Why a continuous glucose monitor may be a good idea for your PCOS

PCOS is a hormone imbalance that can lead to irregular periods, acne, excess hair growth, weight gain, and infertility. In many cases, PCOS is treated with a one-size-fits-all approach. The problem with that approach is that PCOS affects every individual differently, and identifying the “type” of PCOS you have is crucial to treating your symptoms (1).

The most common type of PCOS is insulin-resistant PCOS; in fact, 70-95% of individuals with PCOS fall into this category (3). Read on to learn:

• What is insulin resistance?
• What is the link between insulin resistance and PCOS?
• How can I more closely monitor my blood sugar if I have PCOS? 
  

What is insulin resistance?

Insulin is a hormone secreted by your pancreas that regulates blood sugar levels. Its function is to convert glucose, or blood sugar, into energy for bodily functions. 

Insulin resistance occurs when your muscles, fat, and liver do not respond to insulin. If your body does not respond to insulin, your blood sugar remains higher (since it is not being converted into energy as efficiently) and your pancreas will produce more insulin, leaving your insulin levels high as well. People who are insulin resistant are likely to develop type 2 diabetes and inflammatory conditions down the line (2).

Oftentimes, individuals may not exhibit any symptoms, but over time as the condition worsens, the pancreas is no longer able to produce enough insulin, which results in elevated blood sugar levels. As a result of high blood sugar levels, symptoms such as hunger, energy spikes and crashes, stubborn weight gain, frequent urination, thirst, headaches, and skin infections can occur (2).

The link between PCOS and insulin resistance

There is a strong link between insulin resistance and PCOS in a majority of cases.

Research has shown that high insulin levels can impair ovulation and increase testosterone production in the ovaries (4). Increasing insulin levels leads to a rise in male hormones, which can contribute to fat accumulation around the abdomen, thereby contributing to increased insulin resistance.

Additionally, insulin resistance can lead to a diagnosis of Type 2 Diabetes. Researchers have found that women with PCOS are four to nine times more likely to develop diabetes than women without it. Furthermore, women with PCOS have a much higher risk of developing gestational diabetes during pregnancy (5). 

Stopping the vicious cycle of PCOS and insulin resistance

Despite the lack of a cure for PCOS, lifestyle modifications and medications may ease symptoms. In addition to helping the symptoms of PCOS, lifestyle changes will improve insulin resistance as well.

Some lifestyle and medical treatments for insulin resistance include:

Focusing on a blood sugar-balancing diet: There is a lot of talk around reducing or even eliminating carbohydrates with PCOS, and this is largely due to the majority of cases that are insulin resistant. And there is some validity to this: like prediabetic and diabetic dietary protocols, reducing carbohydrate intake can have a quick impact on improving insulin sensitivity and stabilizing blood sugar. But be wary of fad diets like keto: unless you have an advanced case of insulin resistance, incredibly high blood sugar, or a different metabolic disorder, restricting carbohydrates can quickly backfire. We take a patient-by-patient approach at Pollie, but in general our care teams educate members around how to focus on adding complex carbohydrates (think: more fibrous and less-processed sources of carbs such as whole grains, fruits, and vegetables) to their diets. If you are not working with Pollie, a registered dietitian or nutritionist can provide you with nutrition guidance if you have insulin resistant PCOS.

Exercise: Exercising regularly can improve insulin levels. Studies have pointed to the benefit of high intensity interval training (HIIT) and insulin sensitivity, but it is important not to overdo it as this can leave your body  with too-little recovery time, thus increasing stress hormones and inflammation and further worsening insulin resistance. If you prefer intense sweat sessions, 20-30 minute workouts several times per week should cut it. In general, a combination of aerobic (i.e., steady-state cardio like walking, running, biking, swimming, and more) and strength training is most beneficial.

Reducing stress: Stress hormones like cortisol, can lead to a spike in blood sugar and insulin. Stress-reduction activities such as deep breathing, journaling, and meditation can help to reduce your stress levels.

MedicatIon and supplements: Metformin is a popular drug for insulin resistance and high blood sugar. It can be highly effective for some people, especially when used in tandem with lifestyle changes. Talk to your doctor about whether metformin makes sense for your case of PCOS. If your case of insulin resistance is not severe or if you do not want to use pharmaceuticals, there are also supplements such as myo-inositol, berberine, and others that have been shown to improve insulin sensitivity. While these are available without a prescription, make sure you speak with your physician before starting any new vitamins or supplements; they can still have a powerful effect and it is important to make sure they will not interact with your body in a negative way.

The importance of monitoring blood sugar with insulin-resistant PCOS

If you have PCOS, it is important to routinely test your metabolic markers to monitor for existing or new insulin resistance. PCOS and insulin resistance both have adverse consequences, including vision loss, infertility, and blood clots, so it is important to be aware of your condition so you can determine what treatment works best for you (5).

Make sure to ask your doctor for the following labs during your physical:

• Fasting insulin
• Fasting glucose
• HbA1c
  

But for some of us with more advanced insulin resistance or metabolic syndrome, doing blood work every few months may not be enough. Enter continuous glucose monitors!

A continuous glucose monitor (CGM) device is a type of glucose monitor that works through a tiny sensor inserted under your skin. It measures your interstitial glucose level*, or the fluid between your cells, every few minutes. A transmitter in the device wirelessly sends the information to a mobile app on your phone so that you can monitor what your blood sugar is doing throughout the day. 

If you do not have diabetes, you may be wondering: aren’t glucose monitors not needed for someone like myself?

Even if you do not have prediabetes or diabetes but are insulin resistant - or borderline insulin resistant - committing to several months of using a CGM can be a powerful way to discover what foods, exercises, and habits keep your blood sugar stable and thereby reduce your risk of developing a more serious condition down the line. The instant and personalized feedback about your dietary and lifestyle choices that a CGM provides feedback about what specifically works for your body to optimize your hormone balance, fertility, and overall health (6). 

For example, both brown rice and quinoa are whole grain carbohydrates. But perhaps your body metabolizes quinoa in a way that does not cause a blood sugar spike or vice versa. Or maybe it's a matter of whether you are eating a certain food before or after a workout that makes your body tolerate it better. See where we're going here?

Pollie members who need help understanding what type of PCOS they have and whether a CGM is right for them can speak with their functional nutritionist or health coach for guidance.

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*NOTE: If you have diabetes and monitor blood sugar for insulin purposes, it is important to know that a CGM does not take the place of a finger stick test. Since CGMs monitor the interstitial glucose level and there is a slight lag between this and our blood’s glucose level, you will still want to do a finger prick test if you require injectible insulin for your diabetes. 

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Sources

1. Centers for Disease Control and Prevention. (2020, March 24). PCOS (polycystic ovary syndrome) and diabetes. Centers for Disease Control and Prevention. Retrieved February 2, 2022, from https://www.cdc.gov/diabetes/basics/pcos.html 
2. Insulin resistance: What it is, causes, symptoms & treatment. Cleveland Clinic. (2021, December 16). Retrieved February 2, 2022, from https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance 
3. Briden, D. L. (2020, February 24). The link between PCOS and insulin resistance. PCOS and insulin resistance - Testing and Treatment. Retrieved February 2, 2022, from https://helloclue.com/articles/cycle-a-z/the-link-between-pcos-and-insulin-resistance#:~:text=Insulin%20resistance%20is%20a%20key,4%2C5%2C6 
4. Corbould, A., Kim, Y.-B., Youngren, J. F., Pender, C., Kahn, B. B., Lee, A., & Dunaif, A. (2005). Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. American Journal of Physiology-Endocrinology and Metabolism, 288(5). https://doi.org/10.1152/ajpendo.00361.2004 
5. Ford Brewer, M. D. (2021, September 13). The link between PCOS & Insulin Resistance: Imaware. RSS. Retrieved February 2, 2022, from https://www.imaware.health/blog/insulin-resistance-and-pcos 
6. Means, C., Suyama, J., & Richa, C. (2021, August 25). How continuous glucose monitoring (CGM) can help with infertility and PCOS. Levels. Retrieved February 2, 2022, from https://www.levelshealth.com/blog/how-continuous-glucose-monitoring-cgm-can-help-with-infertility-and-pcos