In around 70% of women with PCOS insulin resistance plays a part, even at a healthy weight (Teede et al., 2023). Insulin resistance means your body has to make more insulin to keep your blood sugar steady. That high insulin seems to be the engine behind many PCOS complaints, from a disrupted cycle to excess hair growth.
I notice that insulin resistance often stays unspoken, while it explains so much. You hear that your hormones are out of balance, but not why. Below you read what insulin resistance is, how it drives PCOS and which blood values say something about it.
What is insulin resistance?
Insulin resistance means your cells respond less well to insulin, the hormone that moves sugar from your blood into your cells. Your body compensates by making more insulin. So your blood sugar stays normal for a while, while your insulin level rises in the meantime.
That high insulin is the silent part of the story. You notice little of it for a long time, because your blood sugar still holds up.
Signals that sometimes fit insulin resistance:
- Fatigue or a dip after carbohydrate-rich meals
- Strong cravings for sweets or quick hunger
- Weight gain around the belly that is hard to influence
- Dark, velvety discolouration of the skin on the neck or armpits
How does insulin drive PCOS?
High insulin can push the ovaries to make more testosterone. That extra testosterone disrupts ovulation and reinforces complaints like acne and hair growth. So insulin and androgens keep each other in a vicious circle.
High insulin also often lowers your SHBG, the protein that binds testosterone in the blood. A low SHBG makes more testosterone freely available, which increases the complaints further.
This explains why improving your insulin sensitivity comes up so much in PCOS. It touches not one complaint, but the whole chain. How weight plays a role here, you read in our article on PCOS and weight.
Which blood values say something about your blood sugar?
No single value proves insulin resistance on its own, but together they give a picture of how your body handles sugar. The most used are your glucose on a fasting morning and your HbA1c, which shows your average blood sugar over the past weeks.
| What you want to know | Value that gives insight | What it shows |
|---|---|---|
| Your blood sugar at one moment | Glucose (fasting) | A snapshot of your blood sugar |
| Your average blood sugar over weeks | HbA1c | A steadier picture over the past 2 to 3 months |
In early insulin resistance, glucose and HbA1c can still be normal while your insulin is already raised. A normal result therefore does not fully rule out insulin resistance. So the result should always be assessed together with your complaints.
The Diabetes panel measures your glucose and HbA1c among others, so you get a picture of how your blood sugar holds up. For the whole PCOS picture, read our PCOS pillar on symptoms, causes and diagnosis.
Why this matters in the long term too
PCOS goes together with a higher risk of type 2 diabetes and cardiovascular disease (Teede et al., 2023). Insulin resistance is an important link in that. So it makes sense to keep an eye on your blood sugar now and then, alongside your cycle.
This does not mean you have or will get diabetes now. It does mean that looking early gives you the chance to adjust before complaints arise.
Points of attention in the longer term:
- A periodic check of your blood sugar, certainly with diabetes in the family
- Attention to your blood pressure and cholesterol
- A steady lifestyle that supports your insulin sensitivity
What can you do yourself?
Improving your insulin sensitivity is the first step that comes up in almost every PCOS guideline (Teede et al., 2023). Small, sustainable changes seem to have more effect than a strict diet you cannot keep up.
What research suggests can help:
- Regular exercise, with attention to strength and stamina
- Food that keeps your blood sugar steadier, with fewer fast sugars
- Fibre-rich meals that let your blood sugar rise more gradually
- Attention to sleep and stress, which also influence your blood sugar
These steps do not replace medical treatment. Some women also receive medication that supports insulin sensitivity. What suits you is something you discuss with your GP.
Frequently asked questions
Do I always have overweight with insulin resistance?
No. In PCOS insulin resistance also occurs at a healthy weight. So watch not only the scales, but also complaints like fatigue after meals or strong cravings for sweets.
Is a normal glucose reassuring?
Partly. In early insulin resistance your glucose can still be normal while your insulin is already rising. A normal result therefore does not fully rule out insulin resistance and should be assessed together with your complaints.
Will PCOS definitely give me diabetes?
No, that is not a certainty. PCOS does go together with a higher risk of type 2 diabetes. Attention to your lifestyle and a periodic check of your blood sugar can help limit that risk.
References
- Teede HJ, Tay CT, Laven J, et al. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University, ESHRE and ASRM, 2023.
- Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-2855. PMID: 27664216.
- NHG and Thuisarts.nl. Polycystic ovary syndrome (PCOS). Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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