Decoding Your Insulin Resistance Labs: What HOMA-IR, Fasting Insulin, and A1C Really Mean

Across the comment sections, a clear and urgent theme emerges: a deep distrust and confusion regarding standard medical testing for diabetes and metabolic health. Viewers are frustrated because their symptoms—fatigue, belly fat, cravings, brain fog—scream insulin resistance, yet their routine lab work, like fasting glucose or A1C, often comes back "normal". They sense a disconnect, realizing that these common tests are late-stage indicators, only flagging a problem after years or decades of underlying metabolic dysfunction. This gap in early detection leaves them feeling unheard by their doctors and desperately searching for better, more sensitive tests that can validate their experience and give them a head start on reversal.

The core concern is being diagnosed too late, after significant and potentially irreversible damage has occurred. Viewers worry that their doctors are missing the real story by not measuring insulin directly. They fear that relying solely on glucose levels means they are ignoring the high insulin that is silently driving inflammation, weight gain, and chronic disease for years. This leads to a profound anxiety that they are on a path to full-blown type 2 diabetes, heart disease, or even dementia, all while being told their labs look "fine".

The most powerful, actionable tip that emerges from both the experts and the audience's collective discovery is to advocate for a fasting insulin test alongside a standard fasting glucose test. These two numbers are the key. Together, they can be used to calculate a HOMA-IR score (Homeostatic Model Assessment for Insulin Resistance), which is a far more sensitive and earlier indicator of metabolic dysfunction than either glucose or A1C alone. Measuring insulin reveals how hard your body is working to maintain normal blood sugar, exposing the problem years before glucose levels become abnormal.

Several creators in the sources emphasize the importance of looking beyond standard glucose tests to get a true picture of metabolic health.

• • Dr. Pradip Jamnadas (on The Diary Of A CEO): He is a strong advocate for comprehensive testing. He advises patients to get a coronary artery calcium (CAC) score if they are over 30 to directly measure plaque buildup, a marker of atherosclerotic disease. He also recommends a detailed inflammatory panel (like the Cleveland HeartLab panel) that looks at markers like hs-CRP, IL-6, and crucially, small dense LDL particles, not just the total LDL number. He clearly states that a high fasting insulin level is a major driver of metabolic disease and that screening patients with insulin levels is a critical tool for early prevention.
• • Jessie Inchauspé (Glucose Revolution): She directly addresses the testing gap, noting that doctors typically only run fasting glucose tests. She strongly encourages viewers to ask for a fasting insulin test, explaining that insulin levels start rising for years before glucose levels become abnormal, making it a much earlier and more useful indicator of insulin resistance.
• • Dr. Sten Ekberg: He provides a clear timeline for the reversal of different markers, which helps viewers set realistic expectations. He explains that glucose changes the fastest (days to months), followed by A1C (a 3-4 month average), but that insulin and HOMA-IR are the last to normalize, taking months and often years to truly reverse because they reflect a decades-long process. This reinforces the idea that insulin is the foundational, long-term metric to track.
• • Dr. Eric Berg DC: He specifically mentions the HOMA-IR test as a way for viewers to know if their insulin resistance is improving, positioning it as a key indicator of progress.

Locate your most recent blood test results. Then, schedule an appointment with your doctor and write down this specific request: "In addition to my next fasting glucose test, I would also like to have my fasting insulin measured so we can calculate my HOMA-IR score."

• Mistake: Accepting "your glucose is normal" as the final word when you still have symptoms.
  Fix: Insist on the fasting insulin test. A normal glucose with high insulin is a classic sign of early insulin resistance.
• Mistake: Focusing only on your LDL ("bad") cholesterol number.
  Fix: Ask about advanced lipid testing that measures LDL particle size. Small, dense LDL particles are much more dangerous than large, fluffy ones, and this context is more important than the total number.
• Mistake: Waiting until you are diagnosed as "pre-diabetic" to take action.
  Fix: Use the HOMA-IR score as your early warning system. By the time your A1C hits the pre-diabetic range, your insulin has likely been high for a decade or more.

• • "So why is the gold standard for testing blood glucose for diabetes/prediabetis only using a 12 hour fast if shorter fasts can actually elevate your BG? ...according to doctors I am prediabetic due to having that 110-120 level after a 12 hour fast. This just doesn't make sense".
• • "It's so difficult to recognize what the elements of the blood test he recommends are. May you please list the tests that should be done? This is the most valuable, actionable part of the interview, and it's lost behind the pronunciation.".
• • "My A1C is 5.2 and the recent blood work reports that my insulin resistance is low, BUT for YEARS, my blood sugars have been 101-113 range... I'm baffled as is my doctor as to why my fasting glucose levels are constantly high. Any thoughts?".
• • "Just called my DR to see why I’m not on K2 if he put me on D35000iu 2 tablets a day. So much good information.".

Relying on standard glucose and A1C tests to manage your metabolic health is like waiting for the smoke alarm to go off when the fire has already been burning in the walls for a decade. The raw comments reveal a massive audience gap: people need and want earlier, more accurate indicators of their health. The key is to become your own health advocate. By understanding and specifically requesting tests that measure fasting insulin and calculate your HOMA-IR score, you can uncover the true state of your metabolic health years before conventional tests would, giving you the power to reverse the process before it becomes a lifelong disease.