What To Do When Your Labs Come Back “Normal” But You Still Feel Awful
The exact protocol I use once I have a HOMA-IR result in hand — thresholds, interventions, the treatment decision framework, and the conversation most physicians never have.
PAID SUBSCRIBER CONTENT · THE IR FILES · PART 2 OF 3
What To Do When Your Labs Come Back “Normal” But You Still Feel Awful
The exact protocol I use once I have a HOMA-IR result in hand — thresholds, interventions, the treatment decision framework, and the conversation most physicians never have.
By Dr. Herman Weiss, MD, MBA, FACOG — Board-Certified OB/GYN · 25 Years Clinical Practice
hweissmd · The Metabolic Fix · Paid Subscriber Article · May 2026
If you’ve read Part 1, you now know two things: that fasting insulin is the test that actually catches insulin resistance in PCOS, and that HOMA-IR is the metric that tells you how serious it is.
What you may not know is what to do with that number once you have it.
That’s what this article is. Not general advice about eating better and exercising more. The actual protocol — differentiated by phenotype, calibrated to your specific HOMA-IR result, and written the way I explain it to patients in my own clinic.
I’m going to walk you through four things: what each HOMA-IR threshold actually means clinically, which intervention belongs at which threshold, how I think through the metformin versus inositol versus GLP-1 decision, and what the right dietary architecture looks like for the insulin-resistant PCOS phenotype.
Read this carefully. Print it out if it helps. Bring it to your next appointment.
