If you have PCOS and insulin resistance, you’ve probably heard about blood sugar. But there’s one specific lab value that can tell you a lot more about what’s actually going on in your body over time, and it often doesn’t get talked about enough.
That lab is your hemoglobin A1c. In this episode, I’m breaking down what it is, why it matters, and how you can use it as a tool to better understand and manage your PCOS.
Why Your A1c Matters When You Have PCOS
If you have PCOS and insulin resistance, you’ve probably heard about blood sugar.
But there’s one specific lab value that can tell you a lot more about what’s actually going on in your body over time and it often doesn’t get talked about enough.
That lab is your hemoglobin A1c. In this episode, I’m breaking down what it is, why it matters, and how you can use it as a tool to better understand and manage your PCOS.
First, Let’s Talk About Insulin Resistance
PCOS is fundamentally a metabolic condition. It used to be thought of primarily as a reproductive condition, but we now understand it’s an endocrine and metabolic condition that affects the reproductive system.
When we talk about metabolic health, we’re talking about how your body regulates energy, processes nutrients, and maintains balance.
Insulin resistance affects about 70% of people with PCOS, and newer research suggests that even those without it may be more predisposed to developing it over time.
Insulin is a hormone that helps your body use glucose for energy. When your cells aren’t responding well to insulin, it’s harder for it to do its job. That’s insulin resistance. And when it goes unmanaged, it can drive a lot of the symptoms you’re already dealing with: fatigue, cravings, irregular cycles, acne, excessive hair growth, and hair thinning.
What Is an A1c and How Is It Different from a Fasting Blood Sugar?
When you go in for a standard physical, you’re likely getting a fasting blood sugar, which is a single snapshot of what your blood sugar looks like at one specific moment in time after not eating for at least eight hours.
Your A1c is different. It measures the percentage of your red blood cells that have glucose attached to them, which gives you a two to three month average of your blood sugar rather than a single moment.
Because red blood cells live in your body for about two to three months, your A1c reflects overall patterns rather than one isolated reading. It’s also more heavily weighted toward your most recent month, which means it can pick up on trends as they’re happening.
And unlike fasting blood sugar, your A1c doesn’t require fasting. You can eat normally and still get it checked.
Why Does This Matter for PCOS?
This primarily matters if you notice your blood sugar creeping up and it’s getting close to the prediabetes range. I’ve worked with a lot of clients whose fasting blood sugar came back within normal limits, but their A1c was elevated in the prediabetic range.
This can happen because your blood sugar might run lower in the morning and then climb higher throughout the day.
A fasting glucose won’t capture that, but your A1c will.
The A1C isn’t automatically included in standard labs. There usually has to be a reason for ordering it, and a lot of times it won’t be checked until your blood sugar is already elevated. But this is exactly the kind of conversation you can have with your doctor when you notice your blood sugar continue to climb.
Asking to have your A1c checked, especially when your fasting blood sugar is close to the pre diabetic range, can give you much more context about how your insulin resistance is being managed over time.
If you have prediabetes or type 2 diabetes and you’re actively working on making changes, the A1c is especially useful because you can recheck it every three to six months and see whether your numbers are moving in the right direction.
A Few Things to Know About the A1c
Like fasting blood sugar, the A1c falls into diagnostic ranges:
- normal
- prediabetic
- diabetic
It’s a helpful tool, but it’s not perfect. Things like anemia or certain medications can affect the reading, so it’s always worth discussing your full picture with your healthcare provider.
The bigger point is this: when it comes to managing PCOS, so much emphasis gets placed on the number on the scale.
What I like to focus on instead is the full picture, including your mental health, your physical symptoms like cycle regularity, acne, and hair changes, and your metabolic markers like blood pressure, cholesterol, triglycerides, and blood sugar.
Your A1c is one important piece of that bigger picture, and it’s a tool that can help you see real trends over time rather than guessing at whether things are actually improving.
Takeaway
If you have PCOS and insulin resistance and you notice your fasting blood sugar is getting up into the 90s, your A1c is worth knowing about and worth asking your doctor to check.
It gives you a window into what’s been happening with your blood sugar over the past few months, not just at one moment in time, and that information can be genuinely useful as you work on managing your health with PCOS.
