High insulin comes first
Researchers followed the children of parents with type 2 diabetes for an average of 13 years. Those who went on to develop diabetes had high insulin and slow glucose clearance long before their glucose became abnormal: one to two decades before diagnosis.1
Glucose rises late, and fast
The Whitehall II study tracked over 6,000 British civil servants. In those who developed diabetes, insulin sensitivity was already falling faster around five years before diagnosis. Glucose measured two hours after a sugary drink rose steeply about six years out, and fasting glucose, the number most check-ups rely on, only climbed sharply in the final two years or so.2
What is HOMA-IR?
HOMA-IR combines fasting glucose and fasting insulin into one estimate of insulin resistance.3 The higher the number, the harder your body is working to keep glucose in range.
HOMA-IR = fasting glucose (mmol/L) × fasting insulin (µU/mL) ÷ 22.5
Example: 5.1 mmol/L glucose and 12.4 µU/mL insulin gives 5.1 × 12.4 ÷ 22.5 ≈ 2.8.
Cut-offs used in research vary by population and laboratory, so the most useful comparison is with your own earlier readings.
Metabolic syndrome and insulin resistance
The first formal definition of metabolic syndrome, from a World Health Organization consultation in 1998, required evidence of insulin resistance or abnormal glucose handling, plus at least two other risk factors.4 In 2009 the major international diabetes and heart bodies agreed a harmonised definition: any three of raised waist size, raised triglycerides, low HDL cholesterol, raised blood pressure and raised fasting glucose.5 None of the five measures insulin itself.
The global picture
The World Health Organization reports that 830 million people were living with diabetes in 2022, more than 95% of them with type 2, and that type 2 diabetes is often diagnosed several years after onset, after complications have already arisen.6 In 2024, 1.1 billion people were living with obesity7 and 1.4 billion adults aged 30–79 had high blood pressure, 44% of them unaware of it.8 Cardiovascular disease caused an estimated 19.8 million deaths in 2022, about 32% of all deaths worldwide.9
References
- Warram JH, Martin BC, Krolewski AS, Soeldner JS, Kahn CR. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Annals of Internal Medicine. 1990;113(12):909–915. Source
- Tabák AG, Jokela M, Akbaraly TN, Brunner EJ, Kivimäki M, Witte DR. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. The Lancet. 2009;373(9682):2215–2221. Source
- Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–419. Source
- Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Medicine. 1998;15(7):539–553. Source
- Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–1645. Source
- World Health Organization. Diabetes: fact sheet. Source
- World Health Organization. Obesity and overweight: fact sheet. Source
- World Health Organization. Hypertension: fact sheet. Source
- World Health Organization. Cardiovascular diseases (CVDs): fact sheet. Source
IN5ULIN is not a diagnostic tool. This page is general information, not medical advice. Talk to a qualified healthcare professional about your own results.