Insulin Resistance and PCOS: Signs, Symptoms, and Treatment Options
In This Article
Insulin-Resistant PCOS Type
Insulin resistance is the main reason most women have PCOS. This includes many who don't weigh too much, which we call "lean PCOS."
Gaining weight is just one thing that can happen because of insulin resistance, but not everyone with Insulin-Resistant PCOS will gain weight.
If someone thinks they don't have insulin problems just because they're not overweight, they might not get the right help for their PCOS.
Scientists found something interesting.
In women with PCOS who weren't overweight, 75% had insulin resistance.
But in similar women without PCOS, only 24% had it.
Among those who were overweight, 95% with PCOS had insulin resistance, compared to 62% without it.
This tells us that having insulin resistance in PCOS doesn't always mean you will gain weight.
Actually, it's usually the insulin resistance that can make you gain weight, not the other way around.
So, even if you're not overweight, you might still have insulin resistance causing your PCOS problems.
PCOS makes it more likely to have insulin issues, no matter how much you weigh.
My PCOS fertility journey
How insulin resistance causes PCOS symptoms
Insulin resistance is like our body's cells not hearing insulin's message to let sugar in from our blood to store it. Insulin works like a key for cell doors.
But in insulin resistance, this key is rusty and struggles to open the cell door, causing insulin to stay in our blood longer than it should.
When insulin levels are high for too long, it makes our ovaries produce more testosterone and other similar hormones.
High insulin also reduces a protein called sex hormone binding globulin (SHBG), which normally soaks up extra hormones to keep things balanced.
With less SHBG and more free-floating male-type hormones, problems start.
These excess hormones can kill scalp hair follicles, leading to hair loss. They can clog skin pores, causing acne. They also transform fine facial and chest hairs into thick, dark ones.
To make things worse, more testosterone means even more insulin is produced, creating a cycle where hormone levels keep going up.
High insulin also lowers the release of follicle stimulating hormone (FSH), which is essential for our egg cells to grow properly for ovulation.
With not enough FSH, ovulation might not happen at all, making periods disappear or become very irregular.
Finally, high insulin causes too much of another hormone, luteinizing hormone (LH), to be released.
LH is usually good for triggering ovulation, but too much can stop or delay it, leading to missing or irregular periods.
Signs and Symptoms of Insulin Resistance
Take the quiz below to rate the likelihood of insulin being a root cause of your PCOS.
Each time you answer yes, give yourself one point.
If you said yes to four or more of the points above, there’s a high chance insulin resistance is the root cause of your PCOS.
If you aren’t sure or would like to confirm this with testing, see below for the best tests to diagnose insulin resistance. Testing is optional.
Problems with Common Tests for Insulin Resistance
You might not know if you have insulin resistance because the tests your doctor used aren't the most sensitive.
The most common tests are fasting glucose and HbA1C, but they're not great at detecting early-stage insulin resistance.
They're more for finding severe insulin resistance, like in type 2 diabetes.
A study in 2014 found that HbA1C missed 45% of type 2 diabetes cases, showing it's not great at catching early insulin resistance.
Fasting blood glucose is another test often used, but the upper "normal" limit might be too high.
The usual limit is 100mg/dL, but a study from 2005 showed that people with levels between 91-99mg/dL could still develop type 2 diabetes.
If you've had an oral glucose tolerance test (OGTT), you know it's not pleasant.
It involves drinking a super sweet drink and getting your blood taken for a few hours to see how your glucose levels change.
It's often used in pregnancy to check for gestational diabetes.
While it's more accurate than the first two tests, OGTT also mainly measures glucose, not insulin, so it can miss early insulin resistance.
Another study showed that OGTTs missed about half of the diabetes cases.
In insulin resistance, blood glucose can be normal because the body is making lots of insulin to keep glucose low.
So, if we only look at glucose levels, they seem fine, but actually, your insulin is working too hard to balance glucose. Relying only on glucose tests could mean missing the right diagnosis and treatment for PCOS.
If your doctor has checked your fasting blood glucose, HbA1C, or OGTT and ruled out insulin resistance, but you still think it might be an issue, don't hesitate to ask for more tests.
I'll talk about the best tests to ask for next.
About The Author - Tamika Woods
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Gold Standard Tests for Insulin Resistance
Blood Test
The best test for insulin resistance is the Glucose Tolerance Test with Insulin Assay.
This test is like an OGTT but checks both insulin and glucose levels.
You'll get a blood test before and then one and two hours after drinking a glucose solution. This test is 75% better at finding diabetes and pre-diabetes than a regular OGTT.
Your fasting insulin should ideally be under 10mlU/L (60pmol/L).
One and two hours after the glucose drink, your insulin should stay below 60mlU/L (410pmol/L). If it's higher, it suggests insulin resistance.
This test isn't as common as a standard OGTT, fasting glucose, or HbA1C test, so your doctor might not know about it.
Keep asking or look for a healthcare provider who can help you get the right tests to confirm or rule out insulin resistance.
Measure Your Waist
Insulin resistance often leads to gaining weight around your belly. The bigger your waist, the more likely you are to have insulin resistance.
To measure, use a tape measure around the top of your hip bone and line it up with your belly button.
Make sure the tape is straight.
Breathe in and out, and let your belly relax without holding it in. Read the number on the tape.
For women, a waist size of 80cm (32 inches) or more suggests a higher chance of insulin resistance. The risk goes up as your waist size increases.
It's important to remember that being overweight doesn't always cause insulin resistance, but it can increase the risk.
So, you can have insulin resistance even without a high waist measurement or being overweight. The symptoms we've talked about can also help show if insulin resistance is an issue for you.
Metformin
If you're overweight or have insulin resistance, you might have been offered Metformin, a popular medicine that makes your body more responsive to insulin.
This can be effective for some women in treating insulin resistance.
However, more than half of the women taking Metformin experience side effects like nausea, diarrhea, and vomiting.
It's also known to lower vitamin B12 levels, so if you're taking Metformin, consider a daily B12 supplement.
Deciding to use Metformin for your PCOS is up to you. You can achieve similar or even better results through the diet and lifestyle changes mentioned in this post.
If Metformin's side effects are bothering you, you might want to try inositol.
Studies have shown that inositol can be more effective than Metformin in weight loss, bringing back regular periods, and increasing the chances of a natural pregnancy, all without the side effects.
"Changing what you eat, how you move and which supplements you take is the most effective way to reverse insulin resistance and thrive with PCOS."
SPOTLIGHT: Maria’s intense sugar cravings
What causes insulin resistance?
Eating Throughout The Day
The PCOS Plate Method
Modifying The PCOS Plate Method
FAQs
I’m getting hungry after my meals following the PCOS Plate Method ratio. What should I do?
If you find you are getting hungry, try increasing your healthy fat source and opt for solid forms of fat like avocado, nuts, and seeds rather than oils.
These are often more satiating because they take up more room in your stomach.
What about sugar, dairy, gluten, caffeine, and alcohol? Should I cut these out?
Can I eat fruit?
Insulin-Resistant PCOS Core Treatment
Core Treatment #3: Reduce high-dose fructose
SPOTLIGHT: How does high-dose fructose worsen insulin resistance?
How to break up with sugar
"Once we get your insulin functioning better, you won’t have intense cravings anymore and you’ll find you can easily maintain your energy levels and focus throughout the day."
For the next four weeks, aim to eliminate all sweetened beverages (like sodas and flavored milks), added sugars, and desserts from your diet.
This is a temporary measure, just for a month, to help reset your blood sugar and insulin levels.
This means avoiding even "natural" sugars found in paleo desserts, bliss balls, and treats made with dried fruit, agave, or coconut sugar.
Also, steer clear of sweetened yogurts, granola bars, and protein bars. However, you can still have one or two servings of whole fruit with protein or healthy fat.
If you need something sweet, opt for natural sweeteners like stevia or monk fruit, which don't cause a spike in blood sugar. A square or two of 85% dark chocolate is also fine, as it's low in sugar.
Make sure your meals and snacks are filling, with plenty of protein, to help you stay satisfied and curb sugar cravings. Remember, once your insulin resistance is reversed, the sugar cravings will disappear.
To help you quit sugar more easily, I've prepared a bonus guide that comes with the PCOS Repair Protocol book: "Kick Your Sugar Cravings," with extra tips for this transition.
After four weeks, you can start reintroducing small amounts of sugar. Try having a dessert or sweet treat once or twice a week, and really enjoy the experience.
Plan when you'll have it and choose something special. Eat mindfully, without distractions, to help reduce the desire for more sugar.
Once your insulin is back to normal, try following the 80/20 rule: eat a balanced, sugar-free diet 80% of the time, and allow yourself small indulgences for special occasions.
Since having insulin resistance means a higher chance of it returning, finding a sustainable, satisfying way to maintain these habits is key.
Experiment with the 80/20 rule to see what works best for you.
The goal is to make the PCOS Repair Protocol a lifelong habit, not just a temporary diet.
This way, you won't feel deprived or unsatisfied, which can lead to abandoning the new eating patterns.
Core Treatment #4: Choose your Meal Times
Core Treatment #5: Consider Supplementing for Insulin Resistance
Core Treatment #6: Find Joyful Movement
SPOTLIGHT: Shannon’s Life Changing Journey
Still having symptoms?
Summary: Core Treatments for Insulin-Resistant PCOS
About The Author - Tamika Woods
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