Is this HOMA IR result valid?

(Fabian ) #1

Hi everyone,

The other day I went to a lab in a small town in Spain where I live to see if they tested for Insulin resistance (HOMA-IR). I asked the guy if I had to be fasted and he said ‘no’, so to avoid another trip to the lab, I took the test on the spot.
The guy seemed to know what he was talking about but then I checked on the internet and it seems like it has to be done in a fasted state.
In my case, I had eaten breakfast 2 hours before and told him so.
Wnat do you guys think?

Here are the results… (I have been on a ‘normal’ diet recently and had eaten carbs 2 hours before)

VALORACIÓN DEL ÍNDICE DE RESISTENCIA A INSULINA EN SUERO POR INMUNOLUMINISCENCIA

Fecha análisis: 2 Enero 2023
Índice resistencia a Insulina (Homa):
(Insulina (mcU/mL)xGlucosa (mg/dL)) / 405

Insulina 6,3 mcU/mL
Glucosa 90 mg/dL
Índice resistencia a Insulina 1,4

Many thanks!

(Michael) #2

Yes, both insulin and blood sugars need to be fasted. That technician should pay the cost of re-doing it since they gave you bad information that they SHOULD know as part of their job.

(Fabian ) #3

Thank you
Does it mean the test cannot indicate anything, even if it’s not optimum?

(Michael) #4

right, needs to be redone. The values you have are meaningless in the context of HOMA-IR or insulin levels.

#5

I am not a tester person but I googled HOMA IR and all said ‘fasted state’ for testing so??
sounds like Naghite nailed this one.
yea, go back and say free test…if ya go back make sure you are fasted and they can do ya again for free :slight_smile:

(You've tried everything else; why not try bacon?) #6

The values that give the proper score require the patient to have fasted (i.e., nothing by mouth except water) for at least eight hours.

Although if your score was this good two hours after a meal, it certainly bodes well for what you will find after fasting. If you get the test redone, I’d love to see the results.

(You've tried everything else; why not try bacon?) #7

I forgot to ask, how long have you been eating keto? If it’s for a significant length of time, then you are probably no longer insulin-resistant.

(Fabian ) #8

Thanks for your answers.
PaulL, I’ve been on keto twice, for one month and then , more recently for about 2 months.
I’ve been following a healthyish diet for a few weeks but not keto (I’m now experimenting with a diet that allows carbs (legumes, veggies) but nothing sweet-tasting , no fruit, no sweeteners…

I’ve probably never been insulin resistant, I think I might have an addiction to sugar that could lead to IR in the future, hence the test to find out for sure.
I will go back to the lab in a fasted state
Thank you!

(You've tried everything else; why not try bacon?) #9

Well, your insulin level in that test was below the threshold of 25 μU/mL which, according to Ralph DeFronzo and his team, means you were in ketosis at the time.

People often make a distinction between “low-carb” and “keto” that I think is unwarranted. Any diet that permits nutritional ketosis in someone is a ketogenic diet for that person. If someone is insulin-sensitive enough to get into ketosis at 100 g/day of carbohydrate, that’s still a ketogenic diet for that person. And if someone is so insulin-resistant that 20 g/day of carbohydrate stimulates too much insulin, then that diet is not ketogenic for that person.

On these forums, we recommend a carb limit of 20 g/day since it will work for almost everyone, except those who are extremely insulin-resistant.

(Bob M) #10

Are those units in micro IU/ml? Or uIU/ml? Or are they some other unit?

The original poster’s insulin and glucose seem quite low to me, especially after eating. So, while the HOMA-IR might be affected, I personally wouldn’t do another one. Both values are so low, I’m not sure what you’d learn.

(You've tried everything else; why not try bacon?) #11

Bob, the unit of measure is micro-units per millilitre, written variously as μU/mL, μIU/mL, uU/mL, and uIU/mL.

It is customary to capitalise the L for litre, since this avoids confusion. “IU” and “U” are the same thing, “international units,” which instead of being a quantity, is a measure of the effectiveness of a dose. (I suppose that typing one less letter qualifies as a time-saving convenience. Never mind that I and U are right next to each other on an American keyboard. [sigh])

The SI abbreviation for “micro” is the Greek letter mu, to distinguish it from the Roman letter ‘m’ that stands for “milli”. People who don’t have easy access to a font containing Greek letters generally substitute a Roman ‘u’ for the Greek ‘μ’ (mu).

And that there is a very good point!

Oh, and for everyone’s reference, I got the figure of 25 μU/mL from Gary Taubes’s book, The Case for Keto, where he cites a paper by Ralph DeFronzo and his team. So I left the abbreviation of the units the way I found it in the book. I should also note that the threshold value is actually just under 25 micro-units, so 24 point something or other.

(Fabian ) #12

Do you mean that if I had been in a fasted state, the results could only have been better? And that with these results I am probably not insulin resistant?

(Bob M) #13

Yes to both. Both of your values are quite low, especially after eating something.

Although if you really want to know how “insulin resistant” you are, the best test is a Kraft test where you take 75 g of glucose, and get both blood sugar and insulin measured immediately before the drink, then periodically afterwards. Often, 30 minutes, one hour, and two hours are used. (The original Kraft tests were longer – 5 hours? – but most think you get the same info in a shorter period.) This is a better gauge of what is going on, because sometimes people look like they have great blood sugar control, when what they have is an overactive pancreas that is cranking out insulin. (This isn’t your case, though, as your insulin is low after eating.)

But I think your results are so low, it’s doubtful that would tell you much. Put it this way, I’ve been keto since 1/1/14, with a lot of fasting multiple days, and my fasting insulin is still around 10, and my morning blood sugar is over 100. I generally get a poor HOMA-IR score.

Your insulin and glucose results are better then mine, after you ate. I’d expect that unless you ate nothing but fat, your insulin would have to increase over what your true fasting insulin would be. Your HOMA-IR is darn good as it is, and fasting would likely be better.

(You've tried everything else; why not try bacon?) #14

I agree with Bob here.

It is also worth pointing out that Dr. Kraft identified five basic patterns of insulin response, only one of which was healthy. He concluded that patients with the other four patterns had diabetes already, even though they did not yet qualify for an official diagnosis, because their glucose was not yet out of control.

It is also worth mentioning that people on a ketogenic diet often look bad when they take a Kraft test, because their time of eating little carbohydrate has convinced their pancreas to stop storing insulin against a sudden glucose load. The absence of this first-phase response means that the pancreas has to produce more insulin in the second phase to compensate, which skews the response curve. Prof. Benjamin Bikman says that a ketonian can get a more normal-looking insulin response by eating a load of carbohydrate 24 hours before the Kraft test.

My guess is also that Bob’s apparently bad (or less-good, at any rate) HOMA-IR score is because he needs more protein than most people, leading to a slightly higher insulin response and a slightly elevated serum glucose from gluconeogenesis, as compared with a more “average” ketonian. In Bob’s case, this appears to be normal and no cause for concern.

(Bob M) #15

I wish those pin-prick insulin monitors people are developing would be released, preferably with some cheaper dollar-per-strip costs. Maybe what I paid a while back for ketone strips, around $3/strip.

I know that when I tested Dave Feldman’s cholesterol drop protocol (I did 4.5 days fasting, 3 days high calories and fat), I got a higher fasting insulin the day after 3 days of high calories/fat. He said that was normal. But that means that what you’re eating for multiple days affects insulin.

What about yesterday? Does what I ate yesterday affect my fasting insulin today?

What if I go on a fat fast for a day? Would that lower insulin? What about if I eat very high protein for a day? Would that raise insulin? What if I have a high carb day? A medium carb day?

I don’t get fasting insulin tested often, but I’ve had anywhere between 3.8 to 33.0, though it’s normally around 10. Why the 3.8? Why the 33? I think the 3.8 was when I was fasting a ton. I have no idea what caused the 33, as I got that value and my HbA1c went down from a previous test. Has never made sense to me.

Anyway, it’d be great to be able to (attempt to) answer some of these questions.

(You've tried everything else; why not try bacon?) #16

Another question: what’s involved in testing glucacgon? If Bikman is right, then what really counts is the ratio of insulin to glucagon, not the absolute value of either. It just keeps on getting more complicated, doesn’t it?

(Bob M) #17

You can get glucagon measured here:

https://ownyourlabs.com/product/glucagon-plasma/

And it comes as part of this (huge) panel, which includes insulin (and a lot more – for a lot more money though):

Maybe the next time I get tested, I’ll get both glucagon and insulin tested. But then I’d only have one result, and I often have a hard time interpreting those. For instance, got c-peptide tested once, and then didn’t know how to interpret it. It was normal, which was good – I guess.

If I do get these (insulin and glucagon) tested, I’ll report back. Planning a 4.5 day fast, and maybe I get one set of these at the beginning and one at the end?