INS and Insulin resistance: High homocysteine levels have been reported in diabetic patients,2,12 and elevated levels are a strong risk factor in these patients.1 The elevation occurs particularly in patients with type 2 diabetes, as well as in individuals in prediabetic states who exhibit insulin resistance.13 The levels of homocysteine in such individuals are also influenced by their insulin concentrations, and therapy with insulin and medications such as metformin and glitazones that can either raise or lower homocysteine levels.12