Why You Should Ask Your Doctor for a Fasting Insulin Test (and Calculate Your HOMA-IR) Today

Most people only discover they have a problem with blood sugar when their HbA1c creeps up or their fasting glucose finally crosses the “diabetes” line. By that time, the disease process has usually been quietly brewing for 10–20 years.

There is a far better, earlier, and almost completely ignored marker: insulin resistance, measured by the HOMA-IR score.

What is HOMA-IR and why does it matter?

HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) is a simple calculation that uses your fasting glucose and fasting insulin levels:

HOMA-IR = (fasting glucose in mg/dL × fasting insulin in μU/mL) ÷ 405
(or if glucose is in mmol/L: glucose × insulin ÷ 22.5)

It tells you how hard your pancreas is working to keep your blood sugar normal.

• Optimal: < 1.0
• Early insulin resistance: 1.0 – 1.9
• Significant insulin resistance: 2.0 – 3.0
• Severe: > 3.0 (some labs flag anything > 2.0)

When HOMA-IR is high, your cells are ignoring insulin’s signal. To compensate, your pancreas pumps out more and more insulin. This excess insulin drives fat storage (especially dangerous visceral fat), inflammation, high blood pressure, fatty liver, PCOS, gout, and even Alzheimer’s disease (now often called “type 3 diabetes”).

The scary part? You can have a perfectly normal HbA1c (even 4.9%) and still have a HOMA-IR of 4.0 or higher — meaning the train left the station years ago.

What the research says

• A 2023 meta-analysis showed that every 1-unit increase in HOMA-IR raises the risk of developing type 2 diabetes by 92% over the next decade.
• Elevated fasting insulin predicts heart attack risk better than LDL cholesterol in many studies.
• In young, seemingly healthy adults, HOMA-IR > 2.0 is already associated with early atherosclerosis on carotid ultrasound.
• People with Alzheimer’s have significantly higher HOMA-IR scores than age-matched controls — even when blood sugar is normal.

Why isn’t every doctor ordering fasting insulin?

1. It’s not in most standard lab panels.
2. Insurance often doesn’t cover it unless you already have diabetes.
3. Medical training still teaches: “If HbA1c and fasting glucose are normal, everything is fine.”
4. Big Pharma makes far more money treating end-stage diabetes than preventing it.

Real-world examples I’ve seen in clinical practice

• 38-year-old software engineer: BMI 26, HbA1c 5.2%, fasting glucose 89 mg/dL → fasting insulin 22 → HOMA-IR 4.8 → reversed to 0.9 in 6 months with low-carb diet and strength training.
• 45-year-old woman with “normal” labs but fatigue and weight-loss resistance → HOMA-IR 5.6 → diagnosed PCOS after years of being dismissed.
• 62-year-old man told he was “perfectly healthy” → HOMA-IR 6.2 → coronary calcium score of 680 (severe plaque).

All of them had normal glucose and HbA1c.

How to get the test

Ask your doctor for:

• Fasting insulin (NOT random)
• Fasting glucose (usually already done)

Then calculate HOMA-IR yourself or use an online calculator.

If your doctor refuses or says “we don’t do that,” consider a direct-to-consumer lab (e.g., Ulta Lab Tests, Walk-In Lab, or Marek Health in the US). The test costs $30–60 out of pocket.

Target fasting insulin < 9 μU/mL (ideally < 5) and HOMA-IR < 1.0.

The bottom line

HbA1c is like the fire alarm going off after your house is already in flames.
HOMA-IR is the smoke detector that warns you years earlier.

Insulin resistance is reversible in almost everyone if caught early — with diet, exercise, sleep, and sometimes targeted supplements or medications.

Don’t wait for the diabetes diagnosis. Test your fasting insulin today. Your future brain, heart, and waistline will thank you.

P.S. Share this with anyone who has been told “your labs are normal” but still can’t lose weight or feels tired all the time. Normal glucose ≠ metabolic health.

— Dr. Suneel Dhand & thousands of other prevention-focused physicians