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PCOS Insulin Resistance: What You Need to Know

PCOS is the most common gynecological condition in the world, affecting more than 10-15% of women worldwide (National Institutes of Health, 2022).  Amongst those women, up to 80% deal with some level of insulin resistance (Fertility & Sterility, 2013).  PCOS insulin resistance affects women of all ages, shapes, and sizes and can be obvious or subtle.

As an expert in PCOS nutrition and functional nutrition specialist with more than a decade of experience working specifically with women with PCOS, I can tell you there are a few major strategies that can make a MAJOR different with your PCOS insulin resistance.  Knowing the signs and symptoms of PCOS insulin resistance, the nutrition strategies to manage PCOS insulin resistance, and the best next steps can completely transform not just your PCOS symptoms but your overall health!

PCOS insulin resistance is a life long issue and can affect us from the time we are young, all the way through menopause and older age.  It’s so important to manage insulin resistance as best we can.   In this article, I’ll share with you my best strategies for managing pcos insulin resistance with my nutrition clients.  You’ll also find an in depth podcast on the topic below.

Risks of PCOS Insulin Resistance

PCOS insulin resistance affects many areas of the body, including our hormones.  High insulin levels are a trigger for excess testosterone production in the ovaries.  In fact, insulin is a hormone itself and therefore has a unique ability to alter the delicate signaling of hormones in our bodies.  From that excess testosterone, symptoms like facial hair, hair loss, irregular periods and infertility are directly linked.

But pcos insulin resistance isn’t just a risk for hormone-related issues.  Insulin resistance itself is connected with other metabolic issues like metabolic syndrome, weight gain, inflammation, cardiovascular disease, type II diabetes, amongst other issues (Cleveland Clinic)

What is Insulin Resistance?

Insulin is a hormone that acts as a shuttle for energy.  When we consume foods with carbohydrates, those carbohydrates break down into a type of sugar called “glucose”.  Glucose is a fuel for our cells and keeps them running strong so they can accomplish important tasks all over the body.

When the glucose hits our blood stream, it raises our blood sugar levels.  These levels need to stay in a delicate balance in order for our bodies to function properly.  Insulin lets the cells know to open their doors and take in this new source of energy.

In insulin resistance (including PCOS insulin resistance) however, the cells are already full of sugar OR they no longer pay attention to the signals from insulin because insulin is always present.  Ideally, insulin levels rise modestly when blood sugar rises and then lower when we’ve taken care of the blood sugar levels.  But when the cells are already full of energy, we still need to get the sugar out of the blood, so our pancreas pumps out more insulin to convince the cells to open up.

The cells, full already and unsure what to do with the extra energy become “resistant” to the signals from insulin, prompting the pancreas to produce more and more insulin over time to get it’s job done.  It can become a vicious cycle, especially if we continue consuming too many foods that spike our blood sugar too fast.

Where does PCOS Insulin Resistance Come from?

PCOS insulin resistance usually comes from a combination of genetic and environmental factors.  If you have a family history of type II diabetes, metabolic syndrome, or obesity, you may be more prone to PCOS insulin resistance.  This can because of genetic predisposition but it can also be because of environmental factors: the family you grew up in may have lived a lifestyle that wasn’t consistent with balanced blood sugar, for example.

Our genetic influences are not static either.  The concept of epigenetics tells us that our genetic expression, including our PCOS insulin resistance severity, can morph and change based on environmental factors like the diet we eat, the exercise we do, and the stress we are under (Cell and Developmental Biology).  This is the beauty of PCOS nutrition and lifestyle changes- they can even change your genes!

Some environmental factors that can contribute to PCOS insulin resistance:

• Standard American Diet
• High sugar/starch diet
• Diet heavy in processed, fast, and fried foods
• Lack of fiber
• Sedentary lifestyle
• Lack of Sleep
• Excess Stress
• Nutrient Deficiencies

How does PCOS Insulin Resistance Cause Symptoms?

Insulin is a fat storage hormone which can lead our body to holding on to more fat over time.  More body fat increases our insulin resistance.  More insulin resistance is also connected to increased resistance to leptin, a hormone that controls hunger and satiety signals.  This essentially means that we struggle with eating intuitively when we have PCOS insulin resistance, because we struggle to know when we have had enough to eat.

I cover leptin resistance in depth in this article on the signs, symptoms, and strategies for leptin resistance.  Intuitive eating is also something that you may have struggled with and I cover it in depth in this article. 

PCOS insulin resistance causes specific PCOS symptoms in the following ways (Cureus, 2022):

• Excess insulin sends a signal to the ovaries to produce more testosterone
• More testosterone mixes up ovarian signals, leading to cyst growth and excess follicles and preventing ovulation
• Lack of ovulation decreases other hormones like progesterone which contribute to symptoms of estrogen dominance
• Excess testosterone is converted into non-beneficial estrogen metabolites via the enzyme aromatase
• Excess testosterone is converted into dihydrotestosterone, the facial hair and hair loss version of testosterone via 5-alpha-reductase enzymes
• PCOS insulin resistance leads to irregular hunger signals, leptin resistance and weight gain that add chronic inflammation and more insulin resistance into the mix

I have several articles on these topics that may help you put the pieces together on your PCOS symptoms and which ones are caused by PCOS insulin resistance.  I’ll link a few for you:

Estrogen Dominance PCOS: What It Is & Best Ways to Fix It

How to Stop Facial Hair Growth Due to PCOS Naturally

6 Best Supplements for PCOS Facial Hair |Evidence Based & Effective

Cyperus Rotundus Oil for PCOS: Effective Facial Hair Solutions

Root Causes of PCOS | Where PCOS Symptoms Come From

Signs and Symptoms of PCOS Insulin Resistance

If you’re curious if you might have PCOS insulin resistance but haven’t received and official diagnosis, these are some signs and symptoms you can check for yourself to see if you may need further support with PCOS Insulin Resistance.

Signs and Symptoms of PCOS Insulin Resistance Include:

• Weakness/Exhaustion between meals (solved by eating, usually)
• Excess weight gain in the abdomen
• Difficulty losing weight
• Darkened patches of skin on the neck, knees, or elbows (acanthosis nigricans)
• Skin tags
• Persistent Fatigue
• Irregular Periods
• Other comorbidities like type II diabetes, metabolic syndrome, or high blood pressure

What labs show PCOS insulin resistance?

This is where things can sometimes get tricky: PCOS insulin resistance CAN show up on lab values but doesn’t always.  There are a number of reasons for this.  First, sometimes pcos insulin resistance is still in the “early” stages and we have a version called “hyperinsulinemia”.  Studies show that up to % of women with PCOS have hyperinsulinemia.

Hyperinsulinemia is a form of PCOS insulin resistance that results in increased insulin levels but the body is still sensitive enough to the signals from insulin that the blood sugar levels remain low enough on lab work to not be caught.  Despite regular fasting glucose levels, and even regular hb-A1c levels, some women with PCOS still have high levels of insulin in the system.  These high insulin levels are still triggering PCOS symptoms.

There are a few standard labs, and some functional medicine measurements, that can help illuminate if PCOS insulin resistance is part of your picture.  However, remember that insulin resistance is a key feature for most women with PCOS, so just because you have normal labs, does not mean that you don’t have insulin resistance. (Rupa Health)

• Fasting Glucose- this measures the amount of sugar in your blood when you haven’t been eating.  Elevated levels of fasting glucose can tell you that your body is struggling to make enough insulin to open up the cells or that the cells aren’t listening well.
• HB-A1C- this is a measurement that can tell how you’re keeping your blood sugar levels balanced over time.  Higher levels indicate more volatile blood sugar.
• Fasting Insulin- this is a functional medicine marker that is often used to get more to the source.  Where fasting glucose can show you how much sugar is in your blood and we can infer from high levels that your insulin may be high, a fasting insulin measure can tell us how much insulin is circulating around outside of meals.  High levels are common in PCOS and sometimes this is the only lab where I as a practitioner can actually “see” pcos insulin resistance on paper.
• HOMA IR- This measurement is a calculation made from taking your A1-C and fasting glucose.  Depending on the ration between the two, this calculation can tell you if you are a higher risk candidate for pcos insulin resistance.
• Continuous Glucose Monitors- These are devices you wear continuously that measure how your blood sugar is responding all day long.  These devices are very helpful for tracking what foods tend to spike your blood sugar and depending on how volatile your blood sugar is, you may be more insulin resistant.  I love these because they can help you tailor and target your pcos diet for the right balance for your unique body.

I tried a continuous glucose monitory myself with great results, it helped me with my own PCOS journey greatly.  This podcast covers Continuous Glucose Monitors, my personal and professional experience with them, and how they might help you.

How to Plan Your PCOS Diet like a Nutritionist

PCOS Insulin Resistance Podcast? How to eat to help