Navigate insulin-resistant PCOS with Meri Sehat's expert advice. Discover strategies for effective management

Insulin-Resistant PCOS

Humza Khizer

Overview

This form of <a href="https://merisehat.pk/disease/polycystic-ovary-syndrome-pcos">polycystic ovary syndrome (PCOS)</a> is characterized by higher-than-normal insulin levels in the body due to insulin resistance. 
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Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age, with a global prevalence of 4-20%<a href="#accordion">[1]</a>. It is characterized by a combination of symptoms, including irregular <a href="https://merisehat.pk/disease/normal-menstrual-cycle">menstrual cycle</a>s, excessive production of androgens, and the development of small cysts on the ovaries. These hormonal imbalances can lead to various issues, such as fertility problems, acne, excessive hair growth, and weight gain.

Insulin-resistant PCOS is the most common type of PCOS, accounting for 70% of cases<a href="#accordion">[2]</a>. The condition occurs from the body&#39;s cells becoming less responsive to insulin in the body. Thus, causing the pancreas to release more and more insulin. Hyperinsulinemia (high insulin levels in the blood) is not only a symptom of PCOS but also a driver of the condition. It can result from inflammation, stress, a diet high in sugar, or an imbalance in blood sugar. The high insulin levels increase testosterone production, further contributing to symptoms of PCOS. 
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Usually excess body weight is a risk factor for insulin resistance, however it can affect any woman irrespective of her body weight. According to research, insulin resistance and compensatory hyperinsulinemia affect 20-25% of lean and 70-80% of obese women<a href="#accordion">[2]</a>. Unfortunately, the presence of obesity with insulin resistance increases the risk of type 2 diabetes in women with insulin-resistant PCOS. 
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There are no types of insulin-resistant PCOS. 
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Signs and Symptoms

Insulin-resistant polycystic ovary syndrome (PCOS) is the most prevalent subtype, affecting approximately 70% of individuals with PCOS<a href="#accordion">[2]</a>. It is characterized by a range of signs and symptoms that stem from the interplay of insulin dysregulation and hormonal imbalances. These include<a href="#accordion">[3]</a>:

<ul>
	<li>Weight Struggles - Individuals often experience difficulties with weight management, particularly around the abdominal region. 
	&nbsp;</li>
	<li>Sugar Cravings - Heightened sugar and carbohydrate cravings are common due to insulin resistance, leading to challenges in maintaining stable blood sugar levels. 
	&nbsp;</li>
	<li>Fatigue And Brain Fog - Insulin resistance can contribute to feelings of fatigue and mental fogginess. 
	&nbsp;</li>
	<li>Androgen-Related Issues - Elevated insulin levels contribute to increased production of androgens, leading to symptoms like excess hair growth (hirsutism), male pattern hair loss (androgenic alopecia), and acne. 
	&nbsp;</li>
	<li>Other Symptoms may include frequent or increased urination, increased thirst or hunger, darkening of the skin in the armpits, groin, or behind the neck, and tingling sensations in the feet or hand. 
	&nbsp;</li>
</ul>

Causes

Insulin resistance in PCOS occurs when cells become less responsive to the effects of insulin, causing the pancreas to produce higher levels of insulin. This condition is often driven by multiple factors, including genetics, lifestyle, and environmental influences. Factors contributing to insulin-resistant PCOS include:

<ul>
	<li>Genetic Predisposition - Genetic factors play a role in an individual&#39;s susceptibility to insulin resistance and PCOS. 
	&nbsp;</li>
	<li>Lifestyle Factors - Sedentary behavior and poor dietary habits, especially a diet high in refined sugars and carbohydrates, can contribute to insulin resistance. 
	&nbsp;</li>
	<li>Obesity - While insulin resistance can affect individuals of all body weights, excess adipose tissue, particularly around the abdomen, can exacerbate insulin resistance. 
	&nbsp;</li>
	<li>Hormonal Imbalances - The high levels of insulin in the body increase luteinizing hormone (LH) levels, which then stimulate the ovaries to produce testosterone. Thus, contributing to androgen-related symptoms. 
	&nbsp;</li>
</ul>

The American College of Obstetricians and Gynecologists (ACOG) and the Endocrine Society recommend screening all women with PCOS for prediabetes and insulin resistance with an oral glucose tolerance test (OGTT)<a href="#accordion">[4]</a>. 
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Diagnosis

Diagnosing insulin-resistant polycystic ovary syndrome (PCOS) involves a comprehensive evaluation that considers clinical manifestations, laboratory tests, and exclusion of other potential causes. Since insulin resistance is a significant component of this type of PCOS, healthcare professionals use a combination of criteria to arrive at a diagnosis.

<ul>
	<li>Clinical Assessment - Healthcare providers begin by reviewing the patient&#39;s medical history, including menstrual irregularities, symptoms of androgen excess (such as hirsutism and acne), and family history of PCOS or metabolic disorders. A thorough physical examination may be conducted to assess signs of hyperandrogenism, such as excess hair growth or male pattern hair loss. 
	&nbsp;</li>
	<li>Laboratory Tests - Specific blood tests are conducted to evaluate insulin resistance and metabolic parameters. These tests may include:</li>
</ul>

<ol>
	<li>Fasting Insulin Levels: Elevated fasting insulin levels are often indicative of insulin resistance. Normal levels are typically less than 10 mIU/L (60 pmol/L).</li>
	<li>Glucose And HbA1c - Assessment of fasting glucose levels and hemoglobin A1c (HbA1c) to evaluate blood sugar control and detect prediabetes or diabetes.</li>
	<li>Lipid Profile - Measurement of cholesterol and triglyceride levels to assess lipid metabolism.</li>
	<li>Hormone Levels - Testing for androgens (such as testosterone), sex hormone-binding globulin (SHBG), and other hormones to assess hormonal imbalances.</li>
	<li>Oral Glucose Tolerance Test (OGTT) - An OGTT involves ingesting a glucose solution followed by periodic blood tests to measure glucose and insulin levels over a few hours. This test provides a more detailed assessment of insulin sensitivity and glucose tolerance. 
	&nbsp;</li>
</ol>

<ul>
	<li>Exclusion Of Other Conditions - Healthcare professionals will also rule out other potential causes of the patient&#39;s symptoms, such as thyroid disorders, hyperprolactinemia, and non-classic congenital adrenal hyperplasia. 
	&nbsp;</li>
</ul>

<h5>Diagnostic Criteria For PCOS</h5>

PCOS is often diagnosed based on established criteria. The most commonly used criteria are the Rotterdam criteria, which require the presence of at least two out of three criteria<a href="#accordion">[5]</a>:

&nbsp;&nbsp; a. Irregular or absent menstrual cycles (oligomenorrhea or amenorrhea)

&nbsp;&nbsp; b. Clinical or biochemical signs of hyperandrogenism

&nbsp;&nbsp; c. Polycystic ovaries visualized on ultrasound 
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Treatment

The management and treatment of insulin-resistant PCOS are focused on enhancing insulin sensitivity, which can help alleviate the symptoms and complications associated with the condition. Approaches to treatment include<a href="#accordion">[3]</a>:

<ul>
	<li>Regular Exercise - Engaging in consistent physical activity promotes glucose metabolism, muscle building, weight loss, and improved insulin sensitivity. 
	&nbsp;</li>
	<li>Dietary Modifications - Adopting a lower carbohydrate diet that emphasizes proteins, healthy fats, and whole foods helps stabilize blood sugar levels and supports insulin sensitivity. 
	&nbsp;</li>
	<li>Sleep And Stress Management - Prioritizing sufficient sleep and implementing stress reduction techniques aid in maintaining balanced blood sugar and insulin levels. 
	&nbsp;</li>
	<li>Nutritional Supplementation - Key nutrients such as magnesium, chromium, NAC (N-acetyl cysteine), inositol, and berberine have shown potential in improving insulin sensitivity. Consulting with a nutritionist or naturopath is essential to determine appropriate dosages and personalized treatment plans.</li>
</ul>

In some cases, doctors may prescribe metformin to help control blood sugar levels. 
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Insulin-resistant PCOS can lead to a range of complications that affect both reproductive and metabolic health. The hormonal imbalances and insulin resistance associated with this condition contribute to these complications<a href="#accordion">[6]</a>.

<ul>
	<li>Type 2 Diabetes - Insulin resistance is a precursor to type 2 diabetes. Over time, the pancreas may struggle to produce enough insulin to compensate for insulin resistance, leading to elevated blood glucose levels and potentially resulting in the development of diabetes. 
	&nbsp;</li>
	<li>Cardiovascular Risks - Insulin resistance and PCOS are associated with an increased risk of cardiovascular problems. This includes high blood pressure, abnormal lipid profiles (elevated triglycerides and low HDL cholesterol), and an increased risk of heart disease. 
	&nbsp;</li>
	<li>Metabolic Syndrome - The combination of insulin resistance, obesity, elevated blood pressure, and abnormal lipid profiles can contribute to the development of metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. 
	&nbsp;</li>
	<li>Gestational Diabetes - Women with insulin-resistant PCOS are at an increased risk of developing gestational diabetes during pregnancy. This condition can pose risks to both the mother and the baby. 
	&nbsp;</li>
	<li>Infertility - Insulin-resistant PCOS can disrupt ovulation and menstrual cycles, leading to difficulties in conceiving. Hormonal imbalances and irregular periods can make it challenging to achieve pregnancy without medical intervention. 
	&nbsp;</li>
	<li>Depression And Anxiety - Hormonal imbalances and the physical symptoms of PCOS can contribute to psychological distress, leading to an increased risk of depression and anxiety. 
	&nbsp;</li>
	<li>Obesity - Insulin resistance can promote weight gain and obesity, which in turn worsens insulin resistance, creating a vicious cycle.</li>
</ul>

It&#39;s important to note that the severity and likelihood of these complications can vary among individuals. Early diagnosis, proper management of insulin resistance, and a comprehensive healthcare approach are crucial for reducing the risk and managing the potential complications associated with insulin-resistant PCOS. 
&nbsp;

The following factors increase the risk of insulin-resistant PCOS:

<ul>
	<li>Age more than 40 years</li>
	<li>Sedentary lifestyle</li>
	<li>Overweight or obese</li>
	<li>Hypertension</li>
	<li>High cholesterol 
	&nbsp;</li>
</ul>

The following steps can help reverse or prevent insulin-resistant PCOS:

<ul>
	<li>Maintain A&nbsp;Healthy Weight - Achieving and maintaining a healthy weight through a balanced diet and regular physical activity can help improve insulin sensitivity and reduce the risk of insulin resistance. Weight loss, if needed, can be especially beneficial. 
	&nbsp;</li>
	<li>Balanced Diet - Focus on a diet rich in whole foods, vegetables, lean proteins, and healthy fats. Limit processed foods, sugary snacks, and refined carbohydrates to help stabilize blood sugar levels. 
	&nbsp;</li>
	<li>Physical Activity - Engage in regular physical activity, such as aerobic exercises (walking, swimming, cycling) and strength training. Exercise helps improve insulin sensitivity and supports overall metabolic health. 
	&nbsp;</li>
	<li>Low Glycemic Index (GI) Foods - Choose low GI foods that have a slower impact on blood sugar levels. These foods help prevent rapid spikes and crashes in insulin levels. 
	&nbsp;</li>
	<li>Regular Meals - Eat regular, balanced meals throughout the day to avoid large fluctuations in blood sugar and insulin levels. 
	&nbsp;</li>
	<li>Stress Management - Practice stress-reducing techniques such as meditation, yoga, deep breathing, and mindfulness to help regulate cortisol levels, which can impact insulin sensitivity. 
	&nbsp;</li>
	<li>Adequate Sleep - Prioritize getting enough restful sleep each night, as poor sleep can affect insulin sensitivity and hormonal balance. 
	&nbsp;</li>
	<li>Quit Alcohol Consumption - Avoiding alcohol consumption is important, as excessive alcohol intake can impact insulin regulation and metabolic health. 
	&nbsp;</li>
	<li>Avoid Smoking - Quitting smoking can contribute to improved insulin sensitivity and overall health. 
	&nbsp;</li>
	<li>Nutritional Supplements - Some supplements, such as magnesium, chromium, and inositol, have been studied for their potential benefits in improving insulin sensitivity. Consult a healthcare professional before taking any supplements. 
	&nbsp;</li>
</ul>

It&#39;s important to note that while lifestyle changes can play a significant role, PCOS is a complex condition influenced by various factors. Even with preventive efforts, some individuals may still develop insulin-resistant PCOS. Therefore, maintaining a healthy lifestyle, early detection, and appropriate medical management are key components of reducing the impact of PCOS on overall health and well-being.

Note: If you suspect you have PCOS or are at risk, it&#39;s advisable to consult a healthcare professional for personalized guidance and recommendations. 
&nbsp;

Key Points

<ul>
	<li>Insulin-Resistant PCOS is characterized by higher-than-normal insulin levels in the body. It is the most common type of PCOS, accounting for 70% of cases.</li>
	<li>Insulin-resistant PCOS is characterized by a range of signs and symptoms that stem from the interplay of insulin dysregulation and hormonal imbalances. These include weight gain, sugar cravings, fatigue, and brain fog.</li>
	<li>Risk factors include genetics, a sedentary lifestyle, obesity, and hormonal imbalances.</li>
	<li>Diagnosis involves clinical assessment, blood tests, hormonal evaluation, and exclusion of other conditions.</li>
	<li>Treatment focuses on improving insulin sensitivity through exercise, diet, sleep, stress management, and supplements.</li>
	<li>Complications include type 2 diabetes, cardiovascular risks, gestational diabetes, infertility, and more.</li>
	<li>Preventive measures include weight management, balanced diet, exercise, stress reduction, and avoiding alcohol and smoking.</li>
</ul>

[3] Jensen E. 4 Types of PCOS - and How to Know Which One You Have. Emily Jensen Nutrition.

[5] Williams T, Moore JB, Regehr J. Polycystic Ovary Syndrome: Common Questions and Answers. Am Fam Physician. 2023;107(3):264-272.

[1] Jabeen A, Yamini V, Rahman Amberina A, et al. Polycystic Ovarian Syndrome: Prevalence, Predisposing Factors, and Awareness Among Adolescent and Young Girls of South India. Cureus. 2022;14(8):e27943. Published 2022 Aug 12. doi:10.7759/cureus.27943.

[2] Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22. doi:10.1016/j.fertnstert.2011.11.036.

[4] Dhesi AS, Murtough KL, Lim JK, et al. Metabolic screening in patients with polycystic ovary syndrome is largely underutilized among obstetrician-gynecologists. Am J Obstet Gynecol. 2016;215(5):579.e1-579.e5. doi:10.1016/j.ajog.2016.07.043.

[6] Purwar A, Nagpure S. Insulin Resistance in Polycystic Ovarian Syndrome. Cureus. 2022;14(10):e30351. Published 2022 Oct 16. doi:10.7759/cureus.30351.