026

Client Overview

  • Name: Client C (anonymized)
  • Age: 36 years
  • Sex: Female
  • Height: 168 cm
  • Initial weight: 82 kg
  • BMI: 29.1 (overweight)
  • Diagnosis: Insulin resistance (HOMA-IR: 3.4)
  • Body composition: ~35–36% body fat, low lean mass for height
  • Physical activity: 3× gym sessions per week + moderate walking

Main Complaints:

  • Energy crashes during the day
  • Strong evening appetite
  • Difficulty losing weight
  • Bloating
  • Unstable blood sugar

Goals & Objectives

Primary Goals:

  1. Improve insulin sensitivity and stabilize blood sugar
  2. Reduce body weight: 82 → 74 kg within 4–6 months
  3. Increase lean mass to improve metabolic expenditure
  4. Sustainable appetite control and reduction of evening overeating
  5. Reduce inflammation and improve hormonal balance

Nutritional Assessment

Dietary Intake (Initial 7-Day Food Diary Analysis)

Average Daily Intake:

  • Calories: ~2100 kcal
  • Protein: 65–75 g
  • Carbohydrates: 260–300 g
  • Fats: ~80 g

Observations:

  • Low protein and fiber intake → strong hunger and unstable blood sugar
  • High carbohydrates without structure → 5–6 glucose spikes per day
  • Evening overeating due to low satiety index during the day
  • Snacks without protein → sharp energy drops
  • Inconsistent hydration (1–1.2 L/day)
  • Low levels of: magnesium, vitamin D, vitamin B12, and omega-3

Baseline Lab Work

  • HOMA-IR: 3.4 (insulin resistance)
  • Glucose: 5.6 mmol/L
  • Insulin: 19 μIU/mL
  • Vitamin D: 18 ng/mL (deficiency)
  • Lipid profile: slightly elevated triglycerides
  • Inflammation: hs-CRP 4.8 mg/L
  • Iron / ferritin: lower limit

Nutrition Intervention Plan

Phase 1: Balance and Stabilization (Weeks 1–4)

Goals:

  • Stabilization of blood sugar
  • Appetite regulation
  • Establishment of a clear eating rhythm.

Targets:

  • Calories: 1850–2000 kcal
  • Protein: 110–120 g
  • Carbohydrates: 130–150 g (low glycemic)
  • Fats: 70–75 g
  • Fiber: 30–35 g/day

Main strategies:

  • First two meals always include protein + fiber
  • Complete elimination of liquid calories
  • Structure: 3 main meals + 1 controlled snack
  • 12–12.5 hours overnight fast

Meal Plan Overview:

Meal Time Components
Breakfast 8:00 AM
 Eggs, vegetables, avocado, raspberries
Snack 11:00 AM Greek yogurt + chia + blueberries
Lunch 14:00 AM Chicken / fish, quinoa, large green salad + olive oil
Afternoon 17:00 PM Protein shake + almonds
Dinner 19:00 PM Tilapia / turkey, asparagus, sweet potato

Supplements Introduced:

  • Vitamin D3 + K2 – 5000 IU
  • Magnesium glycinate – 300–400 mg
  • Berberine – 500 mg × 2
  • Omega-3 – 2–3 g EPA/DHA
  • Probiotic (Lacto + Bifido)

Phase 2: Metabolic Enhancement (Weeks 5–12)

Adjustments:

  • Introduction of resistance training 3× per week
  • Slight increase in protein to 120–130 g
  • Controlled increase of carbohydrates on training days
  • Replacement of berberine with myo-inositol if pregnancy is desired or for hormonal balance

Results after 12 weeks:

  • Weight: –5.2 kg
  • Waist: –8 cm
  • HOMA-IR: 3.4 → 1.9
  • Significantly reduced evening hunger
  • Less bloating and more stable energy

Phase 3: Recomposition and Maintenance (Weeks 13–20)

Focus:

  • Increase in lean mass and further optimization of metabolism.

Refinements:

  • 5 evenly distributed meals
  • Increase protein to 130–135 g/day
  • Introduction of legumes as a primary fiber source
  • Functional foods: turmeric, cinnamon, flaxseed, cherry juice
  • Addition of creatine – 3 g/day

Strength results:

  • Glute bridge: +40%
  • Leg press: +35%
  • Higher NEAT without forcing (“walking more naturally”)

Outcomes

After 5 Months:

Body composition changes included a reduction in weight from 82 to 74.5 kg, a 12 cm decrease in waist circumference, a decrease in body fat from approximately 35% to 29%, and an increase in lean mass of 1.8 kg.

Metabolic markers improved, with HOMA-IR decreasing from 3.4 to 1.6 (normalized), glucose dropping from 5.6 to 4.9 mmol/L, insulin declining from 19 to 8.7 μIU/mL, vitamin D increasing from 18 to 36 ng/mL, and hs-CRP reducing from 4.8 to 1.7 mg/L.

Subjective outcomes included the disappearance of evening overeating, stable energy throughout the day, better concentration, reduced bloating, and higher-quality sleep, with adherence to the plan estimated at approximately 85–90%.

Long-Term Strategy & Maintenance Plan

Goals:

  • Maintain weight at 74–76 kg

Strategies:

  • Introduction of calorie cycling
  • Training 3–4× per week (strength + walking)
  • Maintenance intake of vitamin D, omega-3, magnesium, and myo-inositol
  • Follow-up blood tests every 6 months

Key Learnings & Reflections

  • Insulin resistance improves most effectively through structure, adequate protein, fiber, and controlled carbohydrates
  • Gradual habits and a clear eating rhythm are more important than extreme low-carb approaches
  • The combination of moderate cardio and resistance training is optimal for metabolic health
  • Micronutrients, especially vitamin D and magnesium, are critical for results
  • Proper support reduces emotional eating and stabilizes appetite

Conclusion

This case study demonstrates how a structured and personalized nutritional approach can reverse insulin resistance, stabilize blood sugar, and lead to sustainable results without extremes. The client achieved significant improvements in body composition, metabolic markers, and daily energy, building a solid foundation for long-term health and control.

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