Why Can’t I Lose Weight?

If you’ve wondered, “Why can’t I lose weight in Perimenopause?” … Or even, “what are your labs missing” since you’re doctor told you everything was normal, this is for you!

If you’ve been told your labs look fine but you still can’t lose weight, can’t stop storing fat around your middle, and feel like your body is working against everything you’re doing — there’s a very good chance nobody has looked at your fasting insulin. Or if they did, they told you it was normal. And moved on.

That “normal” is one of the most misleading words in conventional medicine. And it may be the single biggest reason you’re stuck.

What I don’t love is the conclusion most people are drawing from it — that a GLP-1 is the only way to turn the volume down.

If we haven’t met yet… welcome! I’m Dani Conway, Board Certified Practitioner with almost 20 years of clinical experience helping midlife women transform their physiques with my proven method, the Fat Burn Formula for Women Over 40. I battled weight gain, hormone dysfunction, and metabolic chaos myself before I figured out what actually works. TEST DON’T GUESS has been my clinical philosophy for nearly two decades — and fasting insulin is one of the most important tests that most women have never had properly interpreted.

Let’s fix that today.

What Fasting Insulin Actually Measures

Fasting insulin is a blood test that measures how much insulin your pancreas is producing after an overnight fast. That’s it, mechanically. But what it tells you clinically is a completely different story.

Insulin’s job is to escort glucose out of the bloodstream and into your cells for energy. When your cells start ignoring insulin’s signal, otherwise known as a condition called insulin resistance, your pancreas doesn’t just give up. It compensates. It produces more insulin to force the same effect.

So your blood sugar stays normal, your glucose looks fine, your A1C is unremarkable… and meanwhile your insulin is going up, year after year, doing damage the whole time.

This is the part that matters: fasting insulin captures that compensatory elevation early. Often years — sometimes decades — before blood sugar ever budges.

By the time your fasting glucose rises above 100, insulin resistance has typically been present for 10 to 20 years. Your doctor missed the window. Not because they weren’t paying attention, but because they weren’t running the right test.

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The Reference Range Problem — And Why “Normal” Is Not the Same as Optimal

Here’s where I want you to pay close attention, because this is the piece that changes everything. This might seem like common knowledge in the Keto or Carnivore Diet space at this point, however, I still want to be sure you’re still not misinformed.

The standard laboratory reference range for fasting insulin is 2–25 µIU/mL.

That means a result of 24 gets stamped NORMAL on your lab report and sent back to you with zero follow-up. But a fasting insulin of 24 indicates significant insulin resistance. A fasting insulin of 15 indicates meaningful metabolic dysfunction. Even a result of 10 or 11, well within the “normal” range, can be a problem, especially for a woman in perimenopause or menopause whose hormone environment is already working against her metabolism.

So where did that range come from? It was established based on statistical averages across the general population. And the general population — let’s be honest — is not metabolically healthy. We’re using a reference range derived from a population with epidemic rates of obesity, insulin resistance, and type 2 diabetes, and calling it the standard for normal. That’s not a standard. That’s a very low bar.

Functional medicine practitioners use a completely different target. Optimal fasting insulin that I look for is a tight range… 4–6 µIU/mL. That’s where insulin sensitivity is strong, fat burning is accessible, and the metabolic environment supports everything else you’re trying to do — balance hormones, increase energy, improve body composition and reduce inflammation.

The gap between what your lab calls normal and what is actually optimal is not a minor distinction. It’s the difference between a metabolic system that’s quietly breaking down and one that’s actually functioning.

Why High Insulin Makes Fat Loss Physically Impossible

This is another area of misinformation, so I’m going to be direct about it.

Insulin is a storage hormone. Its job, when elevated, is to push energy into cells and suppress the release of stored fat. When insulin is chronically high, even within the “normal” lab range, your body is receiving a constant signal to store, not burn.

You literally cannot access your fat stores efficiently when insulin is elevated. It’s not a matter of trying harder, eating less, or moving more. The hormone signal is overriding the effort. Fat burning requires insulin to be low enough that the body can shift into lipolysis — the process of breaking down stored fat for fuel. Chronically elevated insulin keeps that switch locked in the off position.

This is why so many women come to me having done everything right on paper — clean keto or carnivore diet, intermittent fasting, strength training, decent sleep — and still can’t move the scale or shift visceral fat. Nobody checked their fasting insulin. Or if they did, a result of 14 got called normal and the conversation ended there.

A fasting insulin of 14 means fat burning is significantly impaired.

The Perimenopause and Menopause Connection Nobody Is Talking About

Here’s where it gets even more specific for women over 40, and why I see this pattern constantly in my practice.

Estrogen is not just a reproductive hormone. It plays a direct role in insulin sensitivity. As estrogen declines through perimenopause and into menopause, insulin sensitivity declines with it. The cells become less responsive to insulin’s signal, the pancreas compensates by producing more, and fasting insulin creeps up — even in women who haven’t changed a single thing about their diet or lifestyle.

This is why the woman who was lean and metabolically healthy at 38 can be doing the exact same things at 46 and struggling with visceral fat, energy crashes, carb cravings, and a scale that won’t move. Her fasting insulin has shifted. Her metabolic environment has changed. And if nobody is measuring it, nobody is addressing it.

Add in the cortisol imbalances that come with chronic stress and poor sleep — which, as I’ve talked about before, is too common in midlife women, therefore you have a second driver of insulin resistance layered on top of the estrogen piece. Cortisol signals the liver to release glucose. Glucose triggers insulin. More insulin means more storage, less fat burning, more visceral fat accumulation.

This is not a willpower issue. It is a hormone-driven cascade, and fasting insulin is often the number that reveals it first.

Want more on how to truly optimize the correct use of peptide stacks and protocols for perimenopause and menopause?! I’ve discussed this extensively in The Wellness Collective over the past month. Hop in to learn more!

Ready for help and tired of the guesswork? This is exactly what I do with my clients in both my 1:1 coaching as well as my group Weight Loss Accelerator program.

What Fasting Glucose Misses — And Why You Need Both

I want to address this directly because I see so much confusion around it.

Fasting glucose and fasting insulin are not the same test and they do not tell you the same thing. Most standard panels run fasting glucose. Almost none run fasting insulin. And yet fasting glucose is the later-stage marker — it only rises after insulin resistance has been present long enough that the pancreas can no longer fully compensate.

A fasting glucose of 88 mg/dL looks perfect. But if it takes a fasting insulin of 18 to keep it at 88, that is not a healthy metabolic picture. The glucose is normal only because the insulin is working overtime to make it normal. That overtime is the problem. And it won’t show up on a glucose test.

This is also why I run HOMA-IR on my clients. This is a calculated score that combines both fasting insulin and fasting glucose into a single insulin resistance marker. It gives a far more complete picture than either number alone. A HOMA-IR above 1.5 starts to signal metabolic strain. Above 2.0 is meaningful insulin resistance, regardless of what the individual glucose or insulin numbers look like in isolation.

TEST DON’T GUESS. This is why.

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Signs Your Fasting Insulin May Be Higher Than It Should Be

These are the patterns I look for in clients before we even run labs:

~ Stubborn fat around the abdomen and waist that doesn’t respond to diet changes — visceral fat accumulation is one of the most consistent signs of chronically elevated insulin.

~ Carbohydrate and sugar cravings — especially in the afternoon and evening, which is when blood sugar dysregulation tends to surface.

~ Energy crashes after meals, even meals that seem balanced or low-carb.

~ Difficulty losing weight despite eating clean — the Keto Diet or Carnivore Diet isn’t working the way it used to, or stalls quickly.

~ Waking between 2–4am — cortisol and blood sugar dysregulation are closely linked and often show up as disrupted sleep.

~ Skin tags — one of the more underappreciated clinical signs of chronic insulin elevation.

~ Brain fog and difficulty concentrating — the brain is highly insulin-sensitive and cognitive function suffers when insulin signaling is impaired.

What Actually Moves Fasting Insulin in the Right Direction

Getting fasting insulin into the optimal range is absolutely achievable — but it requires addressing the actual drivers, not just managing symptoms. Here’s what works clinically:

~ Adequate protein at every meal, anchored by animal-based sources. Protein drives a satiety hormone response without the insulin spike that carbohydrates produce. It also supports muscle mass, and muscle is the primary tissue responsible for glucose uptake — more muscle means better insulin sensitivity.

~ Strategic carbohydrate reduction. Keto and Carnivore approaches are among the most effective dietary interventions for lowering fasting insulin because they remove the primary insulin stimulus. This is not about low calorie — it’s about low insulin load.

~ Resistance training with progressive overload. Muscle is the most metabolically active tissue we have that improves insulin sensitivity both acutely and chronically. This is non-negotiable, and it needs to be designed correctly — not just any movement, but a progressive program. Resistance training is also the most under discussed way to overcome insulin resistance!

~ Sleep as a metabolic intervention. One night of poor sleep measurably increases insulin resistance the following day. Chronic sleep deprivation compounds this dramatically. Fixing sleep isn’t a lifestyle suggestion — it’s a priority with direct metabolic consequences.

~ Addressing cortisol. Cortisol and insulin have a bidirectional relationship. Chronically elevated cortisol can drive up insulin. Managing stress, sleep, and adrenal function is part of the insulin picture, not separate from it. Also keep in mind though, when it comes to other stressor, adrenal hormones are responders so you need to work on stress management.

~ Eating enough fat for your individual body and metabolism. This is the piece that gets glossed over constantly, especially in low-carb spaces where fat intake gets treated as a universal variable.

Fat is not just a fuel source — it’s a hormone signal. Adequate dietary fat supports cell membrane integrity, hormone production, and satiety signaling. Under-eating fat while also restricting carbohydrates puts the body in a stress state that can actually drive cortisol up and impair fat burning. What “enough” means is individual because it depends on your metabolic history, activity level, body composition, and where you are in your hormone transition. This is not a one-size-fits-all number, and getting it wrong in either direction has consequences, which is why this is individualized for each client I work with.

~ Comprehensive testing, not guesswork. Fasting insulin, HOMA-IR, fasting glucose, triglycerides, HDL, and a full hormone panel together paint the complete metabolic picture. The triglyceride-to-HDL ratio is one of the simplest and most powerful proxies for insulin resistance — a ratio above 2 is a red flag even when everything else looks fine on paper.

The “Perfect” Fasting Insulin Paradox — And Why It Still Doesn’t Explain Your Weight Loss Resistance

I want to address something I see in my practice constantly — and I mean constantly. About 85% of the women who come to me stuck, frustrated, doing everything right and still not losing weight have fasting insulin that looks perfectly fine on paper. Under 6. Usually 4 or 5! Technically optimal.

And they still cannot lose weight.

This is what I call the perfect fasting insulin paradox, and it’s one of the most important clinical realities I see that almost nobody is talking about in the online health space.

Here’s what’s happening: fasting insulin is one marker. It’s a critical one, and it’s one of the first I run — but it does not tell the whole story. A woman can have a fasting insulin of 4.8 and still have significant fat loss resistance driven by other factors that a single snapshot insulin measurement won’t capture.

What I’m looking at when fasting insulin looks fine but weight loss is stalled:

Reverse T3 dominance. When the thyroid is producing T4 but converting it to reverse T3 instead of active T3, metabolism slows dramatically. The body is essentially putting the brakes on at the cellular level. Fasting insulin won’t show this. Only a full thyroid panel like the one I run on all clients will show this. This is something you might want to try to ask your provider for..

Estrogen dominance relative to progesterone. You can have estrogen levels that look “normal” in isolation and still be significantly estrogen dominant when progesterone is low. Relative estrogen dominance promotes fat storage, particularly in the hips, thighs, and abdomen, and drives water retention that masks fat loss even when it’s occurring.

Gut dysfunction and inflammation. Intestinal permeability, dysbiosis, and chronic low-grade gut inflammation create a systemic inflammatory load that impairs fat metabolism independently of insulin. A woman with a perfect fasting insulin and a compromised gut barrier is still in a fat storage environment — the mechanism is just different.

HPA-T axis dysfunction. The communication between the hypothalamus, pituitary, adrenal glands, and thyroid is often the missing piece. When this axis is dysregulated — which is extremely common in chronically stressed, sleep-deprived midlife women — it creates a cascade of downstream effects on metabolism that no single marker captures.

This is why my approach has always been TEST DON’T GUESS — and why fasting insulin, as important as it is, is the beginning of the investigation, not the end of it. If your fasting insulin is perfect and you’re still stuck, something else is driving it. And we can find it. But only if we’re running the right tests and interpreting them through the right lens. This is why proper interpretation of the labs, not only for optimal ranges of one marker here or there, but the patterns between markers are super important as well!

Ready for REAL RESULTS?!

If this resonates and you’re ready to stop guessing and start getting answers — The Wellness Collective is a great place to start. It’s my private community for women over 40 who are done with the basics and ready to go deeper: hormone optimization, advanced nutrition strategies, peptide protocols, and nearly 20 years of clinical experience in your corner. The Wellness Collective Hop in to learn more!

Food for Thought…

“Normal” is one of the most dangerous words in conventional medicine when it’s being used to describe a population that isn’t well. You deserve a practitioner who interprets your labs against an optimal standard — not an average one. And you deserve to know what your fasting insulin actually is, what it means, and what to do about it.

It’s not your fault that this test hasn’t been run or explained properly. But knowing it now IS your responsibility to act on. Big difference.

I’m committed to helping my clients find real, lasting solutions — not quick fixes. And the fastest path to rebalance and quiet is always through the root, not around it.

Curious as to how I work with clients? Click here to message me, I’d love to chat!

Want to grab my complimentary “Hormones, Hot Flashes and High Fat” Guide? Click here to grab it, and get tons of the best tips, hacks and strategies for weight loss, fat loss, hormone balance and more!

Note: This article is for informational purposes only and should not be considered health or medical advice. Reading this article also does not make me your practitioner! Always work with qualified healthcare providers who understand your individual needs.

XOXO

Board Certified Functional Diagnostic Nutrition Practitioner
Certified Peptide Integration Specialist
Functional Bloodwork Specialist
Certified Hormone Integration Specialist
Peptide Therapies Treatment
Adv. Metabolic Typing Advisor
Kalish Method Functional Med. Practitioner