Prediabetes is very common with Polycystic Ovary Syndrome (PCOS). Prediabetes means that blood sugars are consistently higher than normal, but not quite as high as the range for Type 2 Diabetes.
There is some discussion in the non-diet space as to whether or not prediabetes is a real or helpful medical diagnosis. About 1 in 3 Americans have prediabetes outside of PCOS, and the pharmaceutical industry (the same industry who financially benefits from medication to treat prediabetes) does support the ADA. I think this is a completely valid concern.
A big piece of the criticism around the diagnosis of prediabetes is that generally, it’s not harmful and annually, few people who have blood sugars in the prediabetes range see them increase into the diabetes range.
I think this argument is a little different for PCOS. Insulin resistance is the primary driver of PCOS symptoms in most people with PCOS, and around 30-40% of folks with PCOS have prediabetes. About half of people with PCOS develop Type 2 Diabetes by the time they turn 40. Many people with PCOS are also taking pharmaceuticals to treat insulin resistance before they even have elevated blood sugar. So I do think it’s helpful to be aware of your numbers and how they are trending. Managing insulin resistance can also help you feel better!
The statistics around PCOS and diabetes might sound alarming, but there are plenty of ways to manage these.
Your doctor might order a fasting glucose and hemoglobin A1C to diagnose prediabetes.
The fasting glucose is a lab taken when you’ve been fasting that tells you what your glucose or blood sugar is at one moment in time. A hemoglobin A1C tells you how your blood sugars have been over the past 2-3 months. A hemoglobin A1c of 5.7-6.4% and a fasting glucose of 100-125 mg/dL meet the criteria for prediabetes.
You can find more about diagnosing prediabetes on the American Diabetes Association website.
What can I do if I have been diagnosed with PCOS and prediabetes?
Fortunately, there are a number of things you can do to improve your blood sugar and insulin sensitivity with PCOS and prediabetes! The best news is that you do NOT need to cut out all carbohydrates and sugar. Most of these tips are great for your overall health as well.
- Stop Dieting – Contrary to most advice on social media, you don’t need to start a new diet if you have PCOS and prediabetes. Dieting usually involves making food choices based on weight loss efforts, cutting out foods, or restricting foods in some way. While this might cause temporary weight loss, restricting food usually backfires and makes you more likely to binge. Find out more about PCOS, Binge Eating, and Intuitive Eating here! Studies actually show that yo-yo dieting makes insulin resistance worse over time.
- Instead of Dieting, Create Balanced and Consistent Meals – By “balanced” I mean add a variety of foods and nutrients. This would include carbohydrates paired with fiber, protein, and fat. Even though carbohydrates raise blood sugar – the fiber, protein, and fat helps prevent your blood sugar from spiking and crashing. In other words, the energy from the carbohydrates will probably last longer! Eating consistently (every 3-5 hours) will also help balance blood sugars and prevent binge eating. Yes, this means it’s best to not skip breakfast!
- Movement – All types of movement are great for managing blood sugar. Cardio, weight bearing, yoga – you name it! Even a quick walk after a meal has been shown to help level out blood sugar.
- Stress Management – Managing blood sugars is not just about “diet and exercise” – stress can impact it as well. Of course you can’t eliminate stress, but it’s important to manage it when possible. For example, you could reconsider the amount of commitments that you make, and limit contact with people that stress you out.
- I want to acknowledge that getting a PCOS and prediabetes diagnosis can also cause a lot of stress. It’s okay to feel overwhelmed about it, and you are not alone in that feeling! However, stressing about foods can also be harmful to your blood sugar.
- Lean on your healthcare team and personal support system. Both groups of people can help you manage your PCOS and prediabetes – AND the stress that can come with both conditions. I highly recommend finding healthcare professionals who encourage you to be flexible and make sustainable changes. If you feel stress or anxiety with your healthcare team then this is probably harming you more than it’s helping you!
- Prioritize Sleep – Lack of sleep can make insulin resistance worse, and it can increase food cravings the next day. Shoot for 7+ hours if you can!
- Supplements – There are several supplements that can be helpful for insulin resistance, and I give specific supplement recommendations to my clients. Always consult a healthcare provider before starting a supplement, and don’t just take it because you saw it on the internet!
- Medications – Your doctor may recommend medications like metformin to help control blood sugars and prevent prediabetes from progressing into type 2 diabetes. There is no shame in taking medications!
All of these tips can help you manage prediabetes, but keep in mind that you don’t have to focus on all of these at once. Only pick 1-2 things at a time, and focus on something new when you’re ready!
What’s in my control, and what’s not in my control with PCOS and prediabetes?
While lifestyle factors are important to manage PCOS and prediabetes, it’s important to know that there are factors that may not be within your control. Genetics, environment, and access to nutrient-dense foods can also play a role in developing blood sugars. You did NOT fail if your blood sugars fall in the prediabetic range, or if they increase into the type 2 diabetes range.
Final thoughts about PCOS and Prediabetes
Prediabetes is such a common diagnosis in those with PCOS, but it can still feel overwhelming. Misinformation about nutrition and PCOS can make it even harder to understand how to manage the conditions, too. My tips for PCOS and prediabetes involve lifestyle factors like nutrition, movement, stress management, and sleep. Most importantly, remember that PCOS and prediabetes are NOT your fault!
If you’d like help managing PCOS and prediabetes then please visit my website for more information about my nutrition coaching services!
Diagnosis. diabetes.org. (n.d.). Retrieved March 15, 2023, from https://diabetes.org/diabetes/a1c/diagnosis
Centers for Disease Control and Prevention. (n.d.). Prediabetes – Your Chance to Prevent Type 2 Diabetes. cdc.gov. Retrieved March 15, 2023, from https://www.cdc.gov/diabetes/basics/prediabetes.html
Centers for Disease Control and Prevention. (n.d.). PCOS (Polycystic Ovary Syndrome) and Diabetes. cdc.gov. Retrieved March 16, 2023, from https://www.cdc.gov/diabetes/basics/pcos.html
Tabassum, R., Imtiaz, F., Sharafat, S., Shukar-Ud-Din, S., & Nusrat, U. (2013). Prevalence and clinical profile of insulin resistance in young women of poly cystic ovary syndrome: A study from Pakistan. Pakistan journal of medical sciences, 29(2), 593–596. https://doi.org/10.12669/pjms.292.3180
Tao, T., Zhang, Y., Zhu, Y. C., Fu, J. R., Wang, Y. Y., Cai, J., Ma, J. Y., Xu, Y., Gao, Y. N., Sun, Y., Fan, W., & Liu, W. (2021). Exenatide, Metformin, or Both for Prediabetes in PCOS: A Randomized, Open-label, Parallel-group Controlled Study. The Journal of clinical endocrinology and metabolism, 106(3), e1420–e1432. https://doi.org/10.1210/clinem/dgaa692