Jun 2, 2026 at 10:33 AM#2
you're preaching to the choir. I order fasting insulin and HOMA-IR on virtually every metabolic patient and I'm amazed at how many of my colleagues don't.
The reason this matters so much clinically:
> By the time fasting glucose exceeds 100 mg/dL, the average patient has had insulin resistance for 8-13 years (Kraft insulin response patterns, University of Michigan data).
During those 8-13 years, the pancreas is compensating by producing more and more insulin to keep glucose normal. The beta cells are working overtime. Eventually they burn out → glucose rises → prediabetes → diabetes.
Fasting insulin catches this DURING the compensation phase when glucose still looks normal. A fasting glucose of 96 with a fasting insulin of 32 means the pancreas is screaming to maintain normoglycemia. That's not "normal" — that's compensated disease.
I also find the Kraft insulin response test (5-hour glucose tolerance test with insulin measurements at 0, 30, 60, 120, 180, 240, 300 min) incredibly informative, though it's rarely done outside research settings.
Last edited: Jun 2, 2026 at 11:33 AM
30 8TinaHashiRN, robert_kc, dan_philly and 27 others
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