How does insulin resistance impact PCOS?

You may have heard the words insulin resistance thrown around when you’ve been diagnosed with PCOS. And for good reason – it’s estimated that up to 80% of people with PCOS have insulin resistance, no matter their body weight.

People with PCOS who meet all three criteria of PCOS diagnosis (lack of/irregular periods; hyperandrogenism; polycystic ovarian morphology) have the highest prevalence of insulin resistance.

What is insulin?

Insulin is a hormone that manages the amount of glucose (sugar) we have in our bloodstream. Glucose is in the food we eat and our blood glucose levels rise once we’ve eaten. It is insulin’s job (once released by the pancreas) to help glucose enter the cells. This allows the cells to use glucose for energy or store it for later.

What is insulin resistance?

Insulin resistance is when the body’s tissues are resistant to the effects of insulin – they don’t allow glucose to enter the cells as we would expect. Insulin resistance prevalence is high in people with PCOS because an increase in androgens reduces sensitivity to insulin. Therefore there is more glucose in the blood for longer which can lead to symptoms of hyperglycaemia such as extreme thirst or hunger, feeling hungry after a meal, increased or frequent urination, tingling sensations in hands or feet, feeling more tired than usual and/or frequent infections.

This insulin resistance results in carb cravings because the cells in your body aren’t being ‘fed’ the glucose that is remaining in the bloodstream. In people with PCOS, insulin resistance can cause symptoms like increased inflammation, irregular ovulation, and poor sleep.

What are the signs and symptoms of insulin resistance?

There are several signs that may indicate insulin resistance in people with PCOS. This includes:

• Acanthosis Nigricans
• Skin tags
• Carbohydrate cravings
• Fatigue
• Increased thirst
• Tingling sensations in the hands and/or feet

Is there a test for insulin resistance?

You can have a blood test to determine if you are insulin resistant. A blood test may measure fasting blood glucose, fasting insulin, and HbA1c levels.

Speak to your GP or endocrinologist to request testing for PCOS.

Does insulin resistance impact fertility in people with PCOS?

Insulin resistance leads to higher levels of circulating insulin in the bloodstream. Higher insulin levels stimulate the ovaries to produce more testosterone. High levels of androgens can present clinically as hirsutism (excess hair growth on the chest, back, face, tummy etc.), acne, oily skin and/or thinning hair/loss (alopecia/male pattern baldness). Increased testosterone can impact fertility by reducing the likelihood of ovulation occurring.

How to improve insulin resistance

Insulin resistance can be improved by medication, supplementation and lifestyle changes. Speak with your doctor or healthcare professional if you are concerned about insulin resistance with your PCOS.

Medication

Medication that acts as an insulin sensitiser, like Metformin, can help with insulin resistance. Insulin sensitisers work to lower your blood sugar by increasing the muscle, fat and liver’s sensitivity to insulin.

Metformin can be prescribed by your GP or endocrinologist but may come with side effects like nausea, diarrhoea or stomach pain.

Supplements

Inositol, a vitamin-like substance, is a common supplement for insulin resistance in people with PCOS. Like metformin, inositol acts as an insulin sensitiser and can help reduce blood glucose levels and insulin levels in the body.