Fasting insulin test: what high and low insulin levels and HOMA-IR mean
Fasting insulin (Insulin) · Metabolic work-up (ordered alone or with fasting glucose and A1C) · reported in µIU/mL (micro-international units per millilitre; identical to mIU/L). 1 µIU/mL ≈ 6.9 pmol/L
Insulin is the hormone your pancreas releases to move glucose from the blood into muscle, liver and fat cells. A fasting insulin test measures how much is circulating after 8 to 12 hours without food, which reflects how hard the pancreas has to work to hold blood sugar normal overnight. Most laboratories print a reference range of roughly 2 to 25 µIU/mL, but that range describes the general population rather than metabolic health: lean, insulin-sensitive adults usually run under 8 to 10 µIU/mL, and values in the mid-teens and above are typical of insulin resistance.
The two most common reasons for a high fasting insulin are excess body fat, particularly around the organs, and the early stages of type 2 diabetes, in which the pancreas compensates for resistant tissues by producing more insulin for years before glucose rises. Polycystic ovary syndrome, fatty liver, poor sleep and inactivity all raise it, and so does not actually being fasted. A low fasting insulin usually means good sensitivity, but with a high glucose it means the pancreas is running out, as in type 1 diabetes or advanced type 2.
Fasting insulin is most useful combined with fasting glucose in the HOMA-IR index (glucose in mg/dL times insulin in µIU/mL, divided by 405), where roughly 1 is healthy and above about 2.5 to 2.9 suggests insulin resistance. The test's weakness is standardisation: insulin assays from different manufacturers can disagree by 30 percent or more, there is no internationally agreed cut-off, and the American Diabetes Association does not recommend it for routine diagnosis. Read it as a trend on the same assay, alongside glucose, A1C, triglycerides and waist size, rather than as a verdict.
Insulin at a glance
- What it is: the pancreatic hormone that lowers blood glucose; the fasting level shows how much insulin it takes to keep your overnight glucose normal.
- Lab reference range: about 2–25 µIU/mL (equivalent to mIU/L; multiply by 6.9 for pmol/L); typical printed ranges are 2.6–24.9 or 2.0–19.6. Labs and assays differ substantially.
- Insulin-sensitive: most lean healthy adults are under 8–10 µIU/mL. Insulin resistance is likely above about 12–15, and probable above 20–25, with normal glucose.
- HOMA-IR = (fasting glucose mg/dL × fasting insulin µIU/mL) ÷ 405. Roughly 1.0 is optimal, 1.9–2.5 early resistance, above 2.5–2.9 insulin resistant (cut-offs vary by population).
- Low fasting insulin (under 2–3) with normal glucose is usually healthy; low insulin with high glucose means the pancreas is failing (type 1, LADA, long-standing type 2, pancreatic disease).
- Next step: confirm you were truly fasting, repeat on the same assay with glucose and A1C, add a lipid panel and ALT, and act on weight, activity, sleep and carbohydrate quality, which lower insulin within weeks.
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What Insulin measures
Beta cells in the pancreatic islets make proinsulin, split it into insulin and C-peptide, and release both into the portal vein in response to glucose, amino acids and gut hormones. About half the insulin is removed by the liver on first pass; what reaches the general circulation is what the test measures. Insulin tells muscle and fat to take up glucose, tells the liver to stop making it, and switches fat cells from releasing to storing fatty acids. When these tissues respond poorly (insulin resistance), the beta cells compensate by secreting more, so the fasting level rises while glucose stays normal, sometimes for a decade before prediabetes appears.
Fasting insulin is measured by immunoassay. Unlike glucose or A1C, insulin assays have never been fully standardised: different manufacturers' antibodies recognise proinsulin and insulin analogues to differing degrees, and results for the same sample can vary by 30 percent or more between platforms. This is why there is no agreed universal 'normal' and why a value should be compared with the range and method of the lab that produced it, and trends followed on the same assay. Haemolysed samples read falsely low because red cells release an insulin-degrading enzyme, and samples left unseparated for hours also lose insulin.
HOMA-IR (homeostasis model assessment of insulin resistance) uses the fasting glucose-insulin pair to estimate how resistant the tissues are, calibrated so that a young healthy adult scores about 1. It correlates reasonably with the gold-standard clamp study (r about 0.6 to 0.8) in groups but is noisier in individuals, depends entirely on the insulin assay used, and does not work in people taking insulin or whose beta cells have failed. Related indices include QUICKI and the triglyceride-glucose (TyG) index, which needs no insulin measurement at all. In people with suspected low blood sugar, insulin is instead measured during a supervised fast or an episode of hypoglycaemia, alongside C-peptide and glucose.
Normal range for Insulin
Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.
| Group | Typical range (µIU/mL (micro-international units per millilitre; identical to mIU/L). 1 µIU/mL ≈ 6.9 pmol/L) | Notes |
|---|---|---|
| Typical lab reference range (fasting) | About 2–25 µIU/mL | Common printed ranges: 2.6–24.9, 2.0–19.6, 3–25. Not standardised between assays; use the range on your report. |
| Insulin-sensitive (research and clinical usage) | Under about 8–10 µIU/mL | Where most lean, active adults without metabolic disease fall; not an official cut-off. |
| Probable insulin resistance | Above about 12–15 µIU/mL with normal glucose | Roughly the top quarter of US adults; many clinicians treat values in this band as early compensation. |
| Marked hyperinsulinaemia | Above 20–25 µIU/mL | Common in obesity, PCOS and fatty liver; prediabetes or type 2 diabetes is often present or imminent. |
| HOMA-IR, optimal | About 0.5–1.4 | Healthy young adults average around 1.0. |
| HOMA-IR, early insulin resistance | About 1.9–2.5 | Population cut-offs for the top quartile range from 1.8 to 2.9 depending on the cohort and assay. |
| HOMA-IR, insulin resistant | Above about 2.5–2.9 | Example: glucose 95 mg/dL × insulin 15 µIU/mL ÷ 405 = 3.5. |
| Low fasting insulin | Below about 2–3 µIU/mL | Normal with a normal glucose (very insulin-sensitive, or prolonged fast); abnormal with a glucose over 126 mg/dL (beta-cell failure). |
| Insulin during hypoglycaemia (glucose under 55 mg/dL) | Should be suppressed below 3 µIU/mL | An insulin of 3 or more with a C-peptide of 0.6 ng/mL or more during hypoglycaemia suggests an insulinoma or a sulfonylurea; high insulin with low C-peptide suggests injected insulin. |
High fasting insulin
A high fasting insulin with a normal glucose means your tissues have become less responsive to insulin and your pancreas is compensating. This is insulin resistance, and it usually precedes prediabetes by years: in the prospective studies that followed people into type 2 diabetes, fasting insulin was already raised a decade before the glucose crossed the diagnostic line. It travels with abdominal fat, high triglycerides, low HDL cholesterol, raised blood pressure, fatty liver, high uric acid and, in women, polycystic ovary syndrome. A fasting insulin of 15 µIU/mL with a glucose of 95 mg/dL gives a HOMA-IR of 3.5, well into the insulin-resistant range.
A high insulin with a high glucose means the compensation is no longer enough; this is the usual picture of prediabetes and early type 2 diabetes, and the A1C and fasting glucose, not the insulin, make that diagnosis. Over years the beta cells tire and insulin levels fall again, so a 'normal' fasting insulin in someone with long-standing type 2 diabetes is not reassuring. Medications matter too: glucocorticoids, some antipsychotics (olanzapine, clozapine), beta-blockers and thiazides raise insulin resistance, and anyone who injects insulin will have a reading that depends on the assay and the timing.
A high insulin with a low glucose is a different and rarer problem. Insulin should fall to near zero when glucose drops below 55 mg/dL, so a measurable insulin (3 µIU/mL or more) during hypoglycaemia points to an insulin-secreting tumour (insulinoma), a sulfonylurea or meglitinide drug, insulin autoimmune syndrome, or injected insulin; the C-peptide tells these apart. Finally, the most common 'high insulin' is a sample taken after eating or drinking anything with calories: a post-meal insulin of 40 to 100 µIU/mL is normal and says nothing about resistance.
Common causes
Not actually fasting
Any calories in the previous 8 hours, including milk in coffee, juice or a protein shake, release insulin; a post-meal value is often 5 to 10 times the fasting level. The commonest reason for an unexpectedly high result.
Excess abdominal and liver fat
Visceral fat and fatty liver release fatty acids and inflammatory signals that blunt insulin action; fasting insulin roughly doubles between a BMI of 22 and 35, and tracks waist size more closely than weight.
Prediabetes and early type 2 diabetes
Beta cells compensate for resistance by secreting more insulin for years; fasting insulin is typically 15 to 30 µIU/mL in this phase and falls later as the cells fail.
Polycystic ovary syndrome
Insulin resistance affects 50 to 70 percent of women with PCOS, including many of normal weight; the high insulin drives ovarian testosterone production and lowers SHBG, which is why metformin and inositol are used.
Physical inactivity and loss of muscle
Muscle takes up most insulin-stimulated glucose; a few days of bed rest or two weeks of markedly reduced step count raises fasting insulin and HOMA-IR measurably in healthy adults.
Short or disrupted sleep and sleep apnea
Four nights of 4.5 hours' sleep reduced insulin sensitivity by about 16 to 30 percent in healthy volunteers; untreated obstructive sleep apnea raises fasting insulin independent of weight.
Medications
Prednisone and other glucocorticoids, olanzapine, clozapine and quetiapine, some HIV protease inhibitors, thiazide diuretics at high dose, beta-blockers, oral contraceptives in some women and growth hormone all increase insulin resistance.
Pregnancy, Cushing's syndrome and acromegaly
Placental hormones make the second half of pregnancy insulin resistant by design; excess cortisol or growth hormone does the same pathologically.
Chronic kidney disease
The kidneys clear a large share of insulin; when GFR falls below about 30 to 40 mL/min, insulin lingers and fasting levels rise even without resistance.
Insulinoma, sulfonylureas or injected insulin (with low glucose)
A detectable insulin during true hypoglycaemia is abnormal; insulinoma and sulfonylureas raise both insulin and C-peptide, while injected insulin raises insulin with a suppressed C-peptide. Rare insulin antibodies and genetic insulin-resistance syndromes produce extreme values, often over 100 µIU/mL.
Symptoms that can go with it
- Usually none; insulin resistance is silent for years and found on testing
- Weight gain concentrated around the waist, and difficulty losing it
- Dark, velvety thickening of the skin on the neck, armpits or groin (acanthosis nigricans) and skin tags
- Hunger and energy dips two to three hours after carbohydrate-heavy meals
- Irregular periods, acne and excess hair in women (PCOS)
- Fatigue, brain fog and sleepiness after meals
- Sweating, shaking, confusion or fainting between meals or at night if insulin is high because of an insulinoma or medication
- High blood pressure, high triglycerides and fatty liver on other tests
Low fasting insulin
A low fasting insulin with a normal glucose is usually good news. It means your tissues respond so well to insulin that the pancreas needs to release very little to hold glucose steady overnight; lean, active people and those who have lost substantial weight often read 2 to 4 µIU/mL, and a HOMA-IR under 1 goes with it. A prolonged fast (beyond 12 to 14 hours), a very low-carbohydrate diet or a hard training session the day before also lower fasting insulin without implying anything is wrong.
A low insulin with a high glucose means the opposite: the pancreas cannot make enough. In type 1 diabetes and latent autoimmune diabetes of adults (LADA), the beta cells are destroyed by the immune system and insulin and C-peptide are low or undetectable with glucose over 126 mg/dL; this is confirmed with GAD and other islet antibodies. In long-standing type 2 diabetes, beta-cell output declines over years, and a fasting insulin that has fallen from 25 to 6 while glucose has risen is a sign of that exhaustion rather than of improvement. Chronic pancreatitis, pancreatic surgery, cystic fibrosis and hemochromatosis damage the islets directly.
Laboratory artefact also produces low readings: haemolysis of the sample releases an enzyme that degrades insulin, and insulin in a tube left unspun for several hours falls. People taking insulin analogues may read low on assays that do not recognise the analogue, while C-peptide stays low because their own production is suppressed.
Common causes
High insulin sensitivity
Lean, physically active adults, people after significant weight loss, endurance athletes and people on very low carbohydrate diets commonly have fasting insulin of 2 to 5 µIU/mL with a normal glucose; this is the expected, healthy result.
Type 1 diabetes and LADA
Autoimmune destruction of beta cells; insulin and C-peptide are low with a raised glucose, often with GAD65 or IA-2 antibodies. LADA presents in adults and is often mistaken for type 2 for years.
Long-standing type 2 diabetes with beta-cell failure
After 10 to 15 years of compensation, insulin output falls; a low or low-normal fasting insulin with a glucose over 126 mg/dL marks this stage and usually means insulin therapy is approaching.
Pancreatic disease
Chronic pancreatitis, pancreatectomy, pancreatic cancer, cystic fibrosis and hemochromatosis destroy or clog the islets, producing diabetes with low insulin and often low glucagon.
Prolonged fasting or starvation
Insulin falls to near zero after 24 to 72 hours without food as the body shifts to fat and ketones; a sample after an unusually long fast reads low.
Hypopituitarism and low cortisol or growth hormone
Deficiency of the hormones that oppose insulin improves sensitivity and lowers fasting insulin, sometimes with hypoglycaemia.
Sample handling: haemolysis or delayed separation
Red cells contain insulin-degrading enzyme; a haemolysed or long-standing sample reads falsely low and should be repeated.
Symptoms that can go with it
- None when glucose is normal; a low fasting insulin does not cause symptoms by itself
- With high glucose: thirst, frequent urination, blurred vision, weight loss despite eating, fatigue and recurrent infections
- Nausea, vomiting, abdominal pain, deep rapid breathing and fruity breath, which suggest diabetic ketoacidosis and are an emergency
- Fatty, pale, foul-smelling stools and weight loss when pancreatic disease is the cause
Read it alongside
- Fasting glucose — the pair gives HOMA-IR; high insulin with normal glucose is compensated resistance, high insulin with high glucose is prediabetes or diabetes, low insulin with high glucose is beta-cell failure.
- A1C — the three-month glucose average and the test that actually diagnoses prediabetes (5.7–6.4 percent) and diabetes (6.5 percent or more); insulin does not.
- Triglycerides and HDL cholesterol — a triglyceride-to-HDL ratio above about 3 (in mg/dL) is a simple surrogate for insulin resistance and often rises before glucose does.
- C-peptide — made in equal amounts with insulin but cleared differently; distinguishes your own insulin from injected insulin and confirms beta-cell reserve in suspected type 1 or LADA.
- ALT and GGT — raised liver enzymes with a high fasting insulin usually mean fatty liver, the liver's face of insulin resistance.
- Uric acid — high insulin reduces kidney uric acid excretion; gout and insulin resistance cluster for this reason.
- Testosterone and SHBG — insulin lowers SHBG in everyone, raises ovarian testosterone in women with PCOS and is associated with low testosterone in men.
- eGFR and creatinine — reduced kidney function slows insulin clearance and raises the fasting level without true resistance.
What usually happens next
- Check that you were genuinely fasting (water only for 8 to 12 hours, no gum, no milk in coffee) and that the sample was processed promptly; if not, repeat before drawing any conclusion.
- Ask for the fasting glucose from the same draw and calculate HOMA-IR (glucose × insulin ÷ 405); then ask for an A1C, a lipid panel, ALT and uric acid if they were not already done, since these together define metabolic risk better than insulin alone.
- Repeat on the same assay at the same lab in 3 to 6 months after changes to diet, activity and sleep; insulin responds within weeks, and a fall of 20 to 30 percent is realistic with a 5 to 7 percent weight loss.
- If glucose is also raised, the conversation shifts to prediabetes or diabetes management under the ADA criteria; if glucose is low with a measurable insulin, expect a C-peptide, a sulfonylurea screen and possibly a supervised 72-hour fast.
- Women with high insulin and irregular periods, acne or excess hair should ask about PCOS testing (testosterone, SHBG, LH, FSH, pelvic ultrasound).
- Review medications that raise insulin resistance (steroids, certain antipsychotics, beta-blockers, thiazides) with whoever prescribes them; do not stop any on your own.
Diet, lifestyle and natural levers with evidence
What can move Insulin once the cause is known. Nothing here replaces finding the cause.
Weight loss of 5 to 10 percent
Strong evidenceIn the Diabetes Prevention Program, a lifestyle programme aiming for 7 percent weight loss and 150 minutes a week of activity cut progression from prediabetes to diabetes by 58 percent over 3 years, outperforming metformin (31 percent), and fasting insulin fell in proportion to weight lost. Meta-analyses of diet-induced weight loss show fasting insulin falling by roughly 1 µIU/mL per kilogram in the first 10 kg and HOMA-IR falling by 20 to 40 percent with a 5 to 10 percent loss; the fat lost from the liver and abdomen matters most.
Aerobic plus resistance exercise
Strong evidenceA single bout of exercise increases muscle glucose uptake for 24 to 48 hours without insulin, and a 2017 systematic review of training trials in insulin-resistant adults found HOMA-IR falling by about 0.5 to 1.0 and fasting insulin by 2 to 4 µIU/mL over 8 to 16 weeks, with combined aerobic and resistance training doing better than either alone. Breaking up sitting with 2 to 3 minutes of light walking every 30 minutes lowered post-meal insulin by about 20 percent in controlled studies.
Carbohydrate quality, fibre and meal pattern
Moderate evidenceReplacing refined grains and sugar-sweetened drinks with intact grains, legumes, vegetables and nuts lowers fasting insulin and HOMA-IR by 10 to 20 percent in trials lasting 3 to 6 months, and Mediterranean-style diets in PREDIMED reduced new diabetes by about 30 percent without weight loss. Low-carbohydrate diets (under 130 g a day) produce larger short-term falls in fasting insulin (often 25 to 35 percent) than low-fat diets at the same weight loss, though the gap narrows by 12 months. Eating the bulk of calories earlier in the day and avoiding late-night meals also lowers fasting insulin modestly.
Sleep 7 to 9 hours and treat sleep apnea
Moderate evidenceExperimental sleep restriction to 4 to 5 hours a night for 4 to 7 nights reduced whole-body insulin sensitivity by 16 to 30 percent in healthy adults, and fat-cell insulin response by about 30 percent, within a week; extending sleep in habitually short sleepers improves sensitivity. CPAP for moderate to severe sleep apnea lowers HOMA-IR modestly in meta-analyses (about 0.4 to 0.6), with the clearest effect in people who use it more than 4 hours a night.
Berberine
Moderate evidenceMeta-analyses of randomised trials in people with type 2 diabetes or metabolic syndrome (most 500 mg two to three times a day for 8 to 12 weeks) find berberine lowers fasting insulin by about 2 to 3 µIU/mL and HOMA-IR by around 0.7 to 1.0, with fasting glucose falling about 15 mg/dL and A1C about 0.7 percent, effects comparable to metformin in head-to-head trials. The trials are mostly small and from China, so the size of the effect is less certain than the direction.
Gastrointestinal upset is common; it inhibits CYP3A4 and P-glycoprotein and raises levels of cyclosporine, some statins and other drugs; avoid in pregnancy, breastfeeding and newborns (displaces bilirubin). Can add to the glucose-lowering of diabetes medication.
Myo-inositol (particularly in PCOS)
Moderate evidenceMeta-analyses of randomised trials in women with PCOS (typically 2 g of myo-inositol twice a day for 12 to 24 weeks) find fasting insulin falling by about 2 to 3 µIU/mL and HOMA-IR by around 1.0 compared with placebo, with improved ovulation rates and effects on insulin similar to metformin but better tolerated. Trials in people without PCOS, including gestational diabetes prevention, show smaller but directionally similar effects.
Mild nausea or loose stools at higher doses; limited data in pregnancy beyond gestational diabetes trials.
When to see a clinician promptly
- Symptoms of low blood sugar (sweating, shaking, confusion, fainting), especially fasting or overnight, with a measurable insulin: possible insulinoma or medication effect, needs prompt assessment and a supervised work-up.
- A low or normal insulin with a glucose over 250 mg/dL, or any glucose over 200 with vomiting, abdominal pain, deep breathing or drowsiness: possible diabetic ketoacidosis, an emergency.
- A high fasting insulin with a fasting glucose of 100 mg/dL or more, or an A1C of 5.7 percent or more: prediabetes, to plan prevention and arrange yearly monitoring.
- A fasting insulin above 20 to 25 µIU/mL, or a HOMA-IR above 2.9, with high triglycerides, fatty liver or high blood pressure, to assess overall cardiovascular and diabetes risk.
- Women with high insulin and irregular periods, acne or excess hair, or anyone with dark velvety skin patches on the neck or armpits (acanthosis nigricans).
- Adults diagnosed with 'type 2' diabetes who are lean, lose weight without trying or need insulin early, since a low insulin or C-peptide may mean LADA or type 1.
Frequently asked questions
What is a normal fasting insulin level?
Most laboratories print a reference range of roughly 2 to 25 µIU/mL, but that reflects the whole population, a third of whom are insulin resistant. Lean, healthy, active adults mostly fall under 8 to 10 µIU/mL. Values of 12 to 15 and above with normal glucose usually indicate insulin resistance, and 20 to 25 and above almost always do. Because insulin assays are not standardised and can differ by 30 percent between labs, compare your result only with the range on your own report and follow trends at the same lab.
Is a fasting insulin of 15 high?
By the lab's range it is normal, but metabolically it is in the band most clinicians regard as insulin resistance. With a glucose of 90 mg/dL it gives a HOMA-IR of 3.3, above the usual 2.5 to 2.9 cut-off. If you were truly fasting and the sample was handled properly, a value of 15 is a reason to look at waist size, triglycerides, HDL, ALT, blood pressure and A1C, and to act on weight, activity, sleep and carbohydrate quality, all of which can bring it down within weeks.
How is HOMA-IR calculated and what is a good score?
Multiply fasting glucose in mg/dL by fasting insulin in µIU/mL and divide by 405 (if glucose is in mmol/L, multiply and divide by 22.5). A healthy young adult scores about 1.0; under 1.4 is good, 1.9 to 2.5 suggests early insulin resistance and above about 2.5 to 2.9 is insulin resistant, though published cut-offs vary from 1.8 to 3.0 depending on the population and assay. It is a rough estimate, noisier in individuals than in groups, and meaningless in people who take insulin.
What is the best test for insulin resistance?
The research gold standard is the hyperinsulinaemic-euglycaemic clamp, which is not used clinically. In practice, fasting insulin with glucose (HOMA-IR) is the most direct routine test, while the triglyceride-to-HDL ratio, waist circumference, A1C, ALT and blood pressure together give a good picture with no insulin measurement at all; the triglyceride-glucose (TyG) index is another validated surrogate. An oral glucose tolerance test with insulin levels at each time point catches resistance that a fasting value misses. No single test is definitive, which is why guidelines diagnose prediabetes by glucose and A1C rather than by insulin.
What are the symptoms of high insulin?
Usually none; insulin resistance is silent until glucose rises. Clues include weight gain around the middle that is hard to shift, dark velvety skin on the neck or armpits (acanthosis nigricans), skin tags, strong hunger and energy slumps a few hours after carbohydrate-heavy meals, and in women irregular periods, acne or excess hair. If insulin is high because of an insulinoma or a medication, the symptoms are those of low blood sugar: sweating, shaking, confusion and fainting, typically when fasting or overnight.
How do I lower fasting insulin?
Lose abdominal fat (a 5 to 10 percent weight loss lowers HOMA-IR by 20 to 40 percent), exercise most days combining aerobic and resistance work, replace refined carbohydrates and sugary drinks with fibre-rich whole foods, sleep 7 to 9 hours and treat sleep apnea. These changes lower insulin within 2 to 12 weeks. Berberine and myo-inositol have moderate trial evidence for falls of about 2 to 3 µIU/mL and HOMA-IR reductions of around 1, mainly in people with diabetes, metabolic syndrome or PCOS. Metformin and GLP-1 medications lower it too and are discussed with your clinician when risk is high.
Can fasting insulin be too low?
With a normal glucose, no: a value of 2 to 4 µIU/mL means good insulin sensitivity, and endurance athletes and people on very low carbohydrate diets often sit there. It is a problem only when glucose is high, which means the pancreas cannot keep up, as in type 1 diabetes, LADA, long-standing type 2 diabetes or pancreatic disease; a C-peptide and islet antibodies sort these out. A haemolysed or poorly handled sample can also read falsely low.
Do I need to fast for an insulin test, and for how long?
Yes, 8 to 12 hours with water only. Any calories, including milk, cream or sugar in coffee, juice, gum or a protein shake, release insulin and can multiply the result several times, which is the single most common cause of a misleadingly high value. Avoid a fast longer than about 14 hours, which pushes insulin artificially low, and skip intense exercise the evening before. Mention any diabetes medication, steroids or recent illness, all of which shift the result.
References
- Insulin in blood. MedlinePlus, US National Library of Medicine (2023)View source
- Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia (1985)View source
- Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care (2004)View source
- Staten MA, Stern MP, Miller WG, Steffes MW, Campbell SE; Insulin Standardization Workgroup. Insulin assay standardization: leading to measures of insulin sensitivity and secretion for practical clinical care. Diabetes Care (2010)
- American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes: classification and diagnosis of diabetes. Diabetes Care (2024)
- Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine (2002)View source
- Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Annals of Internal Medicine (2012)
- Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport and Exercise Medicine (2017)
- Lan J, Zhao Y, Dong F, et al.. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. Journal of Ethnopharmacology (2015)
- Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections (2017)
- Insulinoma. Merck Manual Professional Version (2024)
- Prediabetes. Mayo Clinic (2023)View source
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