What Is Insulin Resistance and Why Does It Matter So Much for PMOS?
Quick answer: Insulin resistance happens when your cells stop responding properly to insulin, forcing your pancreas to pump out more of it just to keep your blood sugar stable. Over time, this can lead to type 2 diabetes and it's a major driver of PMOS symptoms, affecting an estimated 50-70% of women with the condition.1
If you've been diagnosed with PMOS (formerly known as PCOS), chances are your doctor has mentioned insulin resistance. Maybe in passing, maybe as a footnote in a longer conversation about your period, your skin, or your fertility. For most women with PMOS, it’s a key player in the hormonal orchestra taking place in their bodies. Here's what it is, how it works, and why it deserves your attention.
What Is Insulin Resistance?
Insulin is the hormone responsible for moving glucose (sugar) out of your bloodstream and into your cells for energy. With insulin resistance, your body’s cells don’t respond as they normally would to insulin. The cells become resistant to insulin’s signal. This results in glucose building up in your blood instead of it being used efficiently. Your pancreas compensates by producing even more insulin to try to force the glucose through.
In short: insulin resistance means your body is technically producing insulin, but that insulin isn't doing its job effectively.
It's important to note that insulin resistance doesn't automatically mean elevated blood sugar or diabetes. Many people who are developing insulin resistance have completely normal glucose levels because their pancreas is working overtime to compensate. In fact, an elevated insulin level with normal blood glucose can itself be a sign of insulin resistance, since it shows your body is producing extra insulin just to keep glucose in a normal range.
How Do I Know If I'm Insulin Resistant?
Most commonly, your health care provider can order a few labs to investigate:
- Your HbA1C (hemoglobin A1C) measures average blood sugar levels over the last three months. Less than 5.5% is considered ideal with a range of 5.5 – 5.9% considered “at risk”. An A1C of 6.0 – 6.4% is considered prediabetic.
- An elevated fasting glucose can also be a sign of insulin resistance, however, fasting glucose in the “normal” range with an elevated fasting insulin can also signal that your pancreas is working harder than it should be to keep your blood sugar in check.
- A HOMA-IR (homeostatic model assessment for insulin resistance) calculation can help to identify insulin resistance even when your bloodwork looks “normal”. A HOMA-IR below 1.0 indicates optimal insulin sensitivity.
Insulin resistance can also present as stubborn abdominal weight gain, persistent sugar cravings, constant hunger, fatigue and dark velvety skin patches typically found around the neck, armpits or groin known as Acanthosis Nigricans.
What Are the Effects of Insulin Resistance in the Body?
To understand insulin resistance, it helps to understand what insulin is supposed to do.
Insulin acts like a key. When you eat, glucose enters your bloodstream, and insulin is released to "unlock" your cells so they can absorb that glucose and use it for energy. In a well-functioning system, this process is smooth: blood sugar rises after a meal, then insulin rises, glucose moves into cells with the help of insulin, and blood sugar levels come back down.
With insulin resistance, the "locks" on your cells become less responsive to the key. Glucose has a harder time getting in, so it lingers in the bloodstream. Your pancreas senses this and releases more insulin to compensate, resulting in chronically elevated insulin levels, a state often referred to as hyperinsulinemia.
Over time, this cycle can put ongoing strain on the pancreas and disrupt multiple systems in the body including, notably, the reproductive system.
Can Insulin Resistance Lead to Type 2 Diabetes?
Yes. Insulin resistance is considered a key precursor to type 2 diabetes. As cells become progressively less responsive to insulin, the pancreas has to work harder and harder to keep blood glucose in a normal range. Eventually, it may not be able to keep up with demand. When this compensation fails and blood glucose levels rise consistently, it can progress into prediabetes and, eventually, type 2 diabetes.
Not everyone with insulin resistance develops diabetes, but insulin resistance is one of the clearest early warning signs that your body's glucose regulation system is under strain, which is exactly why catching it early matters.
What's the Link Between Insulin Resistance and PMOS?
Polyendocrine metabolic ovarian syndrome (PMOS) is a common hormonal condition affecting roughly 1 in 10 women, in which elevated levels of androgens (male hormones) disrupt ovulation and lead to irregular periods, ovarian cysts, and other symptoms.2,3 PMOS is diagnosed using the Rotterdam criteria, though it remains widely underdiagnosed despite how common it is.2,3
An estimated 50-70% of women with PMOS have insulin resistance, making it one of the most common symptoms of PMOS despite its heterogenous nature. This means that while your PMOS might look different than someone else’s, there’s a high chance that both of you have some degree of insulin resistance. You cannot tell by looking at a person if they have insulin resistance.
Severity of insulin resistance can impact the severity of PMOS symptoms. When insulin levels rise, this excess insulin can signal the ovaries to produce and release more androgens. Elevated androgens can wreak havoc in the body leading to the hallmark symptoms of PMOS such as suppressed ovulation, hirsutism (a condition resulting in extra growth of dark hair in a male like pattern), acne and hair loss.
How Does Insulin Resistance Influence PMOS?
Elevated insulin directly stimulates androgen production in the ovaries. This creates a feedback loop where:
- Insulin resistance → higher insulin levels
- Higher insulin levels → increased ovarian androgen production
- Increased androgens → worsened PMOS symptoms
This can intensify symptoms like:
- Irregular or absent menstrual periods
- Painful menstruation
- Abnormal or absent ovulation, which can affect fertility
- Ovarian cysts
- Excess facial and body hair growth
- Acne
What Can You Do if You Think You Have Insulin Resistance?
If you have been diagnosed with PMOS, it’s a good idea to investigate if you have insulin resistance.
1. Complete bloodwork. Insulin resistance isn't always obvious from symptoms alone, and normal blood glucose doesn't rule it out. Talk to your doctor about testing that looks at insulin levels in combination with glucose.
2. Ask about PMOS specifically. If you have PMOS, ask your provider whether insulin resistance has been evaluated as part of your care. It's common but not always tested for by default.
3. Understand it's a spectrum, not a single symptom. Insulin resistance ranges from mild to significant and can exist with or without elevated blood sugar. Your provider can help you understand where you fall on that spectrum.
4. Treat it as part of your PMOS management plan. Because insulin resistance and androgen production are physiologically linked, addressing one can meaningfully affect the other.
5. Monitor over time. Insulin resistance isn't static and it can improve or worsen based on a range of factors. Ongoing check-ins with your provider help track where you stand.
For most women with PMOS, insulin resistance is an important factor that can influence the severity of their symptoms. Understanding the physiology behind it and how excess insulin signals your ovaries to produce more androgens helps explain why so many PMOS symptoms cluster together, and why insulin resistance deserves a central place in the conversation about your care.
How Can July Health Help With Insulin Resistance?
At July Health, we know how frustrating it can be to spend hours googling your symptoms and trying to figure them out on your own.
Our nurse practitioners can help you order the blood work you need to help you identify if you have insulin resistance.
Our registered dietitians can help you with a personalized nutrition protocol to improve your insulin sensitivity without cutting out entire food groups. Book a session with one of our practitioners today.
Want to learn more about how to improve insulin sensitivity? Stay tuned for part two of this post.
This article is for informational purposes only and is not a substitute for professional medical advice. Talk to your healthcare provider about testing and treatment options tailored to you.
References:
1. Zeng X, Xie Y jie, Liu Y ting, Long S lian, Mo Z cheng. Polycystic ovarian syndrome: Correlation between hyperandrogenism, insulin resistance and obesity. Clinica Chimica Acta. 2020;502:214-221. doi:10.1016/j.cca.2019.11.003
2. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics. 2023;13(6):1113. doi:10.3390/diagnostics13061113
3. Salari N, Nankali A, Ghanbari A, et al. Global prevalence of polycystic ovary syndrome in women worldwide: a comprehensive systematic review and meta-analysis. Arch Gynecol Obstet. 2024;310(3):1303-1314. doi:10.1007/s00404-024-07607-x
