Insulin Resistance
Insulin resistance sits behind prediabetes, fatty liver and metabolic syndrome, and it is often marketed with an expensive blood test that adds little for most people.
Medically reviewed by the RIIMS medical team · Last updated: June 2026
Go to hospital now
- Symptoms of very high blood sugar developing quickly, such as excessive thirst, confusion, or fruity-smelling breath with vomiting
See a doctor soon (not an emergency)
- Fatty liver found on a scan with abnormal liver enzymes
- A rising HbA1c or lipid profile on repeat testing
- New skin darkening at the neck or armpits
What is insulin resistance, and should I get a HOMA-IR test?
Insulin resistance means the body's cells respond less well to insulin, so the pancreas has to produce more of it to keep blood sugar normal, often years before blood sugar itself rises. It sits upstream of prediabetes, type 2 diabetes, metabolic syndrome and fatty liver, which is why it gets talked about often, sometimes with a specific blood test attached, HOMA-IR or a fasting insulin level. It is worth being clear about what these tests actually are: research tools, used to compare groups in studies, not routine diagnostic tests with an agreed cut-off for an individual Indian patient. No validated Indian cut-off for HOMA-IR exists, cut-offs used in published Indian studies vary depending on who was studied, and these tests are also marketed, sometimes as part of expensive health-check packages, in a way the evidence does not support. A more useful approach is to look at the consequences of insulin resistance directly: waist circumference, HbA1c, a lipid profile, blood pressure and liver enzymes or an ultrasound for fatty liver. These five together tell you more about your actual risk than a HOMA-IR number would, and they are all tests with established, useful reference ranges.
Symptoms to watch for
- Often no symptoms at all
- A large waist despite a near-normal weight
- Darkened, velvety skin at the neck or armpits (acanthosis nigricans)
- Fatigue after meals
- Fatty liver found on an ultrasound
- Skin tags, in some people
When to consult a doctor
If you have a large waist, fatty liver, or a family history of diabetes, ask for HbA1c, a lipid profile and blood pressure check rather than a HOMA-IR test. These tests tell your doctor more about what to do next.