What does an elevated insulin level of 44 microunits per milliliter (μU/mL) indicate?

What Does an Insulin Level of 44 μU/mL Mean?

An insulin level of 44 μU/mL is significantly elevated and indicates hyperinsulinemia, which most commonly reflects insulin resistance—a hallmark of metabolic syndrome, prediabetes, or type 2 diabetes—though the clinical significance depends critically on the concurrent glucose level and clinical context.

Interpreting the Value

Normal Reference Ranges

• Fasting insulin in healthy, normal-weight individuals: approximately 5-10 μU/mL 1, 2
• Borderline high: 15-20 μU/mL 1
• High: ≥20 μU/mL 1
• Your value of 44 μU/mL is more than double the threshold for "high" fasting insulin 1

Context Matters: When Was It Measured?

Fasting insulin of 44 μU/mL:

• This represents marked hyperinsulinemia suggesting significant insulin resistance 1
• In obese individuals, fasting insulin can increase by 50-100% above normal, but 44 μU/mL still represents substantial elevation 2
• This level is associated with increased risk for type 2 diabetes, cardiovascular disease, and metabolic syndrome 3, 4, 5

Post-glucose challenge (60 or 120 minutes after 75g glucose load):

• Normal 60-minute insulin: approximately 72 μU/mL 6
• Normal 120-minute insulin: approximately 45-63 μU/mL 2, 6
• If your 44 μU/mL was measured at 120 minutes post-glucose, this would be within normal range 2
• However, if measured at 60 minutes, this would be relatively low and could indicate delayed insulin secretion 6

Clinical Implications by Scenario

Most Likely: Insulin Resistance and Type 2 Diabetes Risk

If this is a fasting value with normal glucose (<100 mg/dL):

• You have significant insulin resistance with compensatory hyperinsulinemia 1
• The pancreas is overproducing insulin to maintain normal glucose levels 1
• This represents a prediabetic state even if glucose appears normal 5
• Critical point: Fasting hyperinsulinemia independently predicts progression to type 2 diabetes, even after accounting for insulin resistance 5

If this is a fasting value with elevated glucose (100-125 mg/dL):

• This confirms impaired fasting glucose with insulin resistance 1
• You meet criteria for prediabetes 1
• Risk of progression to diabetes is substantially elevated 5

If this is a fasting value with glucose ≥126 mg/dL:

• This pattern is consistent with type 2 diabetes 1
• The elevated insulin indicates relative (not absolute) insulin deficiency—the pancreas is producing insulin, but not enough to overcome resistance 1

Associated Metabolic Abnormalities

Expect to find:

• Elevated triglycerides: Hyperinsulinemia at this level is strongly associated with hypertriglyceridemia 4
• Low HDL cholesterol: Part of the insulin resistance syndrome 4
• Hypertension: Insulin resistance contributes to elevated blood pressure 1, 4
• Central obesity: Particularly abdominal fat distribution 1
• Acanthosis nigricans: Darkened, velvety skin in body folds (neck, armpits, groin) 1

Less Common: Insulinoma

Consider if:

• You have symptoms of hypoglycemia (confusion, sweating, palpitations, hunger) 1
• Glucose is low (<40-45 mg/dL) when insulin is measured 1
• Insulin level >3-6 μU/mL during documented hypoglycemia suggests insulinoma 1
• Insulin-to-glucose ratio ≥0.3 during hypoglycemia indicates inappropriate insulin secretion 1
• However: This diagnosis requires simultaneous low glucose and elevated insulin, not isolated insulin measurement 1

Health Risks of Sustained Hyperinsulinemia

Beyond glucose regulation, chronically elevated insulin at this level:

• Promotes obesity through increased lipogenesis and decreased lipolysis 3
• Increases cardiovascular disease risk independent of glucose levels 3, 4
• Accelerates atherosclerosis 3, 4
• May reduce lifespan and health span 3
• Impairs cellular defense mechanisms and autophagy 3

Important caveat: While insulin signaling for glucose uptake becomes impaired (insulin resistance), other insulin actions remain unrestricted—this selective resistance means hyperinsulinemia continues to drive harmful metabolic effects 3

Recommended Next Steps

Essential concurrent measurements:

• Fasting glucose and HbA1c to assess glycemic status 1
• Lipid panel (triglycerides, HDL, LDL cholesterol) 1, 4
• Blood pressure measurement 1, 4
• BMI and waist circumference 1

If prediabetes or diabetes confirmed:

• Aggressive lifestyle intervention is first-line: weight loss, dietary modification, increased physical activity 1
• Target weight reduction can improve insulin sensitivity 1
• Consider metformin if HbA1c ≥5.7% or other high-risk features 1

If hypoglycemia suspected:

• Measure C-peptide with simultaneous glucose during symptomatic episode 1
• Consider supervised 48-72 hour fast if insulinoma suspected 1