Of the lipid panel, triglycerides tend to be the most specific marker of insulin resistance. High blood levels of insulin cause the liver to produce very low-density lipoprotein triglyceride (VLDL-TG). If TG are high in the fasting state, this indicates insulin resistance, and when triglycerides are too high their transfer to the HDL particles causes the HDL count to drop. Because the natural range of TG is fairly wide and context-dependent, the value of this single measurement is disputed, fasting TG/HDL ratio is taken as the more sensitive marker.
Perhaps TG/HDL ratio is the most cost effective marker, which can be used as a surrogate for insulin resistance along with a healthy dose of common sense!
The fasting TG/HDL ratio is highly correlated with 2-hour insulin (insulin levels 2 hours after consuming glucose) and, with a higher cut off, is also predictive of fasting hyperinsulinemia. Elevation in the ratio of TG to HDL-c was the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined.
People with the highest TG/HDL levels are 16 times more likely to suffer a heart attack.
So, calculating this ratio is not only a simple trick to measure insulin resistance but also a more-accurate heart disease risk assessment.
Ideally, you want no more than a 2:1 ratio of triglycerides to HDL cholesterol. So, if your triglycerides are 100 mg/dl, your HDL cholesterol should be 50 mg/dl.
Some insulin resistance: 2.0–3.0
Significant insulin resistance and heart disease risk is found at ratios >3.0