Have you ever felt confused about whether or not you have insulin resistance?
This is a common concern with PCOS, especially if you’re newly diagnosed or didn’t get the best information when you were diagnosed.
In today’s episode of the podcast, Sam is helping you understand how insulin resistance is
In today’s episode of the podcast, Sam is helping you understand how insulin resistance is diagnosed so that you can feel more comfortable with your plan for managing PCOS and speaking to your care team.
Insulin Resistance is Common with PCOS
Sam begins the episode by discussing how insulin resistance impacts most people with PCOS.
While statistics of exactly how many people with PCOS have insulin resistance vary depending on which study you’re looking at, up to Sam found research finding anywhere from 65-95% of people have insulin resistance with PCOS.
Despite myths and misinformation that those in smaller bodies don’t have insulin resistance, about 83.3% of people with PCOS with a BMI <25 have insulin resistance. This statistics increases to about 93.1% with a BMI 25 or more.
Does the increase with BMI mean that weight causes insulin resistance? We don’t have research to support that with PCOS. Given that insulin resistance can cause fatigue, hunger, carb cravings, and sleep issues, there could be a variety of reasons why insulin resistance occurs more as BMI increases.
Signs of Insulin Resistance with PCOS
There are some physical and metabolic signs that occur with insulin resistance and PCOS:
- Skin tags
- Acanthosis nigricans – back of neck, elbows, inner thighs
- Always feeling hungry
- Sugar cravings
- Chronic yeast infections
- Sleep issues unrelated to lifestyle
- Elevated triglycerides
- Fatty liver
Tests for Insulin Resistance
There are 3 main lab tests that you will want to be familiar with when it comes to insulin resistance and PCOS:
Fasting glucose – also known as your “blood sugar”, this measures the amount of glucose in your blood at a given moment in time.
A1c – this lab value measures the amount of glucose on your red blood cell, which indicates a 3-month average of your blood sugar. It gives more of a big picture view of your blood sugar.
Oral 75g glucose tolerance test (OGTT) – this test is where you drink a sugary drink and check your blood sugar after 2 hours. You may have heard of this test as it’s already commonly given during pregnancy to test for gestational diabetes.
Why isn’t insulin on this list? Since insulin isn’t usually a lab we look at by itself and there isn’t a standardized recommendation for testing insulin levels, it’s not included in this list.
Insulin Resistance Labs for PCOS: When to Test
The recommendations state that insulin resistance should be monitored in everyone with PCOS, regardless of BMI. Usually your doctor will start with only checking a fasting glucose (usually pulled with a basic metabolic panel that also checks other labs like cholesterol).
The guidelines state “Glycemic status should be reassessed every 1-3 years based on additional risk factors for diabetes.” (Section 1.9.3)
If you don’t know if you have insulin resistance, your doctor may want to test a fasting glucose and A1c first. Since these labs can be normal even when you have insulin resistance, the new recommendations state that you should have an OGTT to fully rule out insulin resistance with PCOS.
The recommendations in the updated international guidelines for PCOS state:
“Healthcare professionals and people with PCOS should recommend the 75g OGTT as the most accurate test to assess glycemic status in PCOS, regardless of BMI.” (Section 1.9.9)
“If an OGTT cannot be performed, fasting glucose and/or A1c could be considered, noting a significantly reduced accuracy.” (Section 1.9.10)
“An OGTT should be considered in all people with PCOS and without pre-existing diabetes, when planning pregnancy, or seeking fertility treatment.” (Section 1.9.11)
If you already know that you have insulin resistance then an OGTT isn’t needed.
Disclaimer: This episode is not medical advice. It is just educational information to help facilitate conversations with your healthcare team.
