Managing Polycystic Ovary Syndrome (PCOS) can often feel like navigating a minefield, taking one step forward and ten steps back.

One crucial factor that frequently complicates this journey, and that many women with PCOS may not be aware of, is insulin resistance.

It’s estimated that over 75% of women with PCOS have insulin resistance, which could be the missing piece in your health puzzle.

As someone who was personally shocked to discover I was insulin resistant, I understand how surprising and unsettling this diagnosis can be.

In this blog post, I will dive deep into the complexities of insulin resistance, exploring how it impacts the body and its significant role in PCOS.

From understanding the fundamental functions of insulin to identifying the symptoms and causes of insulin resistance, we’ll delve into how this condition affects PCOS and discuss practical strategies to manage or even reverse it.

Why not shoot for the stars?

By the end of this post, you will have the knowledge and tools, whether you’re newly diagnosed or seeking better ways to control your insulin resistance.

So, let’s dive in!

What is Insulin?

Insulin is a hormone produced by the pancreas that plays a key role in regulating blood sugar levels.

When you eat, your body breaks down food into glucose (sugar), and enters into your bloodstream.

This rise in blood sugar levels signals the pancreas to release insulin.

Insulin functions like a key, allowing glucose from your blood into your cells, where it’s used for energy.

As a result, your blood sugar levels return to normal. Additionally, insulin instructs the liver to store any excess glucose for future use.

When you haven't eaten for a while, the liver releases this stored glucose to help maintain steady energy levels.

What is insulin resistance?

Insulin resistance (IR) occurs when your body’s cells become less responsive to insulin.

This means that glucose can't enter the cells as efficiently and remains in the bloodstream, leading to elevated blood sugar levels.

To compensate, the pancreas produces more insulin. However, over time, this increased demand can overwhelm the pancreas, resulting in persistently high blood sugar levels and high levels of insulin.

Insulin resistance is particularly concerning because it can lead to type 2 diabetes, which affects more than half of women with PCOS by age 40.

Chronic high blood sugar levels can also lead to serious health complications, such as heart attacks, strokes, and kidney failure.

Therefore, addressing insulin resistance is crucial for preventing these complications and managing your PCOS once and for all.

Common Symptoms of Insulin Resistance

waistline over 35 inches in women
Skin tags
Acanthosis nigricans
Increase thirst
Fatigue
Increased hunger

Risk factors include:

Family history
Excess weight
African, Latino or Native American
Smoking
Medications: steroids, anti-psychotics and HIV medications

Conditions associated with Insulin resistance:

Cushing disease
PCOS
Fatty liver disease
Sleep apnea

What causes insulin resistance?

Insulin resistance can be caused by a variety of factors that impact how effectively your body uses insulin. Let’s break down some of the main causes:

Genetic Factors & Family History

Insulin resistance often runs in families, indicating a genetic predisposition. If you have a family history of diabetes or metabolic syndrome, you may be at a higher risk.

Lifestyle Factors

Poor Diet: Consuming high amounts of refined carbohydrates, sugary foods, and unhealthy fats can contribute to insulin resistance. Diets rich in processed foods and low in fibre are particularly problematic.

Lack of Physical Activity: A sedentary lifestyle exacerbates insulin resistance. Active muscles use glucose more efficiently, so without regular exercise, there's less glucose uptake by cells.

Hormonal Changes

Stress and Cortisol: Elevated stress levels and high cortisol can lead to insulin resistance by increasing blood glucose levels, impairing insulin action, and promoting abdominal fat.

Excess Body Fat

Abdominal Fat: Excess fat, especially around the abdomen, is strongly linked to insulin resistance. Fat cells in this area release substances that impair insulin’s effectiveness.

Too Much Fat (Lipid): Excess fat, whether from being overweight or consuming fatty foods, can cause insulin resistance. Excess fat breaks down into fatty acids that disrupt insulin function, trigger inflammation, and increase sugar production in the liver. It can also cause cell stress, further impairing insulin action.

Ectopic Fat: Fat stored in unusual places, such as the liver or muscles, can contribute to insulin resistance. For example, fat buildup in the liver interferes with its function and worsens insulin resistance.

Inflammation

Chronic Inflammation: Low-grade, chronic inflammation can disrupt insulin regulation. This is often linked to obesity and an inflammatory diet.

Hormonal Imbalances

Polycystic Ovary Syndrome (PCOS): In PCOS, higher androgen levels and insulin can lead to insulin resistance.

Other Endocrine Disorders: Conditions such as Cushing’s syndrome and hypothyroidism can also affect insulin sensitivity.

Ageing

Age-Related Changes: Insulin sensitivity tends to decrease with age due to factors like muscle mass loss and a slower metabolic rate. This can lead to weight gain and increased visceral fat if dietary habits remain unchanged.

Sleep Issues

Poor Sleep Quality: Insufficient or poor-quality sleep can negatively affect insulin sensitivity and contribute to insulin resistance.

Medication Use

Certain Medications: Some medications, like steroids, can impact insulin sensitivity and lead to insulin resistance.

Insulin Resistance and PCOS: The Connection

Insulin resistance is a key factor in Polycystic Ovary Syndrome (PCOS), playing a significant role in both the symptoms and complications associated with the condition. Elevated insulin levels can amplify PCOS symptoms and make them more challenging to manage. Here’s how insulin resistance and PCOS interact on multiple levels:

The Role of Genetics and Lifestyle

Genetics and Lifestyle: Your genetic predisposition, combined with lifestyle factors such as diet and physical activity, influences the development and progression of PCOS. Obesity, often linked to poor lifestyle choices, can worsen insulin resistance, further complicating PCOS management.

Hormonal Changes and Their Impact

Hormonal Imbalance: Insulin resistance leads to elevated insulin levels in the bloodstream. This hormonal imbalance affects other hormones, particularly androgens (male hormones). Elevated hormone levels such as androgens, combined with high insulin levels, disrupt normal ovarian function.

Effects on Ovarian Function and Risk of Diabetes

Ovarian Follicles & Ovulation: The hormonal imbalance caused by high insulin and androgen levels can result in cystic ovarian follicles and prevent normal ovulation, leading to irregular menstrual cycles.

Estrogen & Diabetes Risk: Disrupted hormonal levels can affect estrogen production and increase the risk of developing type 2 diabetes over time.

Symptoms and Associated Risks

Androgen Effects: Higher androgen levels contribute to physical symptoms such as excessive hair growth such as facial hair and acne.

Menstrual Disturbances: Cystic ovaries and anovulation lead to irregular periods.

Diabetes and Cardiovascular Risk: Chronic insulin resistance heightens the risk of developing cardiovascular issues like heart disease, metabolic syndrome and gestational diabetes.

Emotional and Psychological Impact

Body Image & Self-Esteem: Visible symptoms of PCOS, such as acne and excessive hair growth, can negatively impact body image and self-esteem.

Mental Health: The physical and emotional stress caused by these symptoms can contribute to anxiety and depression.

Understanding the interplay between insulin resistance and PCOS is crucial for effective management and treatment. By addressing insulin resistance, you can alleviate many of the symptoms and reduce the risk of associated complications.

How to test for insulin resistance

If you have PCOS and haven’t yet tested for insulin resistance, I highly recommend doing so.

This is a crucial step in understanding and managing your PCOS.

You can discuss testing options with your healthcare provider, or if you're working with me 1:1, I can request these tests for you privately.

Keeping in mind there isn’t a single test to diagnose insulin resistance, a combination of factors are considered:

Personal and Family Medical History: Any relevant health information about you and your family.
Physical Exam Details: Observations from your physical examination.
Signs and Symptoms: Any symptoms you’re experiencing related to insulin resistance.
Relevant Test Results: Results from any previous tests.

To diagnose insulin resistance the following blood tests can be ordered:

Fasting Glucose: Measures your blood sugar levels after fasting for a certain period (usually 8-12 hours).
Fasting Insulin: Assess the amount of insulin in your blood after fasting.
HOMA-IR: Calculates insulin resistance based on fasting glucose and insulin levels using the Homeostasis Model Assessment of Insulin Resistance.
Oral Glucose Tolerance Test (OGTT): Evaluate how your body processes glucose over a few hours by measuring blood sugar levels at intervals after consuming a glucose drink.
Haemoglobin A1c: Provides an average of your blood sugar levels over the past 2-3 months by measuring the percentage of glucose-bound haemoglobin.

These tests, along with your medical history and physical examination, will help your healthcare provider determine if you have insulin resistance and how best to manage it.

For a more detailed guide on the essential blood tests for PCOS and insulin resistance, check out my full blog post here!

Best lifestyle changes to manage insulin resistance

Insulin resistance can significantly impact your PCOS and overall health, but now that we understand its causes, let’s tackle it with effective lifestyle strategies that really work.

Trust me, if you start implementing the following strategies, you'll begin to see improvements.

So, let’s dive in!

Weight Management:
Even if you’re not overweight or obese, excess visceral and ectopic fat can affect insulin signalling.
Losing weight, or focusing on reducing these fat stores, can lessen the impact of fatty acids on insulin and decrease inflammation.
Exercise Regularly:
Engaging in regular physical activity is key.
Muscles are crucial for absorbing glucose, and exercise enhances insulin sensitivity for days.
Incorporate both cardiovascular and resistance training into your routine.
Aerobic exercises, in particular, help decrease visceral fat even without weight loss. Aim for several sessions a week to keep your insulin sensitivity in check.
Reduce Saturated Fat:
Evidence shows that saturated fats, for example, from meats and butter, can harm liver function beyond their calorie content.
Opt for unsaturated fats instead, which are better for your liver and support better insulin function.
Increase Fibre Intake:
Fibre slows the digestion and absorption of carbohydrates, leading to a gradual rise in blood sugar levels.
It also promotes satiety and helps regulate appetite, making it easier to manage your weight and maintain a balanced diet.
Prioritise Quality Sleep:
Poor sleep can disrupt your glucose regulation by increasing appetite and affecting insulin sensitivity. Aim for consistent, restorative sleep to support overall health and glucose balance.
Manage Stress:
Incorporate stress-relief practices into your daily routine. Engaging in activities you enjoy, like hobbies, socialising, reading, or meditating, can lower stress levels. Stress management helps improve insulin sensitivity and overall health.
Avoid Smoking and Limit Alcohol:
Drinking and smoking increases inflammation and disrupts insulin function by harming cells and reducing the hormone adiponectin, which helps regulate insulin sensitivity.

Practical Tips for Better Blood Sugar Control

Start with Fibre: Begin your meals with high fibre foods like vegetables, legumes, or nuts. This approach can help you feel full faster, preventing overeating and stabilising blood sugar levels.
Increase your protein intake: Aim to include protein with every meal. A good rule of thumb is to ensure it makes up about a quarter of your plate.
Add a Splash of Vinegar: Incorporate vinegar into your meals it can help improve glycemic control and make blood sugar management easier.
Eat Slowly: Take your time with meals. Eating slowly allows your body to regulate blood sugar more effectively and helps you feel full with less food.
Choose Healthy Fats: Limit saturated fats from sources like red meat and butter. Instead, focus on unsaturated fats found in olive oil, nuts, seeds, and oily fish. Saturated fats can interfere with insulin signalling and worsen insulin resistance.
Post-Meal Walks: Try walking for 10-15 minutes after heavy meals. This simple activity increases insulin sensitivity in your muscles, helping glucose leave your bloodstream and enter your cells more efficiently.
Timing Matters: Our body is less effective at regulating blood sugar later in the day due to our circadian rhythm. To optimize blood sugar control, shift some of your carbohydrate intake from dinner to lunch or breakfast.
Switch Your Drinks: Replace sugary beverages with zero-calorie or low-calorie sweetened drinks. This swap can help manage blood sugar levels and improve weight loss outcomes.
Focus on Carbohydrate Quality: It’s not about cutting carbs but managing them wisely. Insulin resistance is more about how well your body uses glucose rather than the amount of carbs you consume. Opt for high-quality carbs like fruits, vegetables, and whole grains.

Medications and Supplements for Insulin Resistance

Certain medications and supplements can help improve insulin sensitivity and manage insulin resistance. Metformin and other insulin-sensitising drugs are commonly prescribed.

In addition to medications, several supplements may be beneficial including:

Fibre supplements
Chromium
Magnesium
Berberine
Inositol
Zinc
Cinnamon

While these supplements and medications can be effective, it's crucial to consult with your doctor before starting any new treatment to ensure it is appropriate for you.

Remember, the good news is that insulin resistance is often manageable with the right approach.

By following these evidence based interventions, you can effectively manage PCOS and insulin resistance.

If you’re looking for personalised support and guidance, learn more about my for 1:1 program here to work directly with me and we will create a tailored plan just for you.

Don’t wait, secure your spot today and take the first step toward transforming your health!

Understanding and managing insulin resistance is crucial for women with PCOS. By gaining insight into how it affects your body, you can take practical steps to improve your health and reduce the risks associated with PCOS.

Whether you're newly diagnosed or have been managing PCOS for a while, testing for insulin resistance and addressing it can be a game changer in your journey toward thriving with PCOS.

By following evidence-based interventions like eating a balanced diet, exercising regularly, managing stress, and getting enough sleep, you can enhance your insulin sensitivity and take control of your PCOS symptoms.

Remember, small changes can make a big difference, and with the right knowledge and support, you can confidently navigate insulin resistance.

So, why not take the first step today?

Have any questions or thoughts? Feel free to leave a comment below. I’d love to hear from you and support you on your journey.

Amy x x

Understanding Insulin Resistance: A Key Factor in PCOS