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More than half of women with PCOS are insulin resistance, and this places them at a higher risk of developing type 2 diabetes. What do you need to know about this if you have polycystic ovary syndrome?

Research has found that more than half of women who have polycystic ovary syndrome are insulin resistant — something that makes you more vulnerable to type 2 diabetes. If you've recently been diagnosed with PCOS, all of this is going to be pretty confusing. You may have no more than a vague idea of what insulin actually is, never mind the insights you need to stay as healthy as possible. 

What should all women with PCOS know about insulin resistance and type 2 diabetes?

1. First things first: What is insulin, exactly?

Produced by a part of the pancreas, insulin is an important hormone that helps regulate your blood sugar levels, together with another hormone called glucagon. It is released after you have a meal, playing a key role in allowing the glucose food is broken down into become available as energy to your cells. Insulin lowers your blood sugar levels during this process — except if you do not have enough of it, or your body isn't using your insulin effectively.  

2. Why is insulin resistance common in PCOS patients?

Insulin resistance is a term to describe a state in which your body no longer responds to insulin the way it should. This will cause your body to make even more insulin at first, but it cannot keep this up, and your blood sugar levels will eventually become higher than they should. This is called hyperglycemia. 

Not all women with PCOS will have insulin resistance — interestingly, there are actually different sub-types (phenotypes) of polycystic ovary syndrome. Many do, however, and this insulin resistance may even be a cause, rather than a consequence, of PCOS in some patients. Many women with PCOS are overweight or obese, and this too contributes to the risk of insulin resistance. 

If you have high insulin levels, you may notice:

  • Weight gain
  • Fatigue
  • Sugar cravings
  • Darker skin on the back of the neck, around the armpits, and in the genital region

High insulin levels also stimulate the excess production of androgens, "male" hormones, which can lead to or exacerbate typical PCOS symptoms like absent menstrual periods, irregular cycles, hirsutism (excess hair growth), oily skin, and acne. Should your insulin levels consistently stay high, you are also at an increased risk of developing type 2 diabetes. 

3. What should women with PCOS know about type 2 diabetes?

As a woman with PCOS, you have higher odds of ending up with type 2 diabetes as well as gestational diabetes (during pregnancy), especially if you are also overweight or obese. The reason can be found in insulin resistance. The good news is that there are some things you can do to lower your risk of diabetes:

  • Exercise regularly
  • Eating a healthy, balanced diet
  • Reducing stress levels

4. Women with PCOS should be screened for insulin resistance

You and your doctor will be better able to take proactive steps to manage your condition if you know exactly what is going on, and that is why women with PCOS should regularly be screened for insulin resistance.

Keep at it even if your blood sugar levels are initially completely fine, because problems can show up down the line and their timely diagnosis will give you the best chance at staying as healthy as possible. 

Tests your doctor may recommend include:

  • A fasting blood glucose test involves not eating or drinking for eight hours and then having a blood sample taken to determine your blood glucose (sugar) levels in this fasting state. 
  • During an oral glucose tolerance test, abbreviated to OGTT, you'll be offered glucose in the form of a drink, and blood tests will be done to determine how long it takes for your body to process the glucose. Blood glucose levels that stay up for longer periods of time can indicate insulin resistance.
  • Glycosylated hemoglobin A1C is a blood test that looks at your red blood cells to see how much glucose has bound to them, allowing your doctor to know what your blood sugar levels have been like for the last two or three months. 

You don't need to wait for your doctor to suggest screening for insulin resistance levels to you — if they haven't brought it up, feel free to ask whether you need these tests yourself. A glucometer, which monitors blood glucose levels before meals and after eating, is also available for home use to allow you to keep an eye on your blood sugar levels. 

5. Reducing insulin levels through diet: How?

Cutting down on sugars and starches in favor of more fiber-rich, low-carb, foods is a good first step. Many women with PCOS try a low glycemic index diet, eating foods that don't cause intense blood sugar ups and downs. While you will certainly benefit from working with a nutritionist to figure out your ideal diet, you can take simple steps by yourself, as well:

  • Added sugars — found in pretty much any processed food — lead to high insulin levels and contribute to insulin resistance. We know it's hard, but try to steer clear. 
  • Make your meals from scratch — the less comes out of a package, the better. 
  • Cut down in refined grains, which also cause higher insulin levels. 
  • You do need protein, but too much can contribute to obesity. 
  • Natural healthy fats, such as those found in avocado, fatty fish, and nuts, are actually good for your insulin levels.
  • Choose foods that will slowly give you energy over time, like bananas, avocado, oatmeal made from scratch (don't go for the processed versions!), or peanut butter. This will reduce blood sugar fluctuations.

6. Is metformin right for you?

Metformin (Glucophage) is a diabetes drug, but it is also prescribed to women with PCOS quite often. This drug contributes to regulating your blood sugar levels and increases your insulin sensitivity, lowering your odds of developing diabetes and making weight loss a lot easier as well. 

Your doctor will first make sure that metformin is suitable for you and continue to monitor your health regularly if you are prescribed the drug, which can be offered in liquid or pill form. Though your doctor will tell you how to take metformin, most people will take it twice or three times each day as they eat. 

7. Regular exercise: Can it prevent diabetes?

Women with PCOS are definitely advised to exercise, about five times a week in fact — including both cardio and strength training. Working out often won't just benefit your overall health and fight obesity, it also reduces your risk of type 2 diabetes by increasing insulin sensitivity.

  • Ovalle, F. (2002). Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and Sterility, 77(6), 1095–1105.
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