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HOMA-IR (Using Insulin)

Diabetes
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Report in 4Hrs

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Fasting Required

Details

Estimates insulin resistance.

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HOMA-IR (Using Insulin) - Comprehensive Medical Test Guide

  • Why is it done?
    • Measures insulin resistance - the degree to which cells fail to respond appropriately to insulin, leading to elevated fasting insulin and glucose levels
    • Screen for prediabetes and type 2 diabetes risk in asymptomatic individuals with risk factors
    • Assess metabolic syndrome components, particularly in patients with obesity, hypertension, or dyslipidemia
    • Evaluate polycystic ovary syndrome (PCOS) and other conditions associated with insulin resistance
    • Monitor efficacy of interventions aimed at improving insulin sensitivity in diabetic patients
    • Assess cardiovascular risk, as insulin resistance is associated with increased risk of heart disease and stroke
    • Typically performed during routine physical examinations, metabolic workups, or when investigating causes of obesity or glucose abnormalities
  • Normal Range
    • HOMA-IR Score: < 2.0 is considered normal (typical range: 0.5 - 2.0)
    • Fasting Insulin: 2 - 12 mIU/L or 10 - 70 pmol/L (laboratory-dependent)
    • Fasting Glucose: 70 - 100 mg/dL or 3.9 - 5.6 mmol/L
    • Interpretation: HOMA-IR < 2.0 indicates normal insulin sensitivity; values between 2.0 - 2.9 suggest borderline insulin resistance; HOMA-IR ≥ 3.0 indicates significant insulin resistance
    • Reference Ranges Vary: Reference ranges may differ by laboratory, ethnicity, and population characteristics; always compare results to the specific lab's reference range
  • Interpretation
    • HOMA-IR < 1.0: Excellent insulin sensitivity; low risk of developing type 2 diabetes
    • HOMA-IR 1.0 - 2.0: Normal range indicating adequate insulin sensitivity; minimal metabolic dysfunction
    • HOMA-IR 2.0 - 2.9: Borderline insulin resistance; increased risk for metabolic syndrome and prediabetes; recommend lifestyle modifications
    • HOMA-IR ≥ 3.0: Significant insulin resistance; high risk for prediabetes, type 2 diabetes, and cardiovascular disease; warrants clinical intervention
    • Factors Affecting Results: Obesity, physical inactivity, diet high in refined carbohydrates, medications (corticosteroids, antipsychotics), sleep disorders, stress, inflammation, and hepatic steatosis can elevate HOMA-IR
    • Clinical Significance: HOMA-IR provides a simple, non-invasive assessment of insulin resistance; correlates with more sophisticated clamp studies; helps predict future diabetes risk and guides therapeutic decisions
    • Limitations: Not suitable in type 1 diabetes, advanced renal disease, or when beta-cell function is severely impaired; may overestimate or underestimate insulin resistance in certain populations
  • Associated Organs
    • Primary Organs Involved: Pancreas (insulin production), liver (glucose metabolism and insulin clearance), skeletal muscle (glucose uptake), adipose tissue (insulin signaling)
    • Conditions Associated with Elevated HOMA-IR:
    • Type 2 diabetes mellitus
    • Prediabetes (impaired fasting glucose or impaired glucose tolerance)
    • Metabolic syndrome
    • Polycystic ovary syndrome (PCOS)
    • Nonalcoholic fatty liver disease (NAFLD)
    • Obesity
    • Hypertension
    • Dyslipidemia
    • Cardiovascular disease and atherosclerosis
    • Potential Complications: Chronic hyperinsulinemia contributes to pancreatitis, endothelial dysfunction, atherosclerosis, renal disease, neuropathy, retinopathy, and increased cancer risk
  • Follow-up Tests
    • If HOMA-IR is Elevated:
    • Fasting glucose and 2-hour glucose tolerance test (OGTT) to assess glucose homeostasis
    • Hemoglobin A1C to evaluate long-term glucose control
    • Lipid panel to screen for dyslipidemia associated with metabolic syndrome
    • Blood pressure measurement to assess hypertension
    • Liver function tests (AST, ALT, gamma-GT) to screen for fatty liver disease
    • Renal function tests (creatinine, eGFR) to assess kidney involvement
    • C-reactive protein (CRP) to assess chronic inflammation
    • Testosterone and other hormonal studies in women suspected of PCOS
    • Abdominal ultrasound or FibroScan to assess hepatic steatosis
    • Monitoring Frequency: Repeat HOMA-IR testing every 6-12 months in patients with elevated baseline values to track response to lifestyle changes or medications
    • Related Complementary Tests: QUICKI (Quantitative Insulin Sensitivity Check Index), Matsuda index, and euglycemic clamp studies for more precise insulin sensitivity assessment when needed
  • Fasting Required?
    • Fasting Required: YES
    • Duration: Minimum 8 hours of fasting; preferably 10-12 hours overnight fast for optimal standardization
    • Fasting Instructions: Nothing to eat or drink except water after midnight prior to early morning blood draw; fasting must include no food, beverages (except water), candy, gum, or smoking
    • Medications to Avoid: Consult with healthcare provider regarding timing of regular medications; some medications affecting glucose and insulin metabolism should be held on the morning of testing (e.g., metformin, corticosteroids) - do NOT stop any medication without explicit instruction
    • Additional Patient Preparation: Arrive well-rested and relaxed, as stress and sleep deprivation can affect glucose and insulin levels; avoid strenuous exercise 24 hours before testing; schedule appointment early morning (ideally 7-9 AM) when insulin resistance is most pronounced
    • Specimen Collection: Blood samples drawn via venipuncture into appropriate separator tubes; samples should be processed and separated within 1 hour; serum stored appropriately until analysis to prevent degradation of insulin

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