Mojo Klinik / Conditions / Metabolic health / Insulin Resistance and Metabolic Health
DR MARIA MACKEY
Mojo Klinik · Neutral Bay Sydney
Insulin resistance and metabolic health.
Years before fasting glucose goes abnormal, the picture is already forming
Weight that will not shift.
Hunger 90 minutes after a meal.
Fasting glucose still in range, year after year.
SOUND FAMILIAR?
You will recognise yourself in some of these.
Most patients arrive carrying one or more of these.
- Your weight will not shift despite diet and exercise
- You have abdominal fat that has accumulated
- You feel hungry within 1 to 2 hours of eating
- You crash mid-afternoon and need carbs or caffeine
- You have PCOS (insulin resistance underlies most of it)
- You have a family history of type 2 diabetes
- Your fasting glucose has been borderline for years
- You suspect a metabolic problem but standard tests come back fine
There is almost always a clinical explanation. Pulling on the thread is what we do.
WHAT INSULIN RESISTANCE ACTUALLY IS
An early metabolic shift identified through specific biochemistry, often years before standard glucose markers change.
When cells become less responsive to insulin, the pancreas compensates by producing more of it. Fasting glucose stays normal because the extra insulin is keeping it down. The metabolic picture is forming, with effects on weight, inflammation, and cycle regularity in PCOS, but the standard glucose test misses it.
A metabolic health doctor Sydney approach uses earlier markers to catch the picture in its most treatable phase. HbA1c. The triglyceride to HDL ratio. Inflammatory markers. The metabolic context that fasting glucose alone cannot see.
"Normal fasting glucose. A creeping HbA1c. Raised triglycerides. A low HDL. That is insulin resistance in its most treatable phase. The glucose is still normal, but the picture is forming. This is the window. Ten years later, when the glucose finally becomes abnormal, the window is narrower and the work is harder."
A COMPARISON MAP
Why fasting glucose misses it.
Years of metabolic dysfunction are missed by glucose alone.
MI TOCHONDRIAL
Cellular energy production. Why exercise hurts. Why recovery is delayed.
HPA AXIS
Cortisol pattern is flat. Sleep is broken. The system is stuck on.
VIRAL REACTIVATION
EBV, CMV, and others reactivate. Low-grade chronic inflammation persists.
The earlier we see the pattern, the more we can do about it. The window is years wide
OUR THREE – PHASE APPROACH
Catch the picture early. Build the metabolic plan. Track progress.
Adjust against actual response.
Phase 1
Investigate
Weeks 1 to 3
HbA1c, fasting glucose, fasting insulin, lipid panel, hs-CRP, liver function. Thyroid panel and sex hormones where relevant. The metabolic context across the full picture.
Phase 2
Treat
Months 1 to 6
Dietary framework matched to your metabolic picture (not a generic low-carb prescription).
Movement strategy. Targeted supplementation. Targeted prescription medication where clinically warranted, in coordination with your GP.
Phase 3
Track
Ongoing
Insulin sensitivity is one of the more reversible
chronic metabolic states when caught early. We retest, review, and adjust the plan against your actual response. The aim is sustained improvement, not a one-shot intervention.
WHY FASTING GLUCOSE MISSES IT
Different markers tell you different things.
The standard test catches the picture late. The earlier markers catch it years before.
Fasting glucose
- Your blood sugar after fasting
- Becomes abnormal late in the disease process
- Years after the metabolic shift began
Fasting insulin
- How much insulin your pancreas needs to keep glucose normal
- Becomes abnormal early, years before glucose changes
HbA1c
- Average blood sugar over 3 months
- Detects the picture earlier than a single fasting glucose
Triglyceride to HDL ratio
- A single calculation from a standard lipid panel
- One of the most useful early markers of insulin resistance
hs-CRP
- Low-grade inflammation
- Drives insulin resistance and worsens with it
- Useful for tracking the broader metabolic context
Testosterone (in men)
- Testosterone has an inverse relationship to insulin
- The higher the insulin, the lower the testosterone and vice versa
- If you have a high fasting insulin, then check your testosterone levels
A patient can have significant insulin resistance with a completely normal fasting glucose. The pancreas is compensating. The broader metabolic picture is already shifting (weight, inflammation, lipid markers). Berberine is one of several agents Dr Mackey may consider as part of an individualised plan, where the testing and the clinical picture support it. It has clinically meaningful interactions with several common medications; it is not used in pregnancy or breastfeeding. Quality varies significantly between products.
IS MOJO KLINIK RIGHT FOR YOU?
Is this approach right for you?
IT'S A FIT IF
- Your weight will not shift despite genuine effort with diet and exercise
- You have a family history of type 2 diabetes and want to catch the picture early
- You have PCOS or suspect insulin resistance is part of your hormonal picture
- You want a metabolic workup that goes beyond fasting glucose
- You want a structured plan rather than a generic diet prescription
NOT A FIT IF
- You want a quick weight-loss script with no investigation
- You have established type 2 diabetes that is being well managed by your endocrinologist
- You want us to replace your treating GP for an active metabolic issue
HOW TO START
Two ways to start with us.
You have two booking options with Dr Maria Mackey. The right one depends on the dominant feature of your picture.
OPTION 1
Mojo New Patient Appointment with Dr Maria Mackey
- 1 Hour
- $490 in-person
- $510 Zoom
Medicare rebate available for in-person initial consultations
A comprehensive deep dive into the metabolic, hormonal, and lifestyle
drivers of insulin resistance. The right entry point for most insulin resistance presentations because the work is multi-system.
OPTION 2
Hormone Assessment with Dr Maria Mackey
- 45 Minutes
- $390 in-person
- $410 Zoom
Medicare rebate available for in-person initial consultations
The fast-track if your concerns are primarily PCOS-related (where insulin
resistance and hormones overlap heavily).
For full pricing, see Consultation Fees. Telehealth available Australia-wide for followups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.
FAQ
Frequently Asked Questions.
How much does an insulin resistance consultation cost at Mojo Klinik?
The Mojo New Patient Appointment is the right entry point: 1 hour with Dr
Mackey, $490 in-person or $510 by Zoom, with a Medicare rebate available
for in-person initial consultations. The Hormone Assessment (45 min, $390 /
$410) is the alternative if your concerns are primarily PCOS-related.
Pathology (HbA1c, fasting glucose, lipid panel, hs-CRP) is billed separately
by the lab.
"Insulin resistance is multi-system. The 1-hour Mojo New Patient Appointment is the right entry point. Metabolic, hormonal, inflammatory, and lifestyle pictures need to be looked at together. The 45-minute Hormone Assessment is appropriate where PCOS dominates."
Approximately 20% of Australian adults have measurable insulin resistance, with the majority
having normal fasting glucose. Australian Bureau of Statistics National Health Survey, 2023.
I have been told my blood sugar is fine. Could I still have insulin resistance?
Yes, and this is one of the most common patterns we see. Fasting glucose is a
late marker. HbA1c, the triglyceride to HDL ratio, and other early metabolic
markers catch the picture earlier than fasting glucose alone.
"Normal fasting glucose. A creeping HbA1c. Raised triglycerides. A low HDL. That is insulin resistance in its most treatable phase. The picture is forming. The glucose is still normal. The physiological stress is already there. This is the window."
A 2024 Diabetes Care review documented that compensatory hyperinsulinaemia and metabolic
shifts precede abnormal fasting glucose by an average of 8 to 12 years in the natural history of
type 2 diabetes.
Is insulin resistance reversible?
Insulin sensitivity is one of the more responsive chronic metabolic states
when caught early. The earlier the picture is identified, the more scope there
is for intervention. Specific outcomes depend on the individual situation
and are discussed at consultation.
The 2024 Diabetes Remission Clinical Trial (DiRECT) extended follow-up in the Lancet
documented meaningful outcomes from structured metabolic intervention. Specific outcomes
depend on individual circumstances.
What is the role of diet?
Significant. The right dietary framework is the foundation of any insulin
resistance plan. The wrong one (very common: high refined carbohydrate, irregular eating, excessive snacking) drives the problem. We tailor the framework to your specific picture rather than applying a generic prescription.
"There is no single diet for insulin resistance. There is a set of principles. Lower glycaemic load. Adequate protein. Intentional eating windows. Fibre quality. The framework is tailored to your specific picture, body composition, food preferences, and life context. A protocol that ignores those is a protocol that fails."
Do I need medication?
Not always. Many patients improve significantly with diet, lifestyle, and targeted supplementation. Where prescription medication is clinically indicated, we discuss it openly. Prescribing decisions are communicated to your GP. Medication is a tool, not a default.
What about PCOS (Polycystic Ovarian Syndrome)?
Insulin resistance is the metabolic driver of most PCOS. Improving insulin
sensitivity often improves the cycle, fertility, skin, and other PCOS features.
We address the metabolic driver and the hormonal consequences together
rather than treating them as separate problems.
"PCOS managed only with the oral contraceptive pill is being managed at the symptom level, not the driver level. Address the underlying insulin resistance and the cycle, the skin, the fertility prospects, and the energy picture tend to shift together. That is mechanism, not label."
What testing will I need?
A typical investigation includes HbA1c, fasting glucose, lipid panel
(especially triglyceride to HDL ratio), hs-CRP, liver function (fatty liver and
insulin resistance overlap heavily), and where relevant, thyroid panel and
sex hormones. The specific panel depends on your presentation.
AN INVITATION
Ready to be properly investigated?
One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.
WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089
HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement