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How to Test for Insulin Resistance (HOMA Score Tutorial)

homa score insulin resistance Jun 17, 2021

Note: Reshape Physical Therapy and Wellness evolved into Weight Loss for Health, and finally Zivli. How to Lose Weight After 50 was our first course that eventually grew into Zivli. Some old blog posts or resources mentioned in this episode may have been removed.

Since the time of this recording, we have now partnered with a lab to offer at home insulin resistance testing. Click here for more details.

Do you know if you have insulin resistance? Learn how to test for insulin resistance by finding your HOMA Score with this tutorial. 88% of adults have some degree of insulin resistance and most don’t know about it. If you have type 2 diabetes or prediabetes, you have insulin resistance - the question is to what degree.

Knowing how resistant you are to insulin can be a very important marker for your health status, and motivating to track along your health journey.

How to Reverse Insulin Resistance

Living a low insulin lifestyle is the best, most effective way to lose weight, get healthy, and prevent disease. I truly believe that testing insulin resistance will be the new gold standard for predictive medicine in the future because it’s at the root cause level for so many diseases like type 2 diabetes, heart disease, dementia, and arthritis.

Even if you’re at a healthy weight, you may have insulin resistance and not know it - remember that it’s present in up to 88% of adults.

The scale certainly doesn’t tell the whole story, and in fact I believe a number on the scale is one of the lowest value indicators for your health.

To the degree in which you accept responsibility for your health, you can expect to get results. It’s going to take time. It’s going to take patience. It’s going to take focus and consistent effort. There’s no quick fix here. It probably took you a long time to develop unhealthy habits, and those grooves are deep in your brain.

Give yourself plenty of patience and grace on your journey to better health. Remember you have a lifetime to get healthy, and you need to stay healthy for the rest of your life.

Click here to download a free masterclass that tells you how to reverse insulin resistance and lower your inflammation.

What is Insulin?

Insulin is a hormone made by your pancreas. (Unless you have type 1 diabetes, then your pancreas doesn’t make it and you have to inject it.)

While insulin is best known for regulating our blood glucose, every cell in the body has receptors for insulin. This is unheard of for hormones that typically only affect a couple organs. Insulin can affect them all.

The specific effect insulin has will depend on the cell. Here’s a picture from the book Why We Get Sick by Dr. Ben Bikman describes the many roles insulin can play in the body. If you haven’t yet, definitely check out my episode where I got to interview Dr. Bikman and get some great little-known tips to reduce insulin.

What is Insulin Resistance?

Insulin resistance is when the body becomes resistant to the effect of insulin. It’s easy to compare this to something we’re more familiar with like alcohol or antibiotic resistance.

An alcoholic used to feel a buzz after two drinks, but as time goes on, their body becomes resistant to the effects of alcohol. So more and more of the same substance is required to get the same buzz.

Let’s compare that to a carboholic. The constant spike in blood glucose from eating high carb and sugar foods requires the body to constantly release insulin to allow that blood glucose to move out of the bloodstream and into the cells to be used or stored.

Over time, the body became resistant to insulin so more and more is needed to have the same effect for normal blood sugar levels.

Eventually, the body’s cells will become so insulin resistant, the glucose has a hard time getting into the cells and stays in the blood - leading to the classic high blood sugar common to prediabetes and type 2 diabetes.

For the record, these types of diabetes are insulin resistance. If you have prediabetes or diabetes, you have insulin resistance - the only question is to what degree.

Once you dive down the insulin resistance rabbit hole, you’ll see that insulin resistance is at the center for so many conditions including but not limited to diabetes, dementia, heart disease, liver disease, arthritis, and so many more.

How to Test for Insulin Resistance Using Fasting Insulin

So how do we test for it? Unfortunately, unlike blood glucose, there’s not a simple finger prick solution to check your insulin at home. Researchers are actively developing that technology, but it isn’t available yet.

Nevertheless, you do have some options. And these options will vary based on your geographical location and what’s available in your area.

First, you can request an insulin blood test from your physician. Often the test will be covered by your insurance, but not always (and this is sometimes why the physician may be reluctant to order the test).

If insurance won’t cover the expense, your physician’s office can tell you how expensive the test will be, but it is usually under $100 in the United States.

If your insurance won’t cover the insulin test or you don’t want to wait for a clinic visit, you can simply request a test on your own.

Companies like walkinlab.com and labtestsonline.org offer insulin testing.

These companies partner with local blood testing services to request the test directly. All you do is go into your local lab, have blood drawn, and the company sends you the results. The test costs around 30 to 60 US dollars.

What Are Normal Fasting Insulin Levels?

Unfortunately, because the focus has been on glucose for so long, there is not a wide consensus on insulin levels. Ideally, your blood insulin levels should be less than ~6 microunits per milliliter of blood (µU/mL).

While ~8–9 microunits per milliliter is the average for men and women, it’s not good to be “average” in this case. According to Dr. Bikman in Why We Get Sick, a person with 8 microunits per milliliter has double the risk of developing type 2 diabetes as a person with 5 microunits per milliliter.

How to Test for Insulin Resistance With a HOMA Score

If you can only get fasting insulin, try to get your blood glucose measured at the same time so you can measure your homeostatic model assessment, or HOMA score.

Your HOMA score is a formula that considers both fasting glucose and fasting insulin. It’s more helpful than fasting insulin alone to determine your insulin sensitivity.

Insulin sensitivity has an inverse relationship to insulin resistance. Insulin sensitivity is essentially how sensitive your cells are to insulin.

The more insulin sensitive you are, the less insulin resistant you are. The less insulin sensitive you are, the more insulin resistant you are.

Here’s the equation to determine your HOMA score.

In the US: [Glucose (mg/dL) × Insulin (µIU/mL)] / 405
For most other countries: [Glucose (mmol/L) × Insulin (µIU/mL)] / 22.5

There’s no consensus yet, but according to Dr. Bikman’s book a value over 1.5 indicates insulin resistance, and above 3 usually means you’re on the edge of having type 2 diabetes. Unfortunately, even fasting insulin may have some limitations.

How to Test for Insulin Resistance With an Insulin Response to Glucose Test

There are some people whose fasting insulin may be normal, yet their insulin response to dietary glucose isn’t.

To test this, you’ll need to work with a healthcare professional or research lab. You drink a small cup of 75 grams of pure glucose and immediately get your blood drawn every 30 minutes for two hours.

There are a couple ways to assess insulin resistance with this method. The numbers I’m sharing with you here come from Dr. Bikman’s book Why We Get Sick.

If your insulin peaks at 30 minutes and steadily comes down, you’re likely insulin sensitive which is good.
If your insulin peaks at 60 minutes, rather than 30 minutes, you’re probably insulin resistant and your likelihood of getting type 2 diabetes later in life is five times higher than normal, so you’re in the caution range.
If your insulin progressively climbs and peaks at 120 minutes, you’re most certainly insulin resistant and you’re almost 15 times more likely to get type 2 diabetes, so Dr. Bikman classifies this as the Trouble range.

How to Know if You’re Becoming More Insulin Sensitive

One way to know if you’re becoming more sensitive to insulin if you have type 2 diabetes, is to check and see how your blood sugar levels are responding to your normal medications. Wearing a continuous glucose monitor can be helpful here.

If you have type 2 diabetes and you’ve been prescribed insulin, you can also track your daily insulin dose as a sign of changes. If, after making some lifestyle choices, your normal insulin dose is resulting in lower than typical blood glucose levels, that means your regular insulin dose has become too high because you’re becoming more sensitive to insulin.

Your blood glucose can change very quickly once you start changing your diet. And if you’re not monitoring your glucose, and altering your blood glucose lowering medications, you could overshoot and cause hypoglycemia where your blood sugars get too low.

Signs of Hypoglycemia

Signs of low blood sugar are lethargy, confusion, irritability, unsteadiness, fatigue, sweating, slurred speech, anxiety, and blurred vision. Again, this is a very serious condition and can be scary if you’ve never seen it before.

So if you or your loved one has diabetes, you need to know about hypoglycemia, and know how to use a glucometer to check for it in case you think they are experiencing hypoglycemia. It’s easy to fix with some quickly digesting sugar like juice or glucose tablets.

There is no specific cutoff that defines hypoglycemia, as there is considerable variability in the glucose level at which a person will experience symptoms of hypoglycemia. It depends on what their normal blood glucose levels are. Technically hypoglycemia is described as 70 milligrams per deciliter, but again highly individualized.

Other Signs of Insulin Resistance

If you can’t easily measure your insulin but want to know if you have insulin resistance, you can guesstimate your risk by looking at other risk factors that I talked about in this episode. Just having one or two is a good sign you have insulin resistance.

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