Insulin Resistance - calculation and ranges

[LittleGreyCat]

I recently (December) had a test for insulin resistance.

These are the results: (apologies for the '.' needed for spacing)

"
.........................................................Result......................................Normal Range
FASTING BLOOD GLUCOSE...........* 7.94 mmol/L.......................3.50-5.80
INSULIN............................................. 7.17mIU/L............................2.6-24.9
F INSULIN RESISTANCE INDEX .....* 2.28......................................0.00-1.00
"
I've searched, and I think the calculation used is the HOMA-IR calculation.

For example, in http://gihep.com/calculators/other/homa-ir-molar-units/ or in https://www.thebloodcode.com/homa-ir-calculator/ (where you have to fiddle the results to match US numbers).

Now the formula seems to agree for SI numbers; "Fasting insulin x Fasting glucose / 22.5".

However one says:
"Healthy Range: 1.0 (0.5–1.4)
Less than 1.0 means you are insulin-sensitive which is optimal.
Above 1.9 indicates early insulin resistance.
Above 2.9 indicates significant insulin resistance."

and the other says:
"
Explanation of Result :

Category HOMA Score
Normal insulin resistance < 3
Moderate insulin resistance Between 3 and 5
Severe insulin resistance >5
"

My results as posted show 2.28.
My calculation using the formula comes out at 2.53.

So I am in general quite confused (not unusual) because my calculation doesn't quite match the results and different sites show different values for being diagnosed with IR.

Perhaps it is the wording; I seem to have mild or early insulin resistance but not moderate, significant or severe.

A value of 5 for FBG and 5 for Insulin seems to give a result of 1.1 (just speculating because my Insulin and FBG readings are similar numbers).

Noting that my FBG reading was quite a bit higher than expected, so I don't know if I was liver dumping by the time of the test. I would normally expect between 5 and 6. Foolishly I didn't do a finger prick at the time of the test.

Anyway, does anyone else have results to share?
Does anyone else have better information on the HOMA-IR test and expected results?

 

[ickihun]

I think your results have accounted of everything a type2 experience day in day out.

I too agree fbg should have liver dump included.

I can tell you are still overweight based on your insulin resistance result even thou the fact I'm guessing you are eating low carb.
If not your on gliclizide or small doses of insulin a similar drug to increase insulin manufacture and good diet.
But I could be wrong?

..see what I did? The same as all doctors without these test results. Guessed!

Do you feel happier now you have the full facts?

 

[bulkbiker]

Where did you get your test done? I did have a calculator that I used when I had my fasting insulin checked but I can't find it now which is annoying.
I have tried various other but also can't get your 2.28 most seem to give 2.5 or thereabouts.

Edited by a moderator to moderate language.

 

[Bluetit1802]

Where did you get your test done? I did have a calculator that I used when I had my fasting insulin checked but I can't find it now which is bloody annoying.
I have tried various other but also can't get your 2.28 most seem to give 2.5 or thereabouts.

This is the one you gave me. It is the same one @LittleGreyCat used
http://www.thebloodcode.com/homa-ir-calculator/

 

[bulkbiker]

This is the one you gave me. It is the same one @LittleGreyCat used
http://www.thebloodcode.com/homa-ir-calculator/

Thanks for that I thought it was a hughcalc one but just realised that was for the cholesterol ratios.. I'm not having a good day...

 

[Bluetit1802]

@LittleGreyCat

When @CherryAA did some insulin resistance tests she did a lot of research, and discovered the range given for fasting insulin is far too generous at 24.9. It was calculated from the population at large and many of these folk already had some degree of insulin resistance. I think she discovered that an ideal range is under 6. So you wouldn't be far out at 7.7 - and some of that would be down to your pancreas fighting off the liver dump. Hopefully she can come along and explain.

 

[LittleGreyCat]

I think your results have accounted of everything a type2 experience day in day out.

I too agree fbg should have liver dump included.

I can tell you are still overweight based on your insulin resistance result even thou the fact I'm guessing you are eating low carb.
If not your on gliclizide or small doses of insulin a similar drug to increase insulin manufacture and good diet.
But I could be wrong?

..see what I did? The same as all doctors without these test results. Guessed!

Do you feel happier now you have the full facts?

Define overweight!

I am 6 foot tall and weighed 12 stone 2 lbs this morning. By all normal standards that is a good weight.
I am on Metformin only.
My waist measurement is still around 35.5" which is barely acceptable for a 72" tall male.

The information gives me some more context. It suggests that a push to get half a stone off may pay dividends. If I can get my fasting BG down to 5 on average then I might finally clear most of the IR.
The main lesson learned is that IR is a multiple of BG and Insulin.
Just playing with a spreadsheet shows that if my fasting BG was 5 at the time of the test, with the same insulin level I would have a HOMA-IR of 1.59. Which is very close to the healthy range. If my Insulin was a tiny bit lower (which I would expect with a FBG of 5) then my IR would be fine.

This mainly suggests that I should organise this test to go with my 6 monthly reviews.

 

[LittleGreyCat]

Where did you get your test done? I did have a calculator that I used when I had my fasting insulin checked but I can't find it now which is bloody annoying.
I have tried various other but also can't get your 2.28 most seem to give 2.5 or thereabouts.

Blood drawn at local surgery and test done at Medichecks.

 

[bulkbiker]

Blood drawn at local surgery and test done at Medichecks.

Might be worth e-mailing medichecks and asking what calculator they are using.. after all you have paid for the test so would be nice to know exactly how they work it out. I've found them to be very responsive to queries in the past although not on quite the same thing.

 

[LittleGreyCat]

https://en.wikipedia.org/wiki/Homeostatic_model_assessment has an additional calculation.

The second is a percentage estimate of Beta cell function.

With my results this comes out at 32.3%.

If this is in any way accurate then I would say that this blood test is essential to aid the understanding of the progress of T2 Diabetes.

This has made me very keen to have another test when my FBG is consistently lower.
If I only have 1/3 of my Beta Cells working then I would expect a very low Insulin level at a FBG of 5. Spreadsheet fiddling suggests Insulin of 2.5 mIU/L. So I would expect either a very low Insulin level to match my lower FBG or a higher Insulin level and a higher percentage of Beta cells estimated to be working.

I do note that 2.5 is below the lower limit for normal Insulin so I'm not really trusting that HOMA-ß calculation without a few further tests.

This does raise the thorny issue of the healthy range for Insulin. If I am fasting with a BG of, say, 4.5 then how much Insulin does my body need in my bloodstream? Either Insulin is not effective below a certain minimum concentration or the liver is constantly trickle feeding glucose into the blood stream to counteract the effect of the Insulin taking glucose out of the blood stream. I do note that there is a level of IR which is considered to be healthy, so perhaps IR is a natural thing which allows there to be a level of Insulin circulating in the blood stream without you going hypo.

Whatever, further work and tests required.

I think I have a discount voucher with Medicheck which should help with the next one.

However that would be 4 vials of blood to be taken by the phlebotomist; two for the normal tests and two for the IR. That must be at least an arm full.

 

[LittleGreyCat]

Might be worth e-mailing medichecks and asking what calculator they are using.. after all you have paid for the test so would be nice to know exactly how they work it out. I've found them to be very responsive to queries in the past although not on quite the same thing.

Yes, was considering that.
If you look at my Wikipedia link above there appears to be a HOMA2 computer model which is more recent, which may give more accurate results.
I could also ask them if they calculate an estimate of ß cell function.

 

[ickihun]

Define overweight!

I am 6 foot tall and weighed 12 stone 2 lbs this morning. By all normal standards that is a good weight.
I am on Metformin only.
My waist measurement is still around 35.5" which is barely acceptable for a 72" tall male.

The information gives me some more context. It suggests that a push to get half a stone off may pay dividends. If I can get my fasting BG down to 5 on average then I might finally clear most of the IR.
The main lesson learned is that IR is a multiple of BG and Insulin.
Just playing with a spreadsheet shows that if my fasting BG was 5 at the time of the test, with the same insulin level I would have a HOMA-IR of 1.59. Which is very close to the healthy range. If my Insulin was a tiny bit lower (which I would expect with a FBG of 5) then my IR would be fine.

This mainly suggests that I should organise this test to go with my 6 monthly reviews.

I've very interested in your findings and any further results with your conclusions.
I think what's important is you have found a method you can use to measure IR improvement, for you.

I get obsessive about numbers so this wouldn't work for me, currently. Maybe when I'm of good bmi it would be worth me being curious as you how my body is performing but not as I am today. My high levels would just depress me. A bit like my high bmi. The job is a huge one for me so adding IR huge decrease needs to that burden could be putting the nails in my coffin.
I have to do weight loss first.

From experience with weight loss comes less IR. Even in my teens. Pre-IVF and pre pregnancies.
Weight loss is the answer. Weight lost from liver, kidneys, pancreas and heart is the answer to less or no IR. Always has been.
Carbs have always been one of the main causes of fatty liver. Slim people still get fatty liver and IR but I believe it turns that slim person fatter. Maybe sometimes just inside.

I look forward to your final destination and maintenance. I'm confident your remission is very possible.

 

[CherryAA]

@LittleGreyCat

When @CherryAA did some insulin resistance tests she did a lot of research, and discovered the range given for fasting insulin is far too generous at 24.9. It was calculated from the population at large and many of these folk already had some degree of insulin resistance. I think she discovered that an ideal range is under 6. So you wouldn't be far out at 7.7 - and some of that would be down to your pancreas fighting off the liver dump. Hopefully she can come along and explain.

I did quite a lot of research into this area. basically above 8 is an indication of potential diabetes , so as on average the population is over 8, then on average the population has a tendency to be diabetic - which is hardly news.
It also seems from a trial that Prof Tim Noakes is working on ( that I am part of) that fasting insulin levels reduce over time through following an LCHF lifstyle.

Prof Noakes himself is on record as saying that in his twenties whilst running marathons he had a fasting insulin score of 40 indicating that he was already severely carb intolerant and he had not appreciated its significance at the time.

I also saw some research ( which I think related to T1 and Dr Bernstein,) where the concept was that the lower the AUC ( area under the curve) your insulin usage was, then the longer longevity - ie there are people with T1 diabetes who achieve a great age, and generally this correlates with less insulin usage - so the more tightly controlled diet is to reduce the need for insulin the longer the life span.

the concept being that if you do not have to use/ make insulin to deal with glucose spikes then that creates the lowest AUC possible.

I think if you look up Dr Mercola on the subject he also says somewhere that he believe that those who use the least insulin cumulatively over their life spans also achieve the most longevity.

 

[Tophat1900]

Yes, was considering that.
If you look at my Wikipedia link above there appears to be a HOMA2 computer model which is more recent, which may give more accurate results.
I could also ask them if they calculate an estimate of ß cell function.

This is the homa2 version, you have to download it to use it. It's what I have on my pc.

https://www.dtu.ox.ac.uk/homacalculator/

 

[Alexandra100]

It also seems from a trial that Prof Tim Noakes is working on ( that I am part of) that fasting insulin levels reduce over time through following an LCHF lifstyle.

That's very encouraging.

 

[ringi]

I think if you look up Dr Mercola on the subject he also says somewhere that he believe that those who use the least insulin cumulatively over their life spans also achieve the most longevity.

But this is clearly only the case for people who get reasonable BG control! (Longevity will not be helped by an A1C of 100 regardless of how little insulin is used. But maybe 45 will little insulin is better then 40 with a lot of insulin....)

 

[Sid Bonkers]

Define overweight!

I am 6 foot tall and weighed 12 stone 2 lbs this morning. By all normal standards that is a good weight.
I am on Metformin only.
My waist measurement is still around 35.5" which is barely acceptable for a 72" tall male.

Hi LGC, I have no knowledge of IR tests but I can tell you that you dont have to be obese to have visceral fat and it is visceral fat around our internal organs that causes insulin resistance, dieting will help to lose visceral fat and you will see your IR improve.

It was losing my insulin resistance that first got me off insulin and then the metformin as well and I now eat pretty much what I like although I still eat a low(ish) carb diet through choice and fear of going back to injecting myself 4 or 5 times a day I also eat roughly a third to a quarter of the calories I used to eat in the bad old days when I was obese.

Any reduction in visceral fat will help, I believe there are tests to test your visceral fat although like the IR tests Ive never had one so know little about them but a test will show if you have visceral fat or not.

 

[CherryAA]

But this is clearly only the case for people who get reasonable BG control! (Longevity will not be helped by an A1C of 100 regardless of how little insulin is used. But maybe 45 will little insulin is better then 40 with a lot of insulin....)

Sorry if that was misleading ! - the concept was - you NEED insulin to process foods, keep blood glucose at optimal levels and optimise Hba1C, thus the lower amount of insulin you NEED, general population, T1 or T2 the better. Everyone NEEDS insulin though for T1 it has to be an exogenous supply.