What You Should Know About PCOS and Diabetes

Does having PCOS put you at higher risk of developing diabetes? And if yes, what can you do about it? Getting a positive PCOS diagnosis can be stressful enough (and in some cases, also somewhat relieving as years of searching and questions have been answered), and these complicated feelings are only compounded by hearing about other chronic conditions associated with PCOS. In this article, we’ll discuss what diabetes exactly entails (although this is a common term most people have heard of, pinning down exactly how it is diagnosed and what constitutes it is another matter altogether), how PCOS may be connected to diabetes, as well as how you can reduce your risk of developing and being diagnosed with type 2 diabetes. 

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Let’s dive in. 

• What Is Diabetes? 
• How Is Diabetes Diagnosed
• Is PCOS Connected To Diabetes? 
• How To Reduce Your Risk of Type 2 Diabetes

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What is diabetes? 

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At its core, diabetes is “a condition that affects your body’s ability to use blood sugar for energy.” As a result, your body can’t properly utilize glucose (a simple sugar), and it accumulates in your blood, which leads to blood sugar levels that run too high. In turn, this can lead to serious long-term health implications over time, including: heart disease, kidney disease, stroke, vision problems, and more. How exactly this develops in individuals depends on what type of diabetes you have: type 1, type 2, or gestational diabetes. 

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Type 1 Diabetes 

Accounting for between 5 and 10 percent of cases of diabetes, type 1 occurs when your immune cells attack the part of your pancreas that makes insulin, reducing the amount of insulin able to be produced. Since the hormone insulin is vital to helping get blood sugar into the cells to use for energy, and people with type 1 diabetes don’t make enough of it, they often need to directly inject insulin daily to avoid damage to their body. Fortunately, this form of diabetes isn’t very common, usually presenting itself in childhood or early adulthood. 

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Type 2 Diabetes 

Far more common than the previous type (accounting for around 90% of cases), this type of diabetes is a result of insulin resistance. In this scenario, the body does produce insulin, but either it doesn’t make enough to keep up with blood sugar levels, or the body’s cells aren’t responding to insulin’s instructions to accept glucose into them. Type 2 is most often attributed to “lifestyle factors,” such as nutrition and diet, and is frequently diagnosed after the age of 45. This is also known as “adult onset” diabetes, and is often associated with high cholesterol which can put you at increased risk of cardiovascular disease. This form of diabetes has a strong genetic component in PCOS, meaning that even with “perfect” diet and lifestyle, T2DM can develop. As long as you keep up healthy lifestyle behaviors, it is easier to live a typical life with the condition.

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Fortunately, diabetes can be managed.With more prudent lifestyle change and healthcare, the treatment can be less inconvenient, expensive, and uncomfortable. In addition, a type 2 diagnosis should be taken seriously. The CDC estimates that diabetes is the 7th leading cause of death in the United States (perhaps unsurprisingly, the front-runner on this list, heart disease, is a known potential implication of type 2 diabetes). If you have been diagnosed with this form, then it is critical that you not only treat the symptoms, but also the root cause. This means managing nutrition and diet to keep your blood sugar levels as stable  as possible. 

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Gestational Diabetes 

This refers to diabetes when pregnant. This is a serious, though often temporary, state of diabetes, but it does put both mother and baby at higher risk of complications. The CDC also warns that it can lead to development of type 2 diabetes later in life for mother and child. 

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So now we know what diabetes is: how do you know if you have diabetes? And how is it diagnosed?

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How is diabetes diagnosed? 

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Early symptoms of diabetes have some crossover with other health conditions, but if you have noticed any of the following, then it is critical that you reach out to your primary physician to investigate the cause. The CDC lists the following as frequent symptoms of diabetes:

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• Increased or frequent urination
• Increased thirst
• Fatigue
• Frequent or intense carbohydrate or sugar cravings
• Blurry vision 
• Skin changes 

• Cuts and sores that won’t heal (which can lead to infections and skin ulcers). 
• Darker, thicker patches of skin, particularly in places when your skin folds, such as around the neck, knees, elbows, groin, and armpits. 
• Skin tags. 

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After noticing symptoms, your doctor will likely use blood tests to investigate a diagnosis. There are multiple tests that can be ordered, including: 

• A1C test | This test is used to measure your blood sugar over the past 2-3 months; it does this by measuring the saturation of a blood sugar sensitive protein attached to the hemoglobin in your blood. If you already have a diabetes diagnosis, then this test should be conducted 1-2 times per year or per your provider’s recommendation. 

• Fasting Glucose test | Unlike the previous test, this measures your blood sugar at the time you conduct the test. This typically involves fasting for at least 8 hours, then your doctor taking a sample of your blood, after which your fasting plasma glucose will be measured in mg per dL. The results of the test will indicate whether your blood came back ‘normal’, ‘prediabetes’, or ‘diabetes.’

• Oral glucose tolerance test | This test involves having your blood taken before and after consuming a specially formulated sugary liquid; a slightly modified version of this test is conducted to screen for gestational diabetes as well. It captures how you respond to a ‘dose’ of glucose, and how much insulin is released as a result.

Finally, your doctor may also look at risk factors that could put you at an increased likelihood of developing diabetes. Typically, after the age of 45, your doctor may screen you for diabetes, but for those who are considered ‘at risk’, screening may be conducted earlier in life. 

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• Family history of type 1 diabetes is a risk factor 

• If both mother and father have type 1 diabetes, a child has between a 1 and 10 and 1 in 4 chance of developing type 1 diabetes as well. 
• Women who have a family member with type 1 diabetes are at increased risk of gestational diabetes when pregnant. 

• Lifestyle choices can impact type 2 diagnosis

• Smoking, high stress levels, an imbalanced diet, and physical inactivity are all considered risk factors. 

• Other health conditions 

• Hypertension, high triglyceride levels, high cholesterol, and PCOS are all associated with an increased risk of type 2 diabetes diagnosis. 

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Is PCOS connected to diabetes? 

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One long-term prospective study followed over 250 women with PCOS from youth to middle-age for 10 years and found that women with PCOS were at increased likelihood of developing type 2 diabetes compared to women without PCOS. Specifically, “the age-standardized prevalence of diabetes at the end of the follow-up was 39.3%, which is significantly higher with respect to that of the general Italian female population of similar age (5.8%).” Put another way, women with PCOS in the study had an almost 8x increased likelihood of developing diabetes than their counterparts without PCOS. Researchers also found that the chances of diabetes was positively correlated fasting insulin levels, while the inverse was true for higher SHBG levels (low SHBG levels usually indicate a hormonal disorder): at follow up, a higher SHBG measure “was associated with a lower probability of developing type 2 diabetes.” In addition, normal SHBG levels are associated with better balanced hormones in people with PCOS.

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Another study published in the Journal of Clinical Endocrinology and Metabolism sought to understand the risk of gestational diabetes in women with PCOS. Researchers randomly selected subjects from the national health insurance database in Australia, and collected data via survey at five time points across a period of 13 years; this was a longitudinal, large community-based cohort of reproductive aged women, with over 9000 subjects enrolled in the study in total. Researchers found that “PCOS was independently associated with a higher risk” of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM). 

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Interestingly, in the above study, researchers did not find BMI to be impactful on diabetes diagnosis among PCOS subjects (although it was impactful for women without PCOS). They hypothesize that insulin resistance fundamentally “underpins PCOS”, so that even in lean PCOS women, insulin resistance can contribute to a tendency toward diabetes later in life. They conclude from their meta-analysis that women with PCOS have a three-fold increased risk of GDM compared to women without PCOS, while they have an almost nine-fold increased risk of T2DM compared to women without PCOS. (This increased likelihood echoes the previous study, which estimated around an 8x increase). In concluding remarks, researchers in this study cautioned that women with PCOS should be screened earlier in life for diabetes in order to take a preventative approach to diagnosis. 

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It seems that across multiple studies results indicate the following: PCOS is correlated with a higher risk of type 2 diabetes, as well as gestational diabetes. Emerging research may indicate that women with type 1 diabetes are also at increased probability of developing PCOS. 

How to reduce your risk of type 2 diabetes 

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Unfortunately, at this stage, there is not much to be done regarding developing type 1 diabetes, since this seems to be mostly rooted in autoimmune and genetic factors (and often manifests itself by childhood or early adulthood). However, since type 2 diabetes is strongly associated with ‘lifestyle factors,’ there are concrete steps you can take which are scientifically proven to reduce your chance of developing this form of diabetes. 

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• Stop smoking, if you do 

• People who smoke have a 30% to 40% higher chance of developing diabetes than people who don’t, according to the CDC. 

• Schedule in enough exercise 

• According to multiple studies, adequate exercise lowers your blood sugar levels. For instance, in one study, women with diabetes who spent at least 4 hours a week doing moderate exercise had a 40% lower risk of developing heart disease than women who didn’t (and this is “accounting for confounding factors, such as BMI, heart disease, and smoking”).  
• The CDC also notes that those at higher risk for developing type 2 diabetes exercise less than 3 times per week. 

• Focus your diet on whole, minimally processed foods 

• As much as possible, center your plate around fruits, vegetables, beans, and whole grains, while minimizing your intake of high sodium, high added sugar foods Check out our article on creating a PCOS plate for inspiration on how to construct delicious, balanced meals. 

• Avoid excessive added sugars when possible 

• According to Harvard Health, people who consume sugary drinks regularly (in excess of 1 to 2 cans per day) have a 26% higher chance of developing type 2 diabetes than those who report ‘rarely’ consuming these drinks. Of note, choosing non-nutritively (low or no sugar/calorie) drinks can also increase risk of insulin resistance.
• We have an entire article dedicated to understanding PCOS and your blood sugar levels, for a more in depth insight into how to prevent blood sugar spikes and crashes. 

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To wrap up, the research appears to indicate that PCOS is a risk factor for diabetes. This may mean temporary gestational diabetes during pregnancy, or it may mean an increased chance of developing diabetes in middle age or even earlier. Though this can be overwhelming to think about, especially if you just recently received a PCOS diagnosis, know that just because there is an increased likelihood, does not mean that PCOS in and of itself translates to a prognosis. Type 2 diabetes has genetic elements to it, but it also is heavily weighted by lifestyle factors that we mentioned above. As with most things, exercising, eating minimally processed whole foods, minimizing added sugars, and working with a trusted healthcare professional are all great beginner steps to take, so you can incorporate holistic methods by which you can take control of your health - both short and long term. 

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Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.

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