PCOS and Insulin Resistance

Risk of diabetes runs high if left untreated

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Women with polycystic ovary syndrome (PCOS) frequently have insulin resistance, which is an inadequate response to the hormone insulin. The sluggish response can cause glucose to accumulate in the blood and eventually change the way the body deals with sugar.

Insulin is a hormone that is produced by the pancreas, a gland in the abdomen. It is secreted in response to increased amounts of glucose (sugar) in the blood. Insulin helps transport glucose into your muscle, fat, and liver cells where it is converted into glycogen or fat, so it can be stored for later use when your body needs energy.

Worsening insulin resistance can eventually lead to diabetes.

symptoms of insulin resistance
Illustration by Jessica Olah, Verywell

Symptoms of Insulin Resistance

Women with insulin resistance often have little, if any, symptoms. When they do, it may be a sign that the condition has progressed to diabetes. If you experience any of these symptoms, you should contact your healthcare provider right away.

Symptoms may include:

  • Cravings for sweets and salty foods
  • Darkening of skin in the groin, armpits, or behind the neck
  • Fatigue
  • Frequent or increased urination
  • Increased hunger or thirst
  • Tingling sensation in the hands of feet

If you are experiencing these symptoms, your healthcare provider will likely order blood tests to see how well your body deals with sugar. These include the fasting glucose level, hemoglobin A1C, and glucose tolerance tests.

Risk Factors

In women with PCOS, the risk of insulin resistance is higher after age 40, and for those who are overweight, have high blood pressure, live a sedentary lifestyle, or have high cholesterol.

By and large, women of Hispanic, African American, or Native American origin are at higher risk of insulin resistance than either white or Asian women.

Diagnosing Insulin Resistance

For a fasting glucose level, you would need to suspend eating and drinking at least eight hours before the test. After a blood sample is drawn and sent to the lab, a diagnosis can be made based on the following results:

  • Below 100 mg/dl is a normal result
  • 100 mg/dl to 125 mg/dl is considered prediabetes
  • Above 125 mg/dl can serve as a diagnosis of diabetes

The glucose tolerance test also requires an eight-hour fast before the test can be performed. Upon arrival, your healthcare provider will draw blood to use as a baseline reference. You would then be asked to drink eight ounces of fluid containing 75 grams of sugar. A second blood test would then be taken two hours later.

A diagnosis can be supported based on the following comparative values:

  • Prediabetes is defined as a fasting blood glucose of 100 mg/dl to 125 mg/dl followed by a blood glucose of 140 mg/dl to 199 mg/dl at two hours.
  • Diabetes is defined as a fasting blood glucose of 126 mg/dl or higher followed by a blood glucose of 200 mg/dl or higher at two hours.

Normally, blood sugar will return to normal within three hours. The failure to do so is generally indicative of insulin resistance.

Hemoglobin A1C also known as the A1C test or HbA1c is a simple blood test that measures or reflects your average blood sugar over the last three months.

Interpreting A1C results:

  • Normal: Below 5.7%
  • Prediabetes: 5.7% to 6.4%
  • Diabetes: 6.5% or above

Within the prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes

Living With Insulin Resistance

If you are diagnosed with insulin resistance, there is a lot you can do to reverse the condition. In some cases, medications like metformin may be prescribed to help you better control your blood sugar levels.

Lifestyle changes can also help, whether you are prescribed medications or not.

These include:

  • Follow a healthy diet rich in lean meat, high-fiber grains, vegetables, legumes, leafy greens, and fruit (ideally designed in consultation with a nutritionist)
  • Exercise at least 30 minutes per day most days of the week
  • Get ample rest
  • Learn to manage stress
  • Reduce alcohol intake if you consume above the recommended limits
  • Stop smoking

A few of the diets that have been shown to be possibly beneficial for improving insulin resistance include the Mediterranean Diet, the Dietary Approaches to Stop Hypertension (DASH) Diet, and eating foods with low glycemic indexes.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Rojas J, Chávez M, Olivar L, et al. Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int J Reprod Med. 2014;2014:719050. doi:10.1155/2014/719050

  2. NIH National Institute of Diabetes and Digestive and Kidney Disorders. What is diabetes: insulin resistance and prediabetes. Updated May 2018

  3. Centers for Disease Control and Prevention. Diabetes: getting tested. Updated May 15, 2019

  4. American Diabetes Association. Diagnosis.

  5. Centers for Disease Control and Prevention (CDC). All about your A1C

  6. NIH National Institute of Diabetes and Digestive and Kidney Disorders. Your game plan to prevent type 2 diabetes. Updated February 2017

By Nicole Galan, RN
Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book."