You’ve probably heard by now that PCOS and insulin resistance go hand in hand. You may have been diagnosed with hyperinsulinemia, insulin resistance, or even diabetes; or perhaps you’ve been told that your glucose levels are “normal”. You may be on metformin whether you’ve been diagnosed with blood sugar issues or not.
What does blood sugar have to do with PCOS?
Insulin is a hormone produced by the pancreas that opens the cells to allow glucose to enter and be used for energy. If you have insulin resistance your cells do not respond to the insulin, which causes your body to produce more insulin to try to bring things under control. Eventually, both insulin and glucose will build up in excess, potentially causing pre-diabetes and even type 2 diabetes.
Insulin and testosterone have a close relationship. Most research says that high insulin causes high testosterone but many women have had high testosterone long before their insulin started going up. This study found that high insulin can be caused by high testosterone. It’s a little bit of a chicken-egg situation. In either case, you need to be aware that one can cause the other and be prepared to change your diet and lifestyle to avoid the effects of these conditions.
While certain hormones – like androgens and estrogen – can naturally lower with age, blood sugar balance may worsen. So although you may not have blood sugar issues now, you need to be aware that you could develop them later on.
So how do you know if you have blood sugar problems?
There are a few main things to look for that can help you identify if you have insulin resistance. A large waist or mid-section weight gain, hypoglycemic episodes, and cholesterol imbalance are common. Excessive thirst and frequent urination may be an issue in more advanced cases. Skin tags and acanthosis nigricans (dark, velvety patches of skin) are very common in women with insulin resistance, though they may not always be present. These skin conditions are often mistaken as other symptoms of PCOS but do not get them confused. If you have either of these skin conditions and your doctor is telling you your blood sugar is fine, treat yourself like you have blood sugar issues anyway.
It’s always a good idea to do a few basic tests when you are first getting your PCOS diagnostic tests. Or if you’ve been diagnosed with PCOS but have never been tested thoroughly for insulin resistance. You should request your doctor do the tests so that you know where you stand. I usually try to have it checked every year when I go for my annual exam. You should always fast for the test, ideally 12 hours. I find it easiest to schedule my appointment for the morning so that I am fasting only overnight.
Testing to ask for:
- Fasting insulin
- Fasting glucose
Ideal levels are as follows:
Fasting insulin – Optimal is under 7, Over 10 is insulin resistant
Fasting glucose – ideal range is 70-90, under 86 is optimal
Under 70 is hypoglycemia
90-120 is pre-diabetes
Over 120 is diabetes
A1C – under 5.3 (do not let your doctor diagnose you by this number alone, many do. Read here Why Hemoglobin A1c Is Not a Reliable Marker)
These numbers will look very different from what your doctor will tell you. Typically, they say under 100 is normal, over 126 is diabetes.
What if your fasting insulin and glucose are normal?
Calculating your insulin to glucose ratio can help determine insulin resistant status, even when one or both levels appear to be normal. This is known as the HOMA-IR.
“HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance. The meaningful part of the acronym is “insulin resistance”. It marks for both the presence and extent of any insulin resistance that you might currently express. It is a terrific way to reveal the dynamic between your baseline (fasting) blood sugar and the responsive hormone insulin…
Healthy Range: 1.0 (0.5–1.4)
Less than 1.0 means you are insulin-sensitive which is optimal.
Above 1.9 indicates early insulin resistance.
Above 2.9 indicates significant insulin resistance.” HOMA-IR Calculator
People often resist the idea that their “normal” glucose is not actually normal.
Let me tell you, I was the last person to want to admit that I had blood sugar problems. When I was first diagnosed with PCOS I was told over and over that I probably had blood sugar problems and I needed to change my diet and lifestyle. No one likes being told that they need to change. I would say, “You’re wrong, I have no blood sugar issues.” I totally understand the resistance to the idea. My doctor told me I was fine, and I was willing to accept that, even when I didn’t accept many other things she told me.
It wasn’t until I read Chris Kresser’s series on blood sugar that I finally understood what was going on in my body. My numbers really aren’t normal, and considering the close relationship of PCOS to insulin resistance (insulin is also a hormone, after all) there’s a good chance that yours aren’t either. I still fully believe that you can have PCOS without insulin resistance, but don’t be stubborn about it, because you might regret it someday.
I highly recommend you read Chris Kresser’s series (When your “normal” blood sugar isn’t normal Part One, When your “normal” blood sugar isn’t normal Part Two), he explains the ins and outs of the tests and what to look for and why the A1C is not the best test to go by. If your fasting insulin or sugar is above the optimal level you can ask your doctor for a Glucose Tolerance Test. Everyone with PCOS, or in the process of diagnosis, should do the Glucose Tolerance Test, since fasting insulin and glucose can be normal and still be out of balance after meals. But it can be difficult to convince your doctor when everything looks “normal”.
What is the Glucose Tolerance Test?
For the Glucose Tolerance Test, they take your fasting numbers before, then give you a glucose solution to drink and then they test your glucose (ideally you would also test insulin) every hour after. Some places will do it 2 or 3 hours, some do it even longer. Three hours is ideal. You are looking for your third hour numbers to go back down to your “pre-meal” number or lower.
If your doctor will not do the GTT, you can do an alternative test yourself with a glucometer. This can give you some helpful information on if your body responds properly to glucose but it tells you nothing about your insulin response, which for many women with PCOS is more of an issue than glucose response. You can learn how to do this in Chris Kresser’s article, “How to prevent diabetes and heart disease for $16”. I use the glucometer that Dr. Kresser recommends and I have found it to be comparable to the blood test results ordered by my doctor. I read in other places that this particular meter is best for people who do not have diabetes, so if you have diabetes I don’t know how it will work for you.
Did you know that you can have normal blood glucose and still be insulin resistant?
Read How to Test for Insulin Resistance: Your Comprehensive Guide for more information. I highly recommend everyone read this article, and even printing it to take to doctor’s appointments when requesting testing.