© 2020, The Author(s), under exclusive licence to Springer Nature Limited. Objective: Dietary modification of insulin resistance may be a strategy for reducing chronic disease. For this study, we tested the hypothesis that higher fasting insulin, a marker for insulin resistance, would be related to diet patterns with a high proportion of carbohydrates, those with a high glycemic index, and those characterized by added sugar and processed starches. Study design: Data were analyzed on 13,528 nondiabetic participants of the REasons for Geographic and Ethnic Differences in Stroke (REGARDS), an observational study of adults aged ≥45 years residing in 1855 counties across the continental USA. Information on habitual diet was collected using the Block 98 Food Frequency Questionnaire. Percent energy from carbohydrate, glycemic index, and glycemic load were determined for each participant, as well as adherence to five established diet patterns. Logistic regression was used to examine associations of baseline diet characteristics with odds for high fasting insulin [quartiles 3 and 4 (median = 98.9 pmol/L) vs. quartile 1], after adjusting for covariates. Result: Greater percent carbohydrate, glycemic index, and glycemic load, and adherence to sweets/fat and southern diet patterns, was associated with greater odds for high insulin (P for trend <0.05 to <0.0001), whereas adherence to the plant-based and alcohol/salad patterns was associated with lower odds for high insulin (P for linear trend <0.0001). Conclusion: In conclusion, diet pattern is associated with fasting insulin. Future studies are needed to determine if diet interventions designed to lower insulin, perhaps based on the patterns identified in this study, can improve risk for chronic disease.