PCOS Basics: Insulin & Insulin Resistance

By Amy Medling, founder of PCOS Diva

Updated 2020

Description: One of the major symptoms of PCOS is elevated insulin levels. Elevated insulin levels in the body is considered a key indicator in acquiring insulin resistance (IR) which, unchecked, eventually leads to diabetes. This article will provide you with ample information with regards to insulin resistance and how you can help treat it without relying on drugs like Metformin.

What is Insulin?

Insulin is a hormone secreted by our pancreas. Its purpose is to take the glucose (sugar) from the carbohydrates you eat and use it for energy or store it for future use in the muscles, fat, and liver. This storage reduces the amount of glucose in the blood and signals the body to slow insulin production.

Insulin’s main function is to keep your blood sugar levels from getting too high.  In this way, the pancreas works in conjunction with the liver which adds glucose to the bloodstream to keep blood sugar levels from dipping too low. Together, they keep blood sugar levels even. This constant balancing of blood sugar is key to giving our bodies the energy they need to function.

Insulin is also responsible for regulating carbohydrate, fat, and protein metabolism, as well as promoting healthy cell growth. When this hormone is out of whack, it can increase the risk of gestational diabetes, as well as produce symptoms like weight gain, anxiety, brain fog, and fatigue. Insulin plays a critical role in many functions of the body, so anything that makes it less effective will cause negative effects on our health.

One of the most common “insulin issues” is insulin resistance (IR), a symptom women with PCOS know all too well.

What is Insulin Resistance?

Insulin resistance is an impairment of your body’s ability to control your blood sugar levels. Just like it sounds, your body’s cells begin to resist incoming insulin. This resistance can occur for many reasons including a defect in messaging from your hypothalamus, poor diet, ethnicity, certain diseases, hormones, steroid use, some medications, older age, sleep problems, cigarette smoking, and the birth control pill ^{[1] [2]}. In all cases, the cells are trying to protect themselves from chronically high levels of insulin as a result of too much glucose (sugar) in the bloodstream since insulin at high levels can be toxic.

Ideally, the body detects if the level of glucose in the blood is too high and signals the pancreas to create more insulin to manage the excess and store the glucose in cells. The hope is that since there is more insulin being produced, more glucose will be picked up.

The result of the body’s attempt to balance blood sugar encountering insulin resistance is a tremendous amount of insulin in the blood. This leads to two problems. This demand on the pancreas to produce higher levels of insulin than normal is not sustainable. If the pancreas becomes overwhelmed and cannot produce enough insulin to absorb the glucose, or if the cells become insulin resistant as a result of constant bombardment, blood sugar builds up in the bloodstream and could lead to diabetes, prediabetes, and other serious health disorders.

This kicks off the insulin resistance cycle wherein insulin resistance of cells and tissues create chronically high levels of insulin, and those chronically high levels of insulin bombard cells and perpetuate insulin resistance.

Symptoms of Insulin Resistance:

weight gain

sugar cravings

skin tags

Hypoglycemia

rough or red bumps on upper arms

dark skin patches on neck, knees, elbows, knuckles, chest, groin

 

Between 50-70% of women with PCOS have some degree of insulin resistance. While insulin resistance is often associated with obesity, women with PCOS often struggle with IR even if they are lean. [4, 5, 6]

Effects of Insulin Resistance

The ability to regulate blood sugar levels is probably one of the body’s most important functions, and to have it impaired due to insulin resistance is a lot like throwing a wrench in the works. In fact, insulin resistance is at the heart of most of your PCOS symptoms including infertility, obesity, hirsutism, hyperandrogenism, chronic fatigue syndrome, immune system defects, eating disorders, hypoglycemia, gastrointestinal disorders, depression, and anxiety.  In the long term, when insulin levels rise too high, type II diabetes, atherosclerosis and an increased risk of high blood pressure and stroke can result.

Below are just a few of the sites in the body that requires efficient insulin action and what happens to them when you are insulin resistant.

Muscle

Muscular glucose uptake – how our muscles absorb glucose for biological functions – is essentially insulin dependent, and our muscles account for up to 70% of the entire body’s insulin mediated uptake [7]. After eating, insulin promotes glucose processing and enables the release of energy, especially during intense physical activity such as weightlifting or sports that require physical strength. If you are insulin resistant, the energy transfer to your muscles will be impaired and your performance will suffer.

Fat

Our own body fat helps insulin absorb blood sugar properly and is responsible for at least 10% of the process. In fact, insulin is a fat storage hormone, concentrating fat in the belly region.

Liver

While glucose uptake into the liver is not insulin-dependent, it accounts for about 30% of the body’s overall “blood-sugar disposal.” When you have insulin resistance, your liver takes a beating despite having no significant effects on fat itself. As it turns out, being insulin resistant promotes very low density lipoprotein (VLDL) production in the liver. VLDL is the kind of cholesterol specifically known to cause heart disease [8] as well as increase risks of fatty liver disease [9].

Brain

While the brain is not insulin-dependent so far as glucose uptake is concerned, insulin receptors are located in the brain. Insulin in the brain is involved in various sensations [10] such as satiety, appetite regulation, olfaction, memory, and cognition.

The possibility that syndromes associated with insulin resistance in obesity and type 2 diabetes may also be associated with insulin resistance in the brain, with dysregulation of appetite and body weight, is intriguing. In fact, current research has called Alzheimer’s Disease “Type 3 Diabetes” since it mostly occurs when there is insulin resistance in the brain [11].

*Hormones*

For women with PCOS, insulin resistance will particularly alter their hormonal balance and is at the root of most of our PCOS symptoms. The cells in the ovaries produce estrogen, progesterone, and a small amount of testosterone. These hormones are responsible in the breast development as well as primary controllers of the menstrual cycle.

Elevated insulin levels in women with PCOS can cause the ovaries to produce too much testosterone [12] and can lead to increased body hair, acne, and irregular or few periods. In many cases, it can lead to reduced fertility as well as thinning of scalp hair.

What Can You do to Eliminate Insulin Resistance?

The first step is to upgrade your diet and lifestyle. All research indicated that this is the first line of treatment for insulin resistance as well as PCOS. That means crowding out inflammatory foods that spike your insulin with ones that nourish and tame the flames of your inflammation. The PCOS Diva protocol is specifically designed to get your insulin resistance under control, your hormones balanced, and your health on track. The next step is to add natural supplements such as berberine and Ovasitol to your regimen.

 

 

Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.

 

 

Resources:

[1] Adeniji, A. A., P. A. Essah, J. E. Nestler, and K. I. Cheang. “Metabolic Effects of a Commonly Used Combined Hormonal Oral Contraceptive in Women with and Without Polycystic Ovary Syndrome.” Journal of Women’s Health (2002). U.S. National Library of Medicine, June 2016. Web.

[2] “Prediabetes & Insulin Resistance | NIDDK.” National Institutes of Health. U.S. Department of Health and Human Services, Aug. 2009. Web. 30 Mar. 2017.

[3] Yki-järvinen H. Fat in the liver and insulin resistance. Ann Med. 2005;37(5):347-56.

[4] Gerozissis K. Brain insulin and feeding: a bi-directional communication. Eur J Pharmacol. 2004;490(1-3):59-70.

[5] De la monte SM, Wands JR. Alzheimer’s disease is type 3 diabetes-evidence reviewed. J Diabetes Sci Technol. 2008;2(6):1101-13.

[6] Moghetti P. Insulin Resistance and Polycystic Ovary Syndrome. Curr Pharm Des. 2016;22(36):5526-5534.

[7] Smith, U. “Impaired (‘Diabetic’) Insulin Signaling and Action Occur in Fat Cells Long before Glucose Intolerance–Is Insulin Resistance Initiated in the Adipose Tissue?” International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity., International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity., July 2002, www.ncbi.nlm.nih.gov/pubmed/12080441/.

[8] Prenner, Stuart B, et al. “Very Low Density Lipoprotein Cholesterol Associates with Coronary Artery Calcification in Type 2 Diabetes beyond Circulating Levels of Triglycerides.”Atherosclerosis, Atherosclerosis, Oct. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4209900/.

[9] Yki-Järvinen, H. “Fat in the Liver and Insulin Resistance.” Annals of Medicine., Annals of Medicine., 2005, www.ncbi.nlm.nih.gov/pubmed/16179270.

[10] Gerozissis, K. “Brain Insulin and Feeding: a Bi-Directional Communication.” European Journal of Pharmacology., European Journal of Pharmacology., 19 Apr. 2004, www.ncbi.nlm.nih.gov/pubmed/15094073/.

[11] Monte, Suzanne M. de la, and Jack R. Wands. “Alzheimer’s Disease Is Type 3 Diabetes–Evidence Reviewed.” Journal of Diabetes Science and Technology (Online), Journal of Diabetes Science and Technology, Nov. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/.

[12] Moghetti, P. “Insulin Resistance and Polycystic Ovary Syndrome.” Current Pharmaceutical Design., Current Pharmaceutical Design., 2016, www.ncbi.nlm.nih.gov/pubmed/27510482.