Understanding Insulin Resistance: PCOS Basics Explained

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Dr. Pakhi Sharma, MBBSGeneral Physician, 6+ Years
Published On : 27-Oct-2022Read Time : 6 minutes
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Ever heard of insulin resistance? It’s a term that comes up a lot when someone is discussing Type 2 Diabetes or PCOS. Wait, how did insulin resistance get banded together with PCOS, you ask? Let’s understand how insulin resistance and PCOS are related. Contents:
  • What is Polycystic Ovary Syndrome?
  • What is Insulin Resistance?
  • Insulin Resistance: Causes
  • What is the Role of Insulin Resistance in PCOS?
  • Insulin Resistance: PCOS Symptoms
  • Insulin Resistance: PCOS Test
  • Insulin Resistance: PCOS Treatment
  • Don’t Have Time To Read?
  • FAQs

What is Polycystic Ovary Syndrome?

Polycystic Ovary Syndrome (PCOS) is a hormonal imbalance common among women of childbearing age. In individuals with PCOS, the ovaries produce more than the normal amount of male hormones called androgens, which results in a hormonal imbalance.  Due to the elevated androgen levels, the ovaries are unable to release eggs (ovulation), which causes irregular menstrual cycles and other PCOS symptoms.  The exact cause behind PCOS is unknown. However, some factors are considered to play a significant role in causing PCOS. Apart from excess androgen levels, these factors include genetics, low-grade inflammation, and insulin resistance.

What is Insulin Resistance?

The food you eat is broken down into glucose (sugar) and released into the bloodstream, from where it is directed by a hormone called insulin (produced by the pancreas) into your fat and muscle cells to produce energy. The excess glucose not required to instantly fuel your body is stored in the liver for later use. Insulin resistance is a condition in which the cells in your muscle, fat and liver lose the ability to respond to insulin appropriately. When the cells are not able to take in sugar from the bloodstream, it results in high blood sugar levels.  This triggers the pancreas to pump more insulin into the body to get sugar into the cells and stabilise the blood sugar levels. This condition is called hyperinsulinemia. Eventually, the pancreas is unable to keep up with insulin production, and blood sugar levels stay high. Over time, consistently high blood sugar levels (hyperglycemia) can increase the risk of developing prediabetes and Type 2 Diabetes. Persistently high insulin levels are also harmful as they direct the liver and muscles to store blood sugar, and when full, the liver sends the excess blood sugar to fat cells to be stored as body fat, leading to weight gain.

Insulin Resistance: Causes

It is not exactly clear what causes insulin resistance and research is still ongoing in this regard. Several factors can cause varying degrees of insulin resistance.  Risk factors for developing insulin resistance include:
  • Overweight or obesity
  • Abdominal fat
  • Age above 45
  • Family history of Type 2 Diabetes 
  • A sedentary lifestyle
  • High blood pressure
  • Abnormal cholesterol levels
  • A history of gestational diabetes
  • PCOS

What is the Role of Insulin Resistance in PCOS?

The reason for the relationship between insulin resistance and PCOS is not completely established. Does PCOS cause insulin resistance? No. Experts believe that insulin resistance may play a role in causing PCOS, and it is not the other way around.  Elevated insulin levels due to insulin resistance may be a contributing factor to inflammation and other metabolic complications associated with PCOS.  Experts suggest that insulin resistance and excess insulin in the blood increase the production of androgens in the body, causing difficulties in ovulation and other symptoms of PCOS. It is also important to note that insulin resistance does not affect everyone with PCOS. While many women with insulin resistance develop PCOS, many others do not. As per studies, around 40% of women with PCOS may have insulin resistance.

Insulin Resistance in PCOS: Symptoms

The symptoms of insulin resistance in PCOS are the same as symptoms of insulin resistance in those who don't have PCOS.  If you have insulin resistance, but your pancreas is able to manage increased insulin production to keep blood sugar levels in range, you will not have any symptoms.  The symptoms of insulin resistance only start to appear when insulin resistance gets worse, your pancreas is no longer able to produce enough insulin and you have elevated blood sugar levels.  Symptoms of high blood sugar and insulin resistance include:
  • Darkening of skin in the groin, armpits, or behind the neck
  • Sugar cravings
  • Fatigue
  • Excessive hunger 
  • Increased thirst
  • Frequent urination
  • Weight gain around the abdomen
  • High blood pressure
  • High cholesterol levels
  • Tingling sensation in the hands and feet
  • Blurred vision
  • Headache
  • Frequent infections
  • Slow-healing wounds

Insulin Resistance in PCOS: Tests

There is no one test to confirm the presence of insulin resistance, and as long as your pancreas is producing enough insulin to prevail over the resistance, you may not have any symptoms of insulin resistance. Your doctor will conduct a physical examination and consider several factors when assessing the presence of insulin resistance, including your:
  • Medical history
  • Family history
  • Signs and symptoms
  • Test results
Insulin resistance may be diagnosed on the basis of high blood sugar levels, high triglycerides, high LDL (low-density lipoprotein or “bad cholesterol”), and low HDL (high-density lipoprotein or “good cholesterol”). These blood tests can be performed to help diagnose insulin resistance: 
  • Fasting Blood Glucose Test: This test is used to measure blood sugar levels after an overnight fast. 
  • Glucose Tolerance Test: This test shows the time taken by your body to process and clear sugar.
  • Glycosylated Haemoglobin A1C: This test helps determine your average blood glucose levels for the last 3 months. 
  • Lipid Panel Test: This is a group of tests to measure total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
  • Insulin Blood Test: This test indicates the insulin levels in your blood. Extremely high insulin levels may be linked to insulin resistance.
Your doctor may also order tests to confirm a diagnosis of PCOS to establish that insulin resistance is related to PCOS.

Insulin Resistance in PCOS: Treatment

Insulin resistance can be reversed and treated. Treating insulin resistance can help you manage PCOS better.  Wondering how to control insulin resistance in PCOS? Some factors that contribute to insulin resistance, such as age and genetics, cannot be treated.  However, lifestyle modifications around your eating habits, exercise regularity, and weight management can be the primary treatment for insulin resistance in PCOS. 
  1. Follow a balanced diet containing low glycemic index (GI) foods, and foods with high fibre and protein to provide all the necessary nutrients to your body while helping stabilise your blood sugar levels. This can help you manage insulin resistance. 
  2. Exercise for at least 30 minutes a day, 5 days a week. Exercise helps your body become more sensitive to insulin. It is one of the most effective answers to how to reduce insulin resistance in PCOS. It can also help reduce your weight, which is a risk factor for insulin resistance and PCOS.
  3. Manage your weight with a healthy diet and exercise. A healthy weight can help treat and manage insulin resistance and PCOS. 
  4. Your doctor may prescribe metformin to improve insulin sensitivity and treat insulin resistance. Take prescribed medications regularly and do not miss appointments with your doctor.
  5. Manage your stress levels with activities such as meditation and yoga and get sound sleep for at least 7 hours every night. 
  6. As part of a healthy lifestyle, avoid excessive consumption of alcohol and quit smoking.

Don’t Have Time To Read?

  • Polycystic Ovary Syndrome (PCOS) is a hormonal imbalance in women. Elevated androgen (male hormone) levels in PCOS cause problems with ovulation, irregular menstrual cycles, and other symptoms of PCOS. 
  • Insulin resistance is a condition in which your cells lose the ability to respond to insulin appropriately. This results in high blood sugar levels, consequently high blood insulin levels, and eventually, insulin resistance. 
  • Experts believe that insulin resistance can be one of the causative agents of PCOS.
  • Insulin resistance does not have any symptoms as long as your pancreas is able to produce insulin to keep blood sugar levels in range. Thereafter, the symptoms of insulin resistance are the same as that of high blood sugar levels. 
  • There is no single test to diagnose insulin resistance. Your doctor will analyse your medical and family history, signs and symptoms, and order blood tests such as a fasting blood glucose test, glucose tolerance test, glycosylated haemoglobin A1C, lipid panel, and insulin blood test to diagnose insulin resistance.
  • You can treat insulin resistance by following a balanced diet, exercising regularly, maintaining a healthy weight, taking prescribed medications regularly, managing stress, avoiding alcohol, and quitting smoking.
  • Start your PCOS management journey with Phable. Use the Phable Care App to consult India’s leading gynaecologists, endocrinologists, nutritionists, and dieticians; order medicines; book lab tests; and get real-time remote care from the comfort of your home. Check out our store to order healthy treats, weighing scales, fitness bands, and more! We also have a PCOS Management program that provides ‎360º care.

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