Are you actually metabolically healthy?

HOMA-IR stands for Homeostatic Model Assessment for Insulin Resistance. The formula is: fasting insulin (uU/mL) multiplied by fasting glucose (mg/dL), divided by 405. A HOMA-IR below 1.0 indicates optimal insulin sensitivity. Values of 1.0 to 1.9 are normal. A HOMA-IR of 2.0 to 2.9 suggests early insulin resistance. Above 3.0 indicates moderate to significant insulin resistance. This quiz uses a proxy model because most users will not have their fasting insulin level available. If you want a precise HOMA-IR, ask your GP to order both fasting insulin and fasting glucose.

Yes. Wildman et al. (2008, Archives of Internal Medicine) found that approximately 23.5% of normal-weight adults were metabolically unhealthy. Conversely, roughly 31.7% of obese adults were metabolically healthy by the same criteria. Fat distribution matters more than total fat. Someone carrying most body fat subcutaneously on hips and thighs tends to have significantly better insulin sensitivity than someone carrying even a small amount of visceral fat around the midsection.

The challenge with insulin resistance is it produces no single dramatic symptom. The most commonly reported indicators include: energy crashes one to two hours after eating, particularly after carbohydrate-heavy meals; persistent cravings for sugar or refined carbohydrates; difficulty losing body fat despite a consistent caloric deficit; gradual fat redistribution toward the midsection; skin tags on the neck, armpits, or groin; and acanthosis nigricans (dark, velvety patches of skin in body folds). A cluster of three or more is a meaningful signal worth investigating with a blood test.

Fasting insulin is not included in most standard screening panels because clinical guidelines focus on fasting glucose and HbA1c as primary screening markers for diabetes and pre-diabetes. The limitation is that insulin rises years before glucose does. By the time fasting glucose exceeds 100 mg/dL, the underlying insulin resistance has typically been present for 5 to 15 years. Ask your GP to order both fasting insulin and fasting glucose, framing the request as "I would like to calculate my HOMA-IR to assess insulin resistance risk."

A continuous glucose monitor (CGM) is a small sensor worn on the upper arm that measures glucose levels every few minutes. For someone concerned about insulin resistance, a CGM provides a two-week window into how your body actually responds to different foods, exercise, stress, and sleep. For a screening check, a fasting insulin and fasting glucose blood test gives you a definitive HOMA-IR score at much lower cost. A CGM is most valuable for people who already know they are insulin resistant and want to use real-time feedback to optimise diet and lifestyle.

Insulin resistance is a physiological state: your cells do not respond efficiently to insulin. Metabolic syndrome is a clinical diagnosis requiring three or more of: waist circumference above 102cm in men or 88cm in women, triglycerides at or above 150 mg/dL, HDL cholesterol below 40 mg/dL in men or 50 mg/dL in women, blood pressure at or above 130/85 mmHg, and fasting glucose at or above 100 mg/dL. A person can be insulin resistant without meeting metabolic syndrome criteria, particularly in the early stages. Approximately 34.7% of US adults meet the criteria for metabolic syndrome (NHANES 2011-2016), while the broader metabolically unhealthy category captures 88%.

A high-risk result is not a diagnosis. It is a signal that your profile is consistent with patterns associated with insulin resistance in published research. The most useful next step is to request both fasting insulin and fasting glucose from your GP. Most standard panels include fasting glucose but not fasting insulin, so ask for it explicitly. With both numbers, your HOMA-IR can be calculated. An HbA1c test completes the picture for pre-diabetes screening. The evidence-based interventions with the strongest track record are reducing refined carbohydrate intake, increasing daily movement, prioritising sleep, and resistance training to improve insulin sensitivity.

Fasting insulin is not included in most standard screening panels because clinical guidelines focus on fasting glucose and HbA1c as primary markers for diabetes and pre-diabetes. The limitation is that insulin rises years before glucose does. By the time fasting glucose exceeds 100 mg/dL, the underlying insulin resistance has typically been present for 5 to 15 years. Ask your GP to order both fasting insulin and fasting glucose, framing the request as "I would like to calculate my HOMA-IR to assess insulin resistance risk."