Eat carbs, that gets turned into BG. A healthy body will react w/ insulin production, and heathy cells will allow the insulin to do its job and poof, quickly your BG is back to baseline.
The SAD (Standard American Diet) is so carb-rich that over time, cells resist the effect of insulin, and over time, the pancreas simply puts out a bit more to force the insulin to do its thing brining the BG back to baseline.
So, for most, its the carbs, over time that creates resistance, resulting in an increased insulin level, aka decreased insulin sensitivity. (This is not true for Type I diabetics).
This is why one cannot rely on A1C results alone. Yes, you may have a good A1C, but in fact, your blood insulin level might be much higher than it was a decade ago. Your pancreas is fighting (by increasing insulin) which does lower the A1C, but as time goes by you may wear out the beta cells in the pancreas. And, as time goes by, your cells get more and more resistant, a vicious cycle that = diabetes.
I think the term “pre-diabetes,” is horrific. It should be “ongoing-cardio-circulatory-renal destruction.”
If concerned about insulin sensitivity consider this test, w/ a coupon it cost me $70 and frankly, I was shocked to see that I had become so sensitive to insulin.
Testing was done by https://labtestingapi.com/ but I went to Quest, a local lab for the blood draw.
I wish I had done this test a year ago (it did not exist then, it’s quite new). I’ll bet that a year ago I was above 66. But then a year ago I wore compression stockings every day, these days, nope, not ever.