HOMA-IR

HOMA-IR stands for "Homeostatic Model Assessment for Insulin Resistance".

- Less than 1 means you are insulin-sensitive (Optiomal)

- Greater than 1.9 indicates early insulin resistance.

- Greater than 2.9 indicates significant insulin resistance.

Insulin, a hormone secreted by your pancreas, helps the body use glucose for fuel. When the body becomes insulin resistant, the pancreas will increase its production of insulin to compensate, but increased levels of insulin can damage your overall health and make it very difficult to lose weight.

If insulin resistance is left untreated, it can lead to the development of pre-diabetes, Type 2 diabetes mellitus or other metabolic conditions, like heart disease and fatty liver disease.

Why take the HOMA-IR test?

When insulin resistance is identified early, it can be reversed. Using the HOMA-IR to identify subtle insulin resistance, even before it is evident in more traditional screening measures like hemoglobin HA1c (HA1c) and fasting blood sugar.

The HOMA-IR tool is a validated, non-invasive tool to assess the relationship between glucose and insulin. If elevated, it can guide you to make diet and lifestyle changes that will bring your HOMA-IR score down into the insulin-sensitive range, lose weight, and improve your health.

HOMA-IR and CVD:

HOMA-IR is an independent predictor of CVD in type 2 diabetes. The improvement of insulin resistance might have beneficial effects not only on glucose control but also on CVD in patients with type 2 diabetes.

What is insulin resistance?

Insulin is a hormone produced by β-cells (beta-cells) in the pancreas, an organ found in the upper part of your abdomen. Insulin regulates the sugar level in the blood and is secreted when the blood sugar level is high (e.g., after a meal). It works like a door-opening key – by interacting with specialized receptors in the cell membrane, it makes glucose move into fat, skeletal muscle, and liver cells. This results in the following:

a) The cell receiving a source of energy; and,

b) The blood sugar level is lowered.

Insulin resistance is when cells do not react to the insulin delivered to them via the blood. The causes are numerous. Sometimes there's a problem with a receptor. Sometimes, it's an issue with the signaling pathway. To make up for ineffective insulin, the pancreas produces more of it. As long as the amount of insulin available to the cell is sufficient to compensate for its weak response, blood sugar levels will stay in the normal range.

The pancreas usually cannot maintain this state of increased insulin production for long. When this happens, there will be a lot of insulin and sugar in the blood, as they cannot be 'consumed' by the cells. Persistent hyperglycemia- high blood sugar level – has very well-known harmful effects, such as diabetes and an increased risk of cardiovascular disease.

What are some insulin resistance symptoms? The answer is there isn't any until it's too late, as you don't really feel insulin resistance. This is the same as hyperglycemia, where you don't really feel it until it damages your organs or is high enough to give you acidosis.

What is insulin resistance – is it a separate disease? Well, while we address it like an illness – there are drugs and interventions – it's more a state that precedes more severe metabolic disorders, such as diabetes. It's also usually paired with other cardiovascular risk factors, like obesity, lack of physical activity, high blood pressure, and hyperlipidemia. Early intervention and following the doctor's orders are key to saving yourself from serious consequences, such as blindness or kidney failure.

What markes are needed to calculate the HOMA-IR?

Plasma insulin and glucose levels drawn after an overnight fast.

What is the mathematical formula to calculate HOMA-IR:

Glucose (mg/dl) x Insulin mIU/L // (divided by) 405

Glucose (mmol/l) x Insulin mIU/l // (divided by) 22.4

References:

Enzo Bonora, Gianni Formentini, Francesco Calcaterra, Simonetta Lombardi, Franco Marini, Luciano Zenari, Francesca Saggiani, Maurizio Poli, Sandro Perbellini, Andrea Raffaelli, Vittorio Cacciatori, Lorenza Santi, Giovanni Targher, Riccardo Bonadonna, Michele Muggeo; HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects: Prospective data from the Verona Diabetes Complications Study. Diabetes Care 1 July 2002; 25 (7): 1135–1141. https://doi.org/10.2337/diacare.25.7.1135