High homocysteine is an emerging area of research relating to insulin and glucose so may also be an indicator. I believe this to bee related to serious renal, cardiovascular and vascular dementia developments in those with diabetes so any early detection of homocysteine (not regularly tested) would also be good. If homocysteine is high then folate and b12 depletion and transsulphuration may be related it says on a pathology report I read. My father was diabetic and developed vascular dementia and had vascular related heart bypass. Sorry it was not directly related to HOMA-IR but maybe another indicator. Doing a month trial to increase the particular B vitamins to see if it reduces homocysteine. MTHFR gene mutation may also be related as it can cause low B12 an folate. My father had this gene mutation and developed type 2 diabetes.
Interesting information. My Fasting Insulin level is 2.9 (in optimal range), but my Hemoglobin A1c is 5.7, which is considered high/pre diabetes. How can both be true? I calculated my HOMA-IR to be .6516, so it appears my pancreas is doing its job.
Hi Laurel. I’ve had patients with this exact scenario. You can be insulin-sensitive and still see your A1c drift higher. Fasting insulin and A1c measure very different things, one captures a quiet moment, the other captures your whole day. When fasting insulin is low but A1c is elevated, it usually reflects patterns in how glucose rises and falls across daily life.
Here are the most common reasons this mismatch shows up:
1. Constant grazing.
If you’re nibbling all day, meals, snacks, bites, sips, glucose never fully returns to baseline. Even small rises, repeated over and over, lift the average.
2. Higher or longer post-meal spikes.
You can be insulin-sensitive but still see bigger spikes after meals if they’re low in fiber or protein, or if carbs digest quickly.
3. Eating late in the evening.
Insulin sensitivity drops at night. A meal handled well in the morning can push glucose higher and keep it there longer at night.
4. Stress and poor sleep.
Cortisol and fragmented sleep can nudge glucose up between meals and overnight, even with excellent insulin sensitivity.
5. Long sedentary stretches.
Sitting for hours reduces muscle glucose uptake. Glucose rises more easily through the day, even in someone active at other times.
6. Low muscle mass.
Muscle is the main glucose reservoir. Less muscle means less capacity to clear glucose after meals.
7. Menopause-related changes.
Lower estrogen affects sleep, stress regulation, and liver glucose output. Glucose can drift up despite good insulin sensitivity.
This is where a Continuous Glucose Monitor (CGM) becomes incredibly helpful. A CGM shows you the exact patterns your A1c is hinting at, the post-meal rises, the evening bumps, the late-night elevations, and whether glucose is actually dropping between meals. It helps pinpoint which of these patterns is driving the higher A1c so you can make targeted changes.
Thank you for such a detailed response! Since reading your posts, my husband and I have modified our eating and dieting habits. (Today's post re: Andria resonates!) Of the reasons listed, (self-induced) stress, poor sleep, and low estrogen are most likely the culprits. However, I will continue to add more fiber, protein, and weights as I work on (much) better sleep. Thanks, again.
Active B12 is also indicator of high homocysteine
Yes, it is. Did you have a question about homocysteine? That’s not HOMA-IR.
High homocysteine is an emerging area of research relating to insulin and glucose so may also be an indicator. I believe this to bee related to serious renal, cardiovascular and vascular dementia developments in those with diabetes so any early detection of homocysteine (not regularly tested) would also be good. If homocysteine is high then folate and b12 depletion and transsulphuration may be related it says on a pathology report I read. My father was diabetic and developed vascular dementia and had vascular related heart bypass. Sorry it was not directly related to HOMA-IR but maybe another indicator. Doing a month trial to increase the particular B vitamins to see if it reduces homocysteine. MTHFR gene mutation may also be related as it can cause low B12 an folate. My father had this gene mutation and developed type 2 diabetes.
Ah, thank you for sharing this insight!
Interesting information. My Fasting Insulin level is 2.9 (in optimal range), but my Hemoglobin A1c is 5.7, which is considered high/pre diabetes. How can both be true? I calculated my HOMA-IR to be .6516, so it appears my pancreas is doing its job.
As always...thanks for good, clear information.
Hi Laurel. I’ve had patients with this exact scenario. You can be insulin-sensitive and still see your A1c drift higher. Fasting insulin and A1c measure very different things, one captures a quiet moment, the other captures your whole day. When fasting insulin is low but A1c is elevated, it usually reflects patterns in how glucose rises and falls across daily life.
Here are the most common reasons this mismatch shows up:
1. Constant grazing.
If you’re nibbling all day, meals, snacks, bites, sips, glucose never fully returns to baseline. Even small rises, repeated over and over, lift the average.
2. Higher or longer post-meal spikes.
You can be insulin-sensitive but still see bigger spikes after meals if they’re low in fiber or protein, or if carbs digest quickly.
3. Eating late in the evening.
Insulin sensitivity drops at night. A meal handled well in the morning can push glucose higher and keep it there longer at night.
4. Stress and poor sleep.
Cortisol and fragmented sleep can nudge glucose up between meals and overnight, even with excellent insulin sensitivity.
5. Long sedentary stretches.
Sitting for hours reduces muscle glucose uptake. Glucose rises more easily through the day, even in someone active at other times.
6. Low muscle mass.
Muscle is the main glucose reservoir. Less muscle means less capacity to clear glucose after meals.
7. Menopause-related changes.
Lower estrogen affects sleep, stress regulation, and liver glucose output. Glucose can drift up despite good insulin sensitivity.
This is where a Continuous Glucose Monitor (CGM) becomes incredibly helpful. A CGM shows you the exact patterns your A1c is hinting at, the post-meal rises, the evening bumps, the late-night elevations, and whether glucose is actually dropping between meals. It helps pinpoint which of these patterns is driving the higher A1c so you can make targeted changes.
Thank you for such a detailed response! Since reading your posts, my husband and I have modified our eating and dieting habits. (Today's post re: Andria resonates!) Of the reasons listed, (self-induced) stress, poor sleep, and low estrogen are most likely the culprits. However, I will continue to add more fiber, protein, and weights as I work on (much) better sleep. Thanks, again.
You are welcome. Let me know how it goes. A CGM could also be very helpful.
I was just looking at them online. Something to consider.
If you do this article could help. https://open.substack.com/pub/drlauriemarbas/p/what-continuous-glucose-monitors?r=3ufxse&utm_campaign=post&utm_medium=web&showWelcomeOnShare=false
useful; like most I get just fasting glucose and A1C. These are creeping up so I think fasting insulin must be also but more data is good
Hi Patrick. Glad this brought a new perspective on your labs.