Breaking Free from Insulin Resistance — Practical Steps After Bariatric Surgery

(Part 3 of 3 in our Insulin Resistance Series)

In Part 1, we explored what insulin resistance is and how it quietly drives weight gain, cravings, and fatigue. In Part 2, we looked at why it’s so often missed in the UK — and how metabolic surgery can transform the way the body handles insulin.

Now let’s bring it all together. What can you do if insulin resistance is still affecting you after bariatric surgery?

Lifestyle Strategies That Support Insulin Sensitivity

Insulin resistance isn’t only about surgery or medication. Daily habits can make a huge difference:

• Avoid constant grazing: every snack triggers insulin. Building in gaps between meals allows insulin levels to fall.

• Protein first: prioritising protein at meals reduces cravings and keeps blood sugar stable.

• Choose balanced carbs: whole grains, vegetables, beans, and fibre-rich foods support steadier glucose control.

• Move after meals: even a short walk can help muscles soak up sugar more efficiently.

• Protect sleep and reduce stress: poor sleep and chronic stress both worsen insulin resistance.

These aren’t about perfection — small, consistent changes help reset metabolism over time.

Medical Options

Sometimes lifestyle isn’t enough on its own. Medications can play a role:

• Metformin: lowers glucose production in the liver and improves insulin sensitivity.

• GLP-1 medications (like semaglutide or tirzepatide): mimic natural gut hormones that reduce appetite and improve insulin response.

These tools can help, but they often work best as part of a bigger plan. For many people, especially after surgery, they may only be a stepping stone.

Why Surgery Can Be the Strongest Reset

Bariatric surgery is often called metabolic surgery for a reason. It doesn’t just reduce food intake — it changes the hormones that control hunger, satiety, and insulin function.

• Gastric sleeve: effective for weight loss, but primarily restrictive. Some patients continue to struggle with insulin resistance.

• Roux-en-Y bypass: stronger hormonal effects, often leading to better remission of diabetes.

• Mini Gastric Bypass (MGB): increasingly recognised as one of the most powerful procedures for improving insulin sensitivity.

For patients who’ve had a sleeve and still face cravings, grazing, or a stubborn HbA1c, revision to MGB can act as a true metabolic reset.

This Isn’t About Failure

If you’ve worked hard after sleeve surgery but still feel stuck, it doesn’t mean you’ve failed. It means your biology is still pushing back. Matching the right treatment to the right physiology is the key.

Surgery is not a punishment — it’s one of the most effective treatments for insulin resistance available worldwide.

Putting It All Together

Insulin resistance is common, but it isn’t destiny. With the right mix of lifestyle changes, medical support, and — where needed — surgery, it is possible to reduce cravings, restore energy, and improve long-term health.

This 3-part series has shown:

• Part 1: Insulin resistance explained.

• Part 2: Why it’s often missed, and how metabolic surgery changes the game.

• Part 3: Practical steps to manage and treat it, including the role of MGB for ongoing cases.