Blood WorkThere's no single standard test for insulin resistance. Clinicians look at fasting glucose, A1c, triglycerides and HDL cholesterol, and can add a fasting insulin test to calculate HOMA-IR, an estimate of how hard your body works to keep blood sugar normal. At Passion Health, Essential Blood Work ($59) plus fasting insulin ($30) checks all of these for $89.
What to know about insulin resistance
Insulin moves sugar from your blood into your cells. With insulin resistance, cells respond less, so your pancreas makes more insulin to keep blood sugar normal. That can work for years, which is why blood sugar tests can look fine while insulin runs high.
Over time insulin resistance can lead to prediabetes and type 2 diabetes, and it travels with fatty liver, high triglycerides, high blood pressure, polycystic ovary syndrome (PCOS) and sleep apnea. Clues include weight around the waist and dark, velvety skin on the neck or armpits (acanthosis nigricans).
Who should get tested?
- Overweight, especially around the waist.
- A parent, brother or sister with type 2 diabetes.
- PCOS, or diabetes during a past pregnancy.
- Fatty liver, high triglycerides, low HDL or high blood pressure.
- Age 35 or older: the American Diabetes Association recommends testing everyone for prediabetes from 35.
People of Asian descent develop diabetes at a lower weight, so the ADA suggests testing them from a BMI of 23 instead of 25. Black, Hispanic, Native American and Pacific Islander ancestry also counts as a risk factor.
Which tests check for insulin resistance?
| Test | What it shows | Where it's included |
|---|---|---|
| Hemoglobin A1c | Your average blood sugar over about three months. 5.7% to 6.4% is prediabetes. | Essential $59, Diabetes & Kidney $69, Full Blood Work $149. Alone $20. |
| Fasting glucose | Blood sugar after 8 to 12 hours without food. 100 to 125 mg/dL is prediabetes. | The metabolic panel in the same panels. Alone $20. |
| Triglycerides and HDL | High triglycerides with low HDL is a common pattern in insulin resistance. | Essential $59. Cholesterol panel alone $25. |
| Fasting insulin and HOMA-IR | Fasting insulin shows how hard your pancreas is working; HOMA-IR combines it with fasting glucose. | Fasting insulin $30, added to any panel with no extra fee. HOMA-IR is calculated. |
| ALT | A liver enzyme that can rise with fatty liver, which often comes with insulin resistance, though it's often normal. See fatty liver care. | The metabolic panel. |
HOMA-IR = fasting glucose (mg/dL) × fasting insulin (µIU/mL) ÷ 405.
What your results mean
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| A1c | Under 5.7% | 5.7% to 6.4% | 6.5% or higher, confirmed with a repeat test |
| Fasting glucose | Under 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher, confirmed with a repeat test |
HOMA-IR has no agreed cutoff. Many studies treat values above about 2.5 as insulin resistance, but results vary by lab and population, which is one reason guidelines don't use it to diagnose anything. It's most useful for tracking change over time, measured at the same lab.
What these tests can't tell you
Insulin resistance isn't a diagnosis with an agreed cutoff; prediabetes and diabetes are. These tests also can't tell type 1 from type 2 diabetes, which needs antibody tests, and a normal fasting insulin doesn't cancel out risk when your A1c or family history says otherwise.
If your results are off at Passion Health
A Texas-licensed clinician reviews every result. If you show signs of insulin resistance or prediabetes, we:
- go over your results with your weight, waist, blood pressure and family history;
- build a plan around food, activity, sleep and weight, with a Passion Health dietitian or our WeightCare program when you want help;
- consider metformin for prediabetes when guidelines support it;
- recheck A1c, and fasting insulin if it helped, in 3 to 6 months to see the change.
Lifestyle change works: in the Diabetes Prevention Program, losing about 7% of body weight and walking 150 minutes a week cut the chance of developing type 2 diabetes by 58%.
Care online: prediabetes, WeightCare medical weight loss, PCOS and fatty liver.
Insulin resistance test cost in Texas
Self-pay. Essential Blood Work ($59) plus fasting insulin ($30) is $89 and covers A1c, fasting glucose, cholesterol, liver enzymes and HOMA-IR, with the draw and a clinician's review. If you also want your kidneys checked, the Diabetes & Kidney Panel plus fasting insulin is $99. Fasting insulin on its own is $30 plus the $29 draw and review fee, but HOMA-IR also needs a fasting glucose.
With insurance. If we're in network with your plan, we bill it when the test is covered. You pay cash for a test only after we tell you the price in writing, and Medicare patients sign an Advance Beneficiary Notice first.
Insulin resistance test questions
What is the best test for insulin resistance?
There isn't one standard test. A1c, fasting glucose, triglycerides and HDL together give the clearest picture, and fasting insulin with HOMA-IR adds an estimate of how hard your body is working to keep blood sugar normal.
Why don't doctors order fasting insulin tests?
Insulin tests aren't standardized between labs, there's no agreed normal range, and the first steps of treatment are the same either way. Fasting insulin is still useful when your A1c and glucose look normal but your risk is high, or to track how you respond to changes.
Is insulin resistance the same as prediabetes?
No. Insulin resistance usually comes first and can last years with normal blood sugar. Prediabetes means blood sugar has started to rise: an A1c of 5.7% to 6.4% or a fasting glucose of 100 to 125 mg/dL.
Do I need to fast for an insulin resistance test?
Yes. Fasting insulin, fasting glucose and HOMA-IR only mean something after 8 to 12 hours without food or drinks other than water. Take your usual medicines unless your clinician says otherwise.
Can insulin resistance be reversed?
It often improves a lot. Losing 5% to 7% of body weight, staying active and sleeping well all make cells more sensitive to insulin. In the Diabetes Prevention Program, lifestyle change cut the risk of type 2 diabetes by 58%.