Next time you reach for a bag of candy, think twice - insulin resistance is a real problem
PCOS (Polycystic Ovary Syndrome)
In women who suffer from PCOS, the hormonal imbalance interferes with the ovulation process - the development and release of mature eggs. Without ovulation, there can be no pregnancy. In PCSOS cases where ovulation does occur, the hormonal imbalance may prevent the lining of the uterus from allowing the fertilised egg to implant itself. ‘Polycystic’ means many cysts which appear on the ovaries.
Genetic factor
According to a study done at the University of Alabama at Birmingham, the researchers found that 24% of women with PCOS had a mother with PCSO and 32% of the women had a sister with the condition. Therefore, the risk for PCOS can be inherited. However, that being said, there is no single PCOS gene. A number of genes and mechanism seem to play in role, which may explain why PCOS has a wide range of symptoms and may develop at different ages for women. However, several genetic studies in PCOS have indicated that genes which affect hormone levels and insulin resistance play a part. While being overweight can exacerbate insulin resistance, even lean women with PCOS can suffer from it.
Adrenal driven PCOS
The hormonal imbalance can cause an elevation of androgenic hormones by the adrenal glands and lead to a variety of symptoms such as hair growth on the face, chest or back, irregular periods marked by oligoovulation (irregular ovulation) or anovulation (no ovulation), acne, depression etc. Not everyone with PCOS will have the same symptoms.
SHBG - sex hormone binding globulin
An article in Endocrine Review (Diamanti-Kandarakis and Dunaif, 2012) suggests that insulin resistance may reduce the liver’s ability to produce a protein called sex hormone binding globulin (SHBG). It serves as a transport protein for testosterone, meaning that it takes testosterone from where it is produced (the ovaries and the adrenal glands) and sends it to where it is needed in the body. It binds testosterone and controls where it is allowed to go. If there is less SHBG in the body, there will be more free or unbound testosterone in the body, meaning that it will start targeting tissues it is not meant to in a woman, causing facial hair, hair thinning, acne etc. Research has also suggested a link between low concentrations of SHBG and Type 2 diabetes in both men and women (Wallace, McKinley, Bell and Hunter, 2013). It is important to note that it is normal for women to have androgenic hormones such as testosterone in their bodies. Low testosterone levels can negatively impact on our sex drive, bone density, mood, cognition as well as chronic fatigue. However, high levels of androgenic hormones can affect our menstrual function and fertility.
Insulin resistance driven PCOS
Insulin is a hormone made by pancreas. The pancreas is an abdominal organ located behind the stomach. It is slightly over 15 cm long. It plays an important role in digestion and regulating blood sugar. When we eat, blood sugar levels rise. Insulin decreases the blood sugar level in the blood by signalling the body’s cells to use the glucose (sugar from food) for energy. This in turn causes the levels of glucose and insulin to fall until the next time food or sweet drinks are consumed.
Insulin resistance causes our body to start resisting or ignoring the signal the insulin is trying to send to cells. This causes the levels of insulin to increase because the pancreas is forced to produce more o fit in order to signal our body cells to take glucose out of the blood stream. Increased insulin levels can lead to Type 2 diabetes, weight gain and heart disease. In addition, it is also an underlaying physiological driver of PCOS. It has been suggested that insulin resistance alters the function of the hypothalamus and the pituitary gland in the brain, increasing the production of androgenic hormones, which contribute to PCOS. It is important to note that excessive production of androgenic hormones is a risk factor for female infertility and ovarian dysfunction, with or without PCOS (with or without the cysts on the ovaries).
An increase in weight gain and obesity has led to an increase in PCOS. A correlation between Type 2 diabetes and PCOS has been reported. However, it is important to emphasise that insulin resistance can be present not only in overweight PCOS patients but also in those whose weight is normal. Many people may have insulin resistance without any symptoms. It is a process, often years in the making. Our body will do its best to keep pace with the need for extra insulin production before a breakdown occurs. Some subtle and not so subtle symptoms may occur: dry skin, blurred vision, darkening patches on the neck, in the groin area, or under armpits, feeling exhausted, an increase in yeast infections. Unfortunately, given how busy our everyday lives can be while trying to juggle the family and career, most women do not usually pay any serious attention to these symptoms and tend to brush them off as something insignificant and not related to a more serious condition such as insulin resistance.
Blood tests for adrenal versus insulin resistance driven PCOS
Insulin resistance can be confirmed with blood tests such GTT (glucose tolerance test and glycosylated hemoglobin A1C). With regards to GTT, the blood sugar level is checked first, and then the patient is given a concentrated sugary drink. Blood tests are done at designated intervals (every 60 min for two hours) to determine efficiently blood cells process the sugar. If glucose levels remain elevated, it may indicate that the patient is becoming resistant to insulin.
Glycosylated hemoglobin A1C: This blood test measures your average glucose levels over the past three months by measuring the percentage or amount of hemoglobin that has been glycated or bound with glucose in the bloodstream. High levels of A1C are indicative of poor blood sugar control. These tests will help your health care practitioner decide whether their patient has adrenal versus insulin resistance driven PCOS.
