Insulin Resistance Test: Risk Screener With a HOMA-IR Lab Path
- Screener
- About 4 min
- Original items informed by the harmonized metabolic syndrome criteria and ADA prediabetes ranges
- Runs in your browser, nothing is sent
- Medical review: Medical review pending
What this screener separates
Insulin resistance has no single symptom. It shows up as a cluster: where weight sits, how you feel after meals, a few routine lab values, and a family or pregnancy history. Scoring the four groups apart tells you which part of the picture is already visible and which part only a blood test can fill in.
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16
Risk score
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4
Where the signals sit
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+
The lab path
How this compares with a typical online quiz
| Feature | Typical free quiz | Regenerated.com |
|---|---|---|
| Items state a time window | Rarely | Yes, each question names a period |
| Factors sourced | No | Harmonized metabolic syndrome criteria, ADA Standards of Care |
| Breakdown by group | No | Body signs, daily patterns, lab markers, history |
| Lab test explained with ranges | Vague | HOMA-IR, with the cut-off spread stated |
| Units for US and SI labs | One or the other | mg/dL and mmol/L on every lab item |
| Answers sent to a server | Often | Never; scored in your browser, counts-only events |
The lab path: HOMA-IR, fasting insulin and what the numbers mean
The most accessible blood measure of insulin resistance is the homeostasis model assessment, HOMA-IR, published by Matthews and colleagues in 1985. It multiplies fasting glucose in mg/dL by fasting insulin in uU/mL and divides by 405 (the same as glucose in mmol/L times insulin divided by 22.5). A healthy young adult in the original model scores about 1.0. Fasting glucose 90 mg/dL with insulin 10 uU/mL gives 90 x 10 / 405 = 2.22. You need both values from the same fasting draw; a standard metabolic panel includes glucose but insulin has to be requested.
There is no single agreed cut-off. A population study in Spanish adults (Gayoso-Diz and colleagues, 2013) placed the threshold near 1.85 in men and 2.07 in women at age 50, US research using NHANES data often uses 2.5 or higher, and clinical and research settings in the US use values between 2.0 and 3.0. The educational reading used on this site, and on the HOMA-IR calculator linked below, is: below 1.0 very insulin sensitive, 1.0 to 1.9 typical, 1.9 to 2.9 early insulin resistance worth tracking, 2.9 and above significant insulin resistance that deserves a clinician's attention. Reference ranges differ between laboratories, insulin assays differ more than glucose assays, and a single draw after a poor night or a late meal can mislead, so two readings beat one.
Two related numbers help. An A1C of 5.7 to 6.4 percent or a fasting glucose of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is the American Diabetes Association's prediabetes range, which usually arrives years after insulin resistance begins because the pancreas compensates by making more insulin. A fasting insulin above about 10 to 15 uU/mL with a normal glucose is the earlier signal that compensation is under way. The triglyceride to HDL ratio from a standard lipid panel is a rough proxy when insulin was not measured: a ratio above about 3 (in mg/dL) tracks with insulin resistance in many studies, though less reliably in Black adults.
Why symptoms lag the biology by years
Insulin resistance means muscle, liver and fat cells respond less to insulin, so the pancreas releases more of it to keep glucose in range. For a long time this works: fasting glucose stays normal while insulin climbs. The Whitehall II cohort (Tabak and colleagues, 2009) found that fasting glucose in people who went on to develop type 2 diabetes tracked only slightly above that of people who did not for a decade, then rose steeply in the three to six years before diagnosis. The hidden phase is where the questions on this page point.
The CDC's National Diabetes Statistics Report estimates that 97.6 million US adults, 38 percent, had prediabetes in the most recent survey years, and that only about one in five had been told so. The factors in this screener (a waist over 40 inches in men or 35 in women, triglycerides at or above 150 mg/dL, HDL under 40 in men or 50 in women, blood pressure at or above 130/85, fasting glucose at or above 100 mg/dL) are the five components of the harmonized metabolic syndrome definition (Alberti and colleagues, 2009); three of the five define the syndrome, and insulin resistance is the common thread.
The hopeful part is well established. In the Diabetes Prevention Program (Knowler and colleagues, 2002), adults with prediabetes who lost about 7 percent of body weight through diet and 150 minutes a week of activity cut their progression to type 2 diabetes by 58 percent over three years, more than metformin did. Insulin sensitivity improves within weeks of regular exercise, before much weight changes, which is why the next steps on this page start with movement, sleep and the labs rather than with any product.
Methodology and sources
This screener is made of original items informed by the risk factors in the harmonized definition of the metabolic syndrome (Alberti and colleagues, Circulation 2009), the American Diabetes Association's Standards of Care prediabetes ranges, and the clinical features associated with insulin resistance (acanthosis nigricans, skin tags, polycystic ovary syndrome, gestational diabetes, fatty liver). Each item asks about something concrete in a stated window: a waist measurement in the past month, a lab value in the past three years, a pattern after meals in the past month. The items are not taken from any licensed questionnaire; the one published instrument the page names, HOMA-IR, is a laboratory formula, and it is implemented on its own calculator because a questionnaire cannot take a lab value.
Scoring is one point per yes, for a total of 0 to 16, with four groups of four: body signs, daily patterns, lab markers and medical history. The bands (0 to 2, 3 to 5, 6 to 9, 10 to 16) are educational groupings chosen for orientation; they have not been validated against measured insulin resistance, and a score here does not estimate a HOMA-IR value or a probability of prediabetes. The breakdown matters more than the total: lab markers already in hand mean a clinician can act on numbers, while body signs and history without labs mean the fasting insulin and glucose draw is the obvious next step.
Insulin resistance is a clinical and laboratory assessment made by a clinician. This page organizes what you have measured, noticed and been told so that conversation is shorter and better targeted. Reference ranges differ between laboratories, and two fasting readings on separate days are more informative than one.
Medical review: Medical review pending. Last updated .
References
- Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-419.
- Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-1645.
- American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes 2024. Diabetes Care. 2024;47(Suppl 1):S20-S42.
- Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez MX, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013;13:47.
- Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.