# LP-IR: An insulin resistance score from your cholesterol particles > LP-IR scores insulin resistance from 0 to 100 using your cholesterol particles. Check your score and see how it compares with HOMA-IR. - Also called LP-IR score and Lipoprotein insulin resistance index - Not on a standard checkup - Fast for 8 to 12 hours - Web page: https://picardo.health/guides/biomarkers/lp-ir ## The short answer LP-IR is a score from 0 to 100 that estimates insulin resistance from the size and number of the particles carrying fat in your blood. Higher means more insulin resistant.[1] Labcorp’s range is 45 or under.[6] - **A good result:** 45 or under, Labcorp’s range. That’s the middle score of a reference group without heart disease or diabetes, so it’s a lab category, not a target.[6] - **If yours is high:** It suggests insulin resistance, and higher scores have gone with more type 2 diabetes in large studies.[2][3] Check your fasting glucose and HbA1c. Losing weight lowers the score.[8] - **Should you test?** It comes with the NMR LipoProfile, so the same cholesterol test also gives you an estimate of insulin resistance.[1][5] Labcorp calls LP-IR one part of a clinical assessment, not a diagnosis.[6] ## What is a normal LP-IR level? No guideline sets a target for LP-IR. Labcorp’s report flags anything over 45, the middle score of its reference group, and shows where you sit against that group:[6] | Result (out of 100) | What it means | | --- | --- | | Under 27 | Low: an insulin-sensitive pattern | | 27 to 45 | Within the lab’s range | | 46 to 63 | Above the lab’s range | | 64 or more | High: the pattern that goes with insulin resistance | ### Low: an insulin-sensitive pattern **Range:** Under 27. Your particles look like those of people who respond well to insulin. Labcorp puts this in the lowest quarter of its reference group.[6] **How worried to be:** Nothing to worry about. **What to do next:** 1. Nothing to do. Your fasting glucose and HbA1c still decide whether you have prediabetes. ### Within the lab’s range **Range:** 27 to 45. Your score is at or below the middle of Labcorp’s reference group of people without heart disease or diabetes.[6] **How worried to be:** Nothing to worry about. **What to do next:** 1. Keep doing what you’re doing. ### Above the lab’s range **Range:** 46 to 63. Labcorp flags anything over 45, the middle score of its reference group, so your report will mark this as out of range. About half of that group scores higher than 45 too.[6] Your particles show some of the pattern that goes with insulin resistance.[1] **How worried to be:** Not a worry on its own. **What to do next:** 1. Check your fasting glucose and HbA1c to see whether your blood sugar is affected. Fasting insulin from the same draw adds a second rough estimate, HOMA-IR. 2. Look at your triglycerides and HDL on the same report. High triglycerides and low HDL often come with the same pattern.[1] [Test fasting glucose, insulin and HbA1c, $13.75](https://app.picardo.health/labs/order?tests=001032,004333,001453&ref=guide-lp-ir) Fast for at least 8 hours first. ### High: the pattern that goes with insulin resistance **Range:** 64 or higher. You’re in the top quarter of Labcorp’s reference group.[6] In the Women’s Health Study, each 23-point step up in LP-IR went with about twice the risk of type 2 diabetes over 20 years.[3] An inherited cause of high triglycerides can also push the score up without insulin resistance.[1] **How worried to be:** Worth acting on over the next few months. It isn’t urgent. **What to do next:** 1. Check your fasting glucose and HbA1c to see whether your blood sugar has started to rise. Fasting insulin from the same draw adds a second rough estimate, HOMA-IR. 2. Losing extra weight and being more active lower the score; see how to lower LP-IR below.[8] 3. Recheck after a few months of change, fasting each time.[6] [Test fasting glucose, insulin and HbA1c, $13.75](https://app.picardo.health/labs/order?tests=001032,004333,001453&ref=guide-lp-ir) Fast for at least 8 hours first. ## What is LP-IR? > Think of LP-IR as reading insulin resistance from its fingerprints. Rather than measuring insulin, it looks at the marks insulin resistance leaves on the particles that carry fat through your blood. People with insulin resistance tend to have more large VLDL particles, which carry triglycerides, more small LDL particles and fewer large HDL particles. Their VLDL particles also tend to be bigger, and their LDL and HDL particles smaller.[1] LP-IR combines those six measures, from an NMR cholesterol test, into one score. VLDL size and large VLDL count for the most.[1] It’s a lab-developed score, which the FDA hasn’t cleared.[5][6] ## How is LP-IR different from HOMA-IR? Both estimate insulin resistance; they just use different clues. In the study that built LP-IR, it tracked HOMA-IR and the clamp, the research gold standard, moderately well.[1] | | LP-IR | HOMA-IR | | --- | --- | --- | | What it uses | Six cholesterol particle measures | Fasting insulin and glucose | | Needs an insulin test | No | Yes | | On your lab report | Yes, on the NMR LipoProfile | No, you work it out | | Guideline cutoffs | None | None | From the papers that built LP-IR and Labcorp’s report.[1][6] ## Does LP-IR predict diabetes? In large studies, yes. In a US study of 5,314 adults without diabetes, people in the top quarter of LP-IR were about 3.3 times as likely to develop type 2 diabetes over about 8 years as those in the bottom quarter. After allowing for their fasting glucose, they were about twice as likely.[2] In the Women’s Health Study, which followed 25,925 women for 20 years, each 23-point step up went with about twice the risk of diabetes. Allowing for HbA1c, cholesterol and inflammation, it was about 1.4 times.[3] For the heart, the evidence is thinner. In a Dutch study of 6,232 people published in 2024, LP-IR was linked to heart disease about as strongly as HOMA-IR.[4] ## What can throw off your LP-IR score? - Not fasting: Labcorp says the score isn’t accurate after a meal.[6] - An inherited cause of high triglycerides, which can raise the score without insulin resistance.[1] - Niacin, which can lower the score while insulin resistance gets worse.[1] ## How to lower LP-IR - **Losing weight with exercise:** In a small study of 30 adults with no comparison group, losing about 9% of body weight over 10 weeks on a meal-replacement diet with supervised aerobic exercise lowered LP-IR by about 12 points.[8] How much it helps: some. How sure we are: early evidence. - **Fewer carbohydrates:** In a 20-week feeding trial after weight loss, a low-carb diet lowered LP-IR by about 5 points. On a high-carb diet it rose by about 4, a change that could have been chance. LDL cholesterol didn’t differ between the diets.[9] How much it helps: a little. How sure we are: fairly sure. LP-IR follows insulin resistance, so what improves insulin resistance, such as losing extra weight and being more active, should bring it down. Recheck after a few months, fasting each time.[6][8] ## Who should get an LP-IR test? LP-IR comes with the NMR LipoProfile, an advanced cholesterol test that also reports LDL particle number.[5] US guidelines don’t use advanced lipoprotein tests, NMR included, to estimate heart risk or decide whether to start treatment,[7] so read LP-IR as a sign of insulin resistance rather than of heart risk. It adds the most if you’re having the NMR test anyway and want an estimate of insulin resistance without a separate insulin test.[4] It’s less useful if you have an inherited cause of high triglycerides or take niacin.[1] ## How to get an LP-IR test, and what it costs It comes from the NMR LipoProfile, which costs $37.00 through Picardo. The Heart Health panel adds 16 more tests from the same visit for $150.90. - **Recommended:** [the Heart Health panel, $150.90](https://app.picardo.health/labs/order?panels=heart-health&ref=guide-lp-ir). 17 tests, fast for 12 hours first. The panel includes this test and adds fasting insulin and glucose for HOMA-IR, HbA1c for your three-month blood sugar, ApoB and Lp(a), plus kidney and liver tests. [What’s in it](https://picardo.health/guides/panels/heart-health.md). - [NMR LipoProfile, $37.00](https://app.picardo.health/labs/order?tests=123638&ref=guide-lp-ir). The test this number comes from. Labcorp 123638, fast for 8 to 12 hours. Every order comes with: - Results in 2 to 3 days, in the app - Physician follow-up if you want one - Free Labcorp draw, or $75 at home - No other fees. HSA and FSA eligible. It’s also part of the [Base Core Annual – Men](https://picardo.health/labs/panels/base-core-men) and [Base Core Annual – Women](https://picardo.health/labs/panels/base-core-women) panels, if you want a wider checkup. Already have a result? [Ask Picardo about it](https://app.picardo.health/auth). ## Questions people ask ### Is the triglyceride-to-HDL ratio as good as LP-IR? Not quite, for diabetes. LP-IR tracked insulin resistance a little better than the ratio,[1] and in a large US study it still predicted diabetes after allowing for the ratio, but not the other way round.[2] For heart disease, a 2024 Dutch study found the two about equally linked, and its authors suggested the ratio may be enough in practice.[4] You can work out the ratio from a standard cholesterol test. ### Do I need to fast for an LP-IR test? Yes, for 8 to 12 hours. Labcorp says the score isn’t accurate if you haven’t fasted.[5][6] ### Is LP-IR the same as HOMA-IR? No. HOMA-IR uses insulin and glucose; LP-IR uses cholesterol particles and needs no insulin test. In the study that built it, the two tracked each other only moderately.[1] ### Why is my LP-IR high when my blood sugar is normal? Changes in fat-carrying particles are among the earliest signs of insulin resistance, often well before blood sugar rises.[1] An inherited cause of high triglycerides can raise the score too.[1] ### Is LP-IR FDA-approved? No. It’s a lab-developed score, and the FDA hasn’t cleared it.[6] ## Often checked alongside - [HOMA-IR](https://picardo.health/guides/biomarkers/homa-ir.md): An insulin resistance score from glucose and insulin - [Fasting insulin](https://picardo.health/guides/biomarkers/fasting-insulin.md): An early sign of insulin resistance - [LDL particle number](https://picardo.health/guides/biomarkers/ldl-particle-number.md): How many LDL particles you have - [Triglycerides](https://picardo.health/guides/biomarkers/triglycerides.md): Blood fats that rise with sugar and alcohol ## Test details - **Labcorp test:** NMR LipoProfile® With Lipids and Insulin Resistance Markers (With Graph), 123638 - **LOINC:** 62255-5 - **Sample:** Blood - **Fasting:** 8 to 12 hours[5] - **Typical lab range:** 45 or under, on a scale of 0 to 100[6] - **Units:** None. It’s a score from 0 to 100.[1] - **Method:** NMR spectroscopy[5] ## Sources 1. Shalaurova I, Connelly MA, Garvey WT, Otvos JD. Lipoprotein insulin resistance index: a lipoprotein particle-derived measure of insulin resistance. Metab Syndr Relat Disord. 2014;12(8):422–429. https://doi.org/10.1089/met.2014.0050 2. Mackey RH, Mora S, Bertoni AG, et al. Lipoprotein particles and incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis. Diabetes Care. 2015;38(4):628–636. https://doi.org/10.2337/dc14-0645 3. Harada PHN, Demler OV, Dugani SB, et al. Lipoprotein insulin resistance score and risk of incident diabetes during extended follow-up of 20 years: the Women’s Health Study. J Clin Lipidol. 2017;11(5):1257–1267.e2. https://doi.org/10.1016/j.jacl.2017.06.008 4. Flores-Guerrero JL, Been RA, Shalaurova I, et al. Triglyceride/HDL cholesterol ratio and lipoprotein insulin resistance score: associations with subclinical atherosclerosis and incident cardiovascular disease. Clin Chim Acta. 2024;553:117737. https://doi.org/10.1016/j.cca.2023.117737 5. Labcorp. NMR LipoProfile with lipids and insulin resistance markers (with graph), test 123638. Labcorp test menu. Accessed October 28, 2026. https://www.labcorp.com/tests/123638/nmr-lipoprofile-with-lipids-and-insulin-resistance-markers-with-graph 6. Labcorp. Sample report, NMR LipoProfile with lipids and insulin resistance markers (with graph), test 123638. September 2026. Accessed October 28, 2026. https://files.labcorp.com/testmenu-d8/sample_reports/123638_0.pdf 7. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154–e1276. https://doi.org/10.1161/CIR.0000000000001423 8. Grammer EE, McGee JE, Bartlett AN, et al. Effects of weight loss and weight maintenance on lipoprotein insulin resistance scores in adults with overweight and obesity. Metab Syndr Relat Disord. 2024;22(8):598–607. https://doi.org/10.1089/met.2023.0180 9. Ebbeling CB, Knapp A, Johnson A, et al. Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia—a randomized controlled feeding trial. Am J Clin Nutr. 2022;115(1):154–162. https://doi.org/10.1093/ajcn/nqab287 Updated 2026-11-03. This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.