Fasting Insulin Test and HOMA-IR: Normal Range and Formula

Written by TSMC/FMR/36195 · Published: October 9th, 2026 · 15 min read · 34 references
Torn-paper collage of two engraved anatomical drawings: a side-on cross-section of a brain with the pituitary gland coloured blue, and a cross-section of a breast with its lobules and ducts tinted terracotta, joined by a gold arrow across a dotted field on a cream background.

HOMA-IR is your fasting insulin in µIU/mL multiplied by your fasting glucose in mg/dL, then divided by 405.1 In 21,684 healthy-weight adults, fasting insulin ran from 2.52 to 13.14 µIU/mL and HOMA-IR from 0.39 to 2.86.2 No agreed criteria turn either number into a diagnosis, and different insulin tests can read the same blood twofold apart.3, 4

So read your score beside your fasting glucose and HbA1c (your average blood sugar). With the 2-hour glucose tolerance test, these are the main tests used to diagnose prediabetes and diabetes.5 If your HOMA-IR sits near a cut-off, a repeat at the same laboratory is only worth doing when your doctor expects it to change the plan.6, 4, 7

How do you calculate HOMA-IR? Copy link

Take fasting insulin and fasting glucose from one blood draw, multiply them, and divide by 405 when glucose is in mg/dL.1 With glucose in mmol/L, divide by 22.5 instead.8

The two divisors are one formula in two unit systems. Glucose in mmol/L times 18 gives mg/dL, which is why the ADA pairs 126 mg/dL with 7.0 mmol/L.5 And 22.5 × 18 = 405.

Worked as arithmetic: an insulin of 12 µIU/mL and a glucose of 95 mg/dL give 12 × 95 ÷ 405 = 2.8.

HOMA-IR estimates insulin resistance from the balance between fasting glucose and fasting insulin, the state your body settles into when your muscle, liver and fat cells respond less to insulin. The model describes the overnight feedback loop between glucose and your own insulin. It does not directly measure how any one tissue takes up glucose.9, 10 In the 1985 paper that introduced it, the estimate tracked the euglycemic clamp, a reference research method for insulin sensitivity, with a correlation of 0.88.9, 1 A correlation of 1.0 would mean the two rose and fell together perfectly, not that they gave the same numbers. The same paper put the precision of one estimate at a coefficient of variation, a measure of scatter, of 31%.9

If you inject insulin, do not calculate HOMA-IR, and do not read one off a report on its own. The model assumes the insulin in the sample came from your pancreas, in a loop with your glucose. Injected insulin breaks that assumption, and insulin assays measure insulin medicines differently.9, 11

HOMA-IR formula: fasting insulin (µIU/mL) × fasting glucose (mg/dL) ÷ 405, worked example 2.8 HOMA-IR equals fasting insulin in micro-international units per milliliter multiplied by fasting glucose in milligrams per deciliter, divided by 405. Worked example as arithmetic: 12 times 95 divided by 405 equals 2.8. If glucose is in millimoles per liter, divide by 22.5 instead. If insulin is in picomoles per liter, divide it by 6 first. HOW TO CALCULATE The HOMA-IR formula fasting insulin (µIU/mL) × fasting glucose (mg/dL) 405 12 insulin µIU/mL × 95 glucose mg/dL ÷ 405 divisor = 2.8 HOMA-IR Glucose in mmol/L: divide by 22.5 Insulin in pmol/L: divide by 6 first Formula and units: refs 1, 3, 8. The example is arithmetic, not a patient.
Figure 1. How to calculate HOMA-IR: fasting insulin (µIU/mL) multiplied by fasting glucose (mg/dL), divided by 405. The worked example (12 × 95 ÷ 405 = 2.8) is arithmetic, not a patient. With glucose in mmol/L the divisor is 22.5; insulin reported in pmol/L is divided by 6 first. References 1, 3 and 8.

Check the units before you multiply. µIU/mL, µU/mL and mIU/L are one number written three ways, since a micro-unit per milliliter equals a milli-unit per liter (arithmetic). If your report gives insulin in pmol/L, divide by 6 first. A 2010 expert group on insulin testing wrote 12 pmol/L as about 2 µU/mL, the same factor of 6.3 Skip that step and the score comes out six times too high.

Some reports print HOMA2-IR, which comes from a computer version of the model that its authors described in 1998.12 The computer model has been used less widely than the formula.10 It is a different, non-linear model, so a HOMA2 result cannot be read against HOMA1 cut-offs. In 75 healthy controls in Puducherry, the median was 1.51 by HOMA2 and 2.67 by the formula.8 Some reports add a figure for insulin sensitivity, HOMA2-%S. In the Nepal study it ran from 58.83% to 233.20% in healthy adults.13 Check which version your laboratory used before you hold your number against any cut-off.

What is a normal HOMA-IR? Copy link

There is no single normal HOMA-IR. Three recent studies put the top of the reference interval, the range covering 95% of healthy people, at 2.35, 2.86 and 3.50.14, 2, 13

The three measured different people. The 2.35 came from 1,065 strictly screened German adults. The 2.86 came from 21,684 Brazilian adults, 86% of them women, and the 3.50 from 135 healthy adults of normal weight in Nepal.14, 2, 13 Each also used its own insulin assay, the kit that measures the hormone.

Studies that set the line by metabolic syndrome, a cluster of heart-risk findings, land somewhere else. A Spanish population study of 2,459 adults put the cut-off for men without diabetes at 2.05 by one metabolic syndrome definition and 1.85 by another. Its cut-offs also shifted with sex and age, and the 3.46 it compared them with was an earlier 90th-percentile line, the top tenth of scores.15 Indian studies have proposed 2.86 in 150 adults in Puducherry, 1.23 in 192 adults around Madurai and 2.5 in 691 urban adolescents.8, 16, 17

Laboratory pages draw their own lines too. Five Indian laboratory and hospital pages read on 7 October 2026 put the top of normal anywhere from 1.4 to 2.5.18 In 2010 the same expert group on insulin testing wrote that no criteria exist to classify an individual as insulin sensitive or insulin resistant.3

Published reference intervals and cut-offs for fasting insulin and HOMA-IR. Reference intervals describe healthy people; cut-offs were chosen to separate people with and without metabolic syndrome. Each study used its own insulin assay.
StudyWho was measuredFasting insulin (µIU/mL)HOMA-IR lineWhat the line is
Germany, 20211,065 strictly screened adults aged 35 to 74Not reported here2.35 (median 1.09)Upper limit of the reference interval
Brazil, 202421,684 adults aged 20 to 60, healthy weight, normal glucose and lipids2.52 to 13.140.39 to 2.8695% reference interval
Nepal, 2026135 healthy adults aged 20 to 69, BMI 18.5 to 24.92.63 to 14.560.56 to 3.50 (HOMA2: 0.30 to 1.70)95% reference interval
Spain, 20132,459 adults from the general populationNot reported here2.05 in men without diabetes (IDF definition); 1.85 by the ATP III definition; varies with sex and ageMetabolic syndrome cut-off
Puducherry, 2020150 adults, half with metabolic syndromeNot reported here2.86Metabolic syndrome cut-off
Madurai, 2023192 adults from a hospital checkup and a nearby villageNot reported here1.23Metabolic syndrome cut-off
Urban India, 2013691 adolescentsNot reported here2.5Metabolic syndrome cut-off
Mumbai, 20261,313 people aged 16 to 2515 or more counted as highAbove 2.5 counted as insulin resistantLines used for a prevalence count
HOMA-IR normal range: healthy upper limits 2.35, 2.86 and 3.50; Indian cut-offs 1.23, 2.5 and 2.86 Dot plot on a HOMA-IR scale from 0 to 4. Upper limits of healthy reference intervals: 2.35 in Germany (2021), 2.86 in Brazil (2024) and 3.50 in Nepal (2026). Metabolic syndrome cut-offs from Indian studies: 1.23 in Madurai (2023), 2.5 in urban adolescents (2013) and 2.86 in Puducherry (2020). A shaded band from 1.4 to 2.5 marks where five Indian laboratory and hospital pages put the top of normal. HOMA-IR · PUBLISHED LINES Where the line falls Indian lab pages 1.4 to 2.5 Germany 2021 upper limit 2.35 Brazil 2024 upper limit 2.86 Nepal 2026 upper limit 3.50 Madurai 2023 cut-off 1.23 Adolescents 2013 cut-off 2.5 Puducherry 2020 cut-off 2.86 0 1 2 3 4 Green: healthy upper limits. Blue: metabolic syndrome cut-offs. Refs 2, 8, 13, 14, 16, 17, 18.
Figure 2. Where published studies put the HOMA-IR line, on one scale. Green dots are upper limits of healthy reference intervals (Germany 2.35, Brazil 2.86, Nepal 3.50); blue dots are metabolic syndrome cut-offs from Indian studies (1.23, 2.5, 2.86). The shaded band is the top of normal printed on five Indian laboratory and hospital pages, 1.4 to 2.5. The lines show how much studies differ; none is a diagnostic boundary. References 2, 8, 13, 14, 16, 17 and 18.

What does a HOMA-IR of 2, 3 or 4 mean?

Less than the number suggests. A HOMA-IR of 2 sits inside the three healthy reference intervals above. A 3 or a 4 sits past the upper limit proposed by one or more of them.14, 2, 13 None of those lines can tell you whether you have insulin resistance that matters. Each came from a different assay and a different population, and no threshold has been validated for diagnosis or treatment decisions.3, 15

Risk climbs with the score, without a clean threshold. In a Korean study that followed 4,314 adults without diabetes, the top third of HOMA-IR had 1.86 times the odds of new type 2 diabetes. That held regardless of HbA1c, and the authors called for more work on a cut-off.19

Unsurprisingly, people with metabolic syndrome scored higher. In two South Indian studies they had a median of 4.63 and a mean of 6.56.8, 1

What is a normal fasting insulin level? Copy link

Healthy adults in reference studies sit between about 2.5 and 13 to 15 µIU/mL. The Brazilian study found 2.52 to 13.14 µIU/mL, and a 2026 study of healthy Nepali adults of normal weight found 2.63 to 14.56, with a median of 7.69.2, 13

Indian laboratory pages can print a far wider interval, such as 2 to 25 or 2.6 to 24.9 µIU/mL.18 An insulin of 18 can therefore arrive marked normal while sitting above the top of both healthy reference intervals. MedlinePlus adds that ranges vary between laboratories, and that a result outside the usual range need not mean a condition that needs treatment.11

A low fasting insulin is not automatically abnormal. With a low or normal glucose it can be what a healthy pancreas does, and some commercial assays perform poorly near 2 µIU/mL.3 Low insulin beside a high glucose is different. MedlinePlus says it can mean the pancreas is not making enough insulin, as in type 1 diabetes or pancreatitis, and your doctor may add a C-peptide test.11

Fasting insulin normal range: 2.52 to 13.14 and 2.63 to 14.56 µIU/mL in healthy adults; 2 to 25 on Indian lab pages Three horizontal bars on a linear scale from 0 to 25 micro-international units per milliliter. Healthy adults, Brazil 2024: 2.52 to 13.14. Healthy adults, Nepal 2026: 2.63 to 14.56. Interval printed on Indian laboratory pages: 2 to 25. A dashed vertical line at 15 marks the line a 2026 Mumbai study used for high fasting insulin. FASTING INSULIN · µIU/mL Fasting insulin ranges Healthy adults, Brazil 2.52 13.14 Healthy adults, Nepal 2.63 14.56 Indian lab pages 2 25 0 5 10 15 20 25 15: Mumbai 2026 high line Bars: 95% reference intervals (refs 2, 13). Lab pages and the 15 line: refs 18, 20.
Figure 3. Fasting insulin normal range in two healthy-adult reference studies (2.52 to 13.14 and 2.63 to 14.56 µIU/mL) beside the 2 to 25 µIU/mL interval printed on Indian laboratory pages. The dashed line marks 15 µIU/mL, the line a 2026 Mumbai study used for high fasting insulin. Linear scale. References 2, 13, 18 and 20.

In one Mumbai study, high readings were common even in young adults who were not overweight. The 2026 study measured 1,313 people aged 16 to 25. It counted hyperinsulinemia, meaning too much insulin in the blood, as a fasting insulin of 15 or more or a high value after a glucose drink.20

How common it was is unclear. The abstract gives one prevalence, the paper's own group counts add up to about a third, and the groups do not sum to the whole sample. The exact figure is uncertain.20 The study also used a HOMA-IR above 2.5 as its working line for insulin resistance, with no clinical standing beyond that paper. By that line, 17.3% qualified, and a third of them were neither overweight nor obese.20

What is a normal insulin level for a woman?

About the same as for a man. In the Brazilian study, fasting insulin ran 2.54 to 13.30 µIU/mL in women and 2.43 to 11.89 in men. The authors judged separate ranges unjustified.2 The German study found no significant difference in HOMA-IR between men and women either.14

Why can the same blood give two different HOMA-IR results? Copy link

Because laboratories measure insulin with different assays, and the assays disagree. When 11 commercial insulin assays ran the same 150 samples, their results varied by a factor of two.4

Newer comparisons have not closed the gap. A 2017 test of eight assays found a 1.8-fold spread between the lowest and highest median results.21 In a German comparison of three assays, the calculated HOMA-IR shifted systematically from one assay to the next.14

In 2025, twelve widely used assays from nine manufacturers were checked against a reference method, mass spectrometry, that identifies insulin by its molecular weight. Only one agreed with it fully, although every one claimed to be calibrated to the same WHO insulin standard.22

As arithmetic, take a fasting glucose of 95 mg/dL. An insulin read as 8.1 µIU/mL gives a HOMA-IR of 1.9. Read 1.8 times higher, at 14.6, the same blood gives 3.4, with nothing changed in you.

HOMA-IR from the same blood on two insulin assays: 1.9 and 3.4 when the assays differ 1.8-fold Schematic. One blood sample with a fasting glucose of 95 mg/dL is measured on two insulin assays that read 1.8-fold apart. Assay A reads insulin 8.1 µIU/mL, giving HOMA-IR 1.9. Assay B reads 14.6 µIU/mL, giving HOMA-IR 3.4. On a scale from 0 to 4, the first sits below a 2.5 line and the second above it. Arithmetic, not a patient. WHY RESULTS DIFFER Same blood, two scores Assay A 8.1 µIU/mL HOMA-IR 1.9 Assay B 14.6 µIU/mL HOMA-IR 3.4 2.5 line 0 1 2 3 4 Glucose 95 mg/dL in both. 1.8-fold assay spread: ref 21. Arithmetic, not a patient.
Figure 4. Schematic. The same blood (glucose 95 mg/dL) read on two insulin assays that differ 1.8-fold gives insulin of 8.1 or 14.6 µIU/mL, and HOMA-IR of 1.9 or 3.4. Arithmetic, not a patient; the 1.8-fold spread is from a comparison of eight assays. Reference 21.

Your own insulin moves as well. Postmenopausal women with diet-controlled type 2 diabetes gave a fasting sample every four days, ten times over. For a repeat HOMA-IR to count as a real change, it had to rise by more than 90% or fall by more than 47%.6 In overweight women with PCOS, the thresholds were a 322% rise or a 31% fall.23 Both studies were small, with 12 patients each.

A difficult blood draw can drag insulin down too. Of 1,048 samples in one study, 4.5% were hemolyzed, meaning red cells had burst in the tube. In paired samples, insulin read 25% to 98% lower in the hemolyzed tube.24

In practice, compare your result only with the interval printed on the same report, as you would for any other blood test. If a borderline score is repeated, use the same laboratory and the same length of fast, and treat a small move as unproven. Laboratory guidelines do not recommend routine insulin testing for most people at risk of diabetes, so a repeat is a decision for your doctor.7

Is HOMA-IR better than HbA1c? Copy link

For diagnosis, no. Glucose and HbA1c diagnose prediabetes and diabetes, and an insulin test is not normally used for that.5, 11

These are the 2026 ADA lines for diabetes, with the prediabetes band where one exists:5

  • an HbA1c result of 6.5% or higher (prediabetes 5.7 to 6.4%)
  • fasting glucose: 126 mg/dL or higher (prediabetes 100 to 125)
  • the 2-hour reading on a glucose tolerance test: 200 mg/dL or higher (prediabetes 140 to 199)
  • random glucose, taken at any time of day: 200 mg/dL or higher, counted only with classic symptoms such as heavy thirst and frequent urination, or in a hyperglycemic crisis (a diabetes emergency)

Unless high blood sugar is unequivocal, as in a hyperglycemic crisis, one diabetes-range result is not enough. The ADA asks for two abnormal results, from two different tests or from the same test on two occasions.5

So a normal fasting sugar sits below 100 mg/dL. Insulin appears nowhere in those criteria.

Where HOMA can help is timing. In the Whitehall II study of 6,538 British civil servants, insulin sensitivity measured by HOMA fell steeply over the five years before diabetes was diagnosed.25 Fasting glucose rose steeply only in the last three years, from 5.79 to 7.40 mmol/L.25 That cohort was 91% white, and whether Indians show the same lead time was not tested.

An older study points the same way. In 155 people whose parents both had type 2 diabetes, lower insulin sensitivity was detectable more than a decade before diagnosis. It was measured with an intravenous glucose test.26

Whatever the score, an unremarkable HOMA-IR does not override an abnormal fasting glucose, HbA1c or glucose tolerance result. Those are the tests the diagnosis rests on.5

Researchers have also proposed that South Asians secrete less insulin to begin with. It remains a hypothesis built on emerging data.27

Why don't doctors routinely order a fasting insulin test? Copy link

Its main established job is narrow. MedlinePlus lists finding the cause of low blood glucose as the main reason for insulin testing, and notes that diabetes is diagnosed with glucose tests.11

The 2023 international guideline on PCOS says available insulin assays are of limited clinical relevance. It does not recommend them in routine care.28 A global consensus renamed the condition polyendocrine metabolic ovarian syndrome (PMOS) in May 2026, with a three-year transition to the new name.29, 30 For glucose status in PCOS, the guideline prefers the oral glucose tolerance test, taken with a 75-g glucose drink, which it calls the most accurate check.28

Even the model's authors are cautious. Their 2004 review gives cohort and population studies as examples of appropriate use, and warns that the input data must be reliable.10

The ADA's screening rules also point to glucose tests. They say testing should be considered in adults of Asian ancestry with a BMI of 23 or more who carry a risk factor. Listed risk factors include diabetes in a close relative (parent, sibling or child), PCOS, acanthosis nigricans (dark velvety skin folds) and fatty liver disease.5

Some people who inject insulin develop antibodies against it, and those antibodies can interfere with the test.11 The ADA reserves C-peptide, a by-product of the insulin your own pancreas makes, for classifying diabetes in people already taking insulin.5, 11

How do you prepare for a fasting insulin test? Copy link

Fast for 8 to 12 hours before the draw, following your laboratory's instructions.11 The rest fits on one checklist:

  • ask the laboratory whether plain water is allowed during the fast
  • tell the laboratory if you take biotin or a supplement that contains it, especially a high dose; MedlinePlus says to stop it at least a day before, and your laboratory may ask for longer11
  • if you use insulin, mention it to your doctor and to the laboratory, and stop no medicine unless your doctor says so11
  • for HOMA-IR, have insulin and glucose taken from the same fasting sample, since the model works from that single sample10

If the laboratory flags the sample as hemolyzed, the insulin result may read falsely low, and a repeat sample may be needed.24

HOMA-IR test price in India Copy link

On 7 October 2026, Sapiens read the public booking pages of eight private providers. They listed a HOMA-IR package at ₹582 to ₹2,004, depending on provider and city. Most listed prices fell between ₹900 and ₹1,400, and one page showed a struck-through list price (MRP) of ₹4,072.18 The packages listed five to seven parameters, built around fasting glucose, fasting insulin and the calculated score.18 These are Sapiens' own observations, and provider names are not published here.

Government rates are lower. India's Central Government Health Scheme (CGHS) issued a rate list effective 13 October 2025. On it, an insulin test is reimbursed at ₹500 at accredited facilities in Tier I cities. Non-accredited ones get ₹425. A fasting glucose is ₹40 at the accredited rate.31 Tier II cities get rates 10% lower, and Tier III cities 20% lower.31 These are reimbursement ceilings for government beneficiaries, and a private laboratory charges whatever it lists.

An HbA1c is ₹300 on the same list. Insulin, fasting glucose and HbA1c together come to ₹840 at accredited Tier I rates (arithmetic). That is a sum of reimbursement rates. No provider sells it as a package at that price.31

What should you do about a high HOMA-IR? Copy link

Your glucose and HbA1c come first. A result in the prediabetes range sets the plan. A diabetes-range result needs a confirming second result, and HOMA-IR plays no part in that step. If both tests are normal, a high HOMA-IR flags risk without diagnosing anything.5, 19, 3

Ask your doctor whether a repeat of a borderline score, at the same laboratory, would change anything. If not, skip it.6, 4, 7 If you have PCOS, ask for the oral glucose tolerance test the guideline prefers.28

Then work on the habits that lower diabetes risk. The Indian Diabetes Prevention Programme followed 531 adults with impaired glucose tolerance, meaning a raised two-hour glucose result, for a median of 30 months.32 Three-year diabetes incidence was 39.3% with lifestyle advice against 55.0% in the control group. Metformin alone did about as well, at 40.5%. Combining the two did no better, at 39.5%.32

For PCOS, the international guideline says metformin should be considered in adults whose BMI is 25 or above, for outcomes that include insulin resistance.28

The ADA and PCOS guidelines set no retest interval for HOMA-IR. For glucose tests, the ADA advises yearly testing with prediabetes and, from age 35, at least every three years otherwise.5

Can insulin resistance be estimated without an insulin test? Copy link

Partly, from a fasting glucose and a lipid profile. The TyG index combines fasting triglycerides with fasting glucose in a logarithmic formula. It was proposed in 2008 as a stand-in that needs no insulin measurement.33

Indian data on these scores are recent and small. In 312 adults at an Indian hospital, TyG separated people with and without metabolic syndrome slightly better than HOMA-IR. Its AUC, a 0-to-1 score where 1.0 means perfect separation, was 0.85 against 0.81.34 Around Madurai, in 151 adults over 30, a lipid-and-BMI score called SPISE did about as well as HOMA-IR. Both AUCs were modest, at 0.66 for SPISE and 0.64 for HOMA-IR.1

These are research scores, and none of them measures insulin. The Indian studies tested how well they pick out metabolic syndrome, which is not the same as diagnosing insulin resistance in one person, and neither score replaces glucose and HbA1c screening.34, 1 In the original TyG study, the best cut-off caught 84% of people with insulin resistance but correctly cleared only 45% of those without it.33 Already have a lipid profile and a fasting glucose on file? Ask your doctor whether a TyG calculation answers the question before you pay for an insulin test.

Frequently asked questions Copy link

Does the HOMA-IR test need fasting?

Yes. Both inputs are fasting values, so the sample is drawn after 8 to 12 hours without food. Insulin and glucose come from that same draw. Insulin rises after you eat, so a sample taken after a meal cannot be scored with the HOMA-IR formula.11, 10

What if your fasting insulin level is high?

If your glucose and HbA1c are normal, a high fasting insulin can mean your pancreas is releasing extra insulin to hold glucose in range. That pattern can come with insulin resistance, but it cannot diagnose it. Let glucose and HbA1c carry the diagnostic weight. Repeat the insulin test only if your doctor thinks it would change the plan.11, 3, 5

What is a prediabetic fasting insulin level?

Prediabetes is defined by glucose, so no insulin level marks it. It means a fasting glucose of 100 to 125 mg/dL or an HbA1c of 5.7 to 6.4%. A 2-hour glucose tolerance result in the 140 to 199 mg/dL band also counts. Studies that flag high insulin use their own lines, such as 15 µIU/mL in a 2026 Mumbai study.5, 20

What does a very high insulin level point to?

It depends on your glucose. High insulin beside normal or high glucose usually reflects insulin resistance. High insulin with low glucose is a different pattern, investigated as a cause of hypoglycemia, and it needs prompt assessment by a doctor. Confusion, a fit or collapse with a low sugar is an emergency: treat the low sugar first, test later.11

Is HbA1c the same as fasting insulin?

No. HbA1c is a glucose test. Its lines are 5.7% for prediabetes and 6.5% for diabetes, and a diabetes-range result is normally confirmed. Fasting insulin measures the hormone that moves glucose into your cells, and it is not normally used to diagnose diabetes. HOMA-IR needs fasting insulin and fasting glucose from one sample. HbA1c measures longer-term blood sugar separately.5, 11

References Copy link

  1. Sreekumar S, Eagappan S, Raghavan KS, Sridhar S. Single point insulin sensitivity estimator as a marker of metabolic syndrome in a South Indian cohort. Indian J Med Res. 2026;163(5):593-597. doi:10.25259/ijmr_2608_2025
  2. Schrank Y, Fontes R, Perozo AFDF, et al. Proposal for fasting insulin and HOMA-IR reference intervals based on an extensive Brazilian laboratory database. Arch Endocrinol Metab. 2024;68:e230483. doi:10.20945/2359-4292-2023-0483
  3. 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;33(1):205-206. doi:10.2337/dc09-1206
  4. Manley SE, Stratton IM, Clark PM, Luzio SD. Comparison of 11 human insulin assays: implications for clinical investigation and research. Clin Chem. 2007;53(5):922-932. doi:10.1373/clinchem.2006.077784
  5. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49. doi:10.2337/dc26-S002
  6. Jayagopal V, Kilpatrick ES, Jennings PE, Hepburn DA, Atkin SL. Biological variation of homeostasis model assessment-derived insulin resistance in type 2 diabetes. Diabetes Care. 2002;25(11):2022-2025. doi:10.2337/diacare.25.11.2022
  7. Sacks DB, Arnold M, Bakris GL, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023;46(10):e151-e199. doi:10.2337/dci23-0036
  8. Endukuru CK, Gaur GS, Yerrabelli D, Sahoo J, Vairappan B. Cut-off Values and Clinical Utility of Surrogate Markers for Insulin Resistance and Beta-Cell Function to Identify Metabolic Syndrome and Its Components among Southern Indian Adults. J Obes Metab Syndr. 2020;29(4):281-291. doi:10.7570/jomes20071
  9. 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;28(7):412-419. doi:10.1007/BF00280883
  10. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27(6):1487-1495. doi:10.2337/diacare.27.6.1487
  11. MedlinePlus, National Library of Medicine. Insulin in Blood Test. Last updated 30 September 2026. medlineplus.gov
  12. Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998;21(12):2191-2192. doi:10.2337/diacare.21.12.2191
  13. Paudel P, Paudel P, Khanal A, Nagila A, Pokharel DR. Reference intervals for fasting insulin and insulin-related indices in healthy adults: a cross-sectional study in Gandaki Province, Nepal. BMJ Open. 2026;16(3):e109523. doi:10.1136/bmjopen-2025-109523
  14. Matli B, Schulz A, Koeck T, et al. Distribution of HOMA-IR in a population-based cohort and proposal for reference intervals. Clin Chem Lab Med. 2021;59(11):1844-1851. doi:10.1515/cclm-2021-0643
  15. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013;13:47. doi:10.1186/1472-6823-13-47
  16. Jog KS, Eagappan S, Santharam RK, Subbiah S. Comparison of Novel Biomarkers of Insulin Resistance With Homeostasis Model Assessment of Insulin Resistance, Its Correlation to Metabolic Syndrome in South Indian Population and Proposition of Population Specific Cutoffs for These Indices. Cureus. 2023;15(1):e33653. doi:10.7759/cureus.33653
  17. Singh Y, Garg MK, Tandon N, Marwaha RK. A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents. J Clin Res Pediatr Endocrinol. 2013;5(4):245-251. doi:10.4274/jcrpe.1127
  18. Unpublished Sapiens editorial observations, not independently verifiable from this reference. Read 7 October 2026 between 00:20 and 00:35 IST from the public booking pages of eight private diagnostic providers in India (HOMA-IR package list price; number of parameters where stated): provider 1, Hyderabad, ₹582 to ₹780 by centre; provider 2, Delhi NCR, ₹599, 7 parameters; provider 3, seven cities, ₹1,000, "starts at ₹600"; provider 4, ₹909 in Mumbai, Delhi, Gurgaon and Kolkata, ₹959 in Hyderabad, ₹1,289 in Bangalore, 5 parameters; provider 5, Delhi, ₹1,000, 5 parameters; provider 6, ₹1,300, quoting ₹1,000 to ₹1,400 by city; provider 7, Delhi, ₹1,360, 5 parameters; provider 8, ₹1,629 against a struck-through ₹4,072, ₹1,681 in Delhi and Gurgaon and ₹2,004 in Bangalore, Hyderabad and Chennai, 6 or 7 parameters. Ranges printed on five Indian laboratory and hospital pages the same day: fasting insulin 2 to 25 and 2.6 to 24.9 µIU/mL; top of the HOMA-IR normal range 1.4, 1.8, 1.9, 2.5 and 2.5. Provider names and URLs are withheld under Sapiens editorial policy and are held in the internal editorial ledger. Prices change. editorial standards
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  20. Moitra P, Madan J, Kalita S, Desai S, Udipi SA, Vaidya R. Prevalence of hyperinsulinemia and its association with measures of adiposity and body composition in 16-25-year-old adolescents and young adults in Mumbai. BMC Endocr Disord. 2026;26:117. doi:10.1186/s12902-026-02230-0
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This article is general health information for readers in India and does not diagnose anything. HOMA-IR and fasting insulin have no agreed diagnostic cut-off; read your result against the interval printed on your own report, with your doctor, alongside your glucose and HbA1c. Prices are the published rates and list prices described in the references, checked on 7 October 2026, and they change. Sapiens is operated by Pangaea Sciences Private Limited, Hyderabad. Report an error on this page.

Written by Dr. Tarun Reddy, MBBS · Registered medical practitioner (TSMC/FMR/36195) at Sapiens · Published 9 October 2026 · Editorial standards