Got questions about navigating life with diabetes? Ask D’Mine! Our weekly advice column, that is, hosted by veteran type 1 and diabetes author Wil Dubois. This week, Wil is looking at a serious health condition that isn’t diabetes, but can certainly be impacted and further complicated by our insulin-deprived pancreatic states… yes, it’s all a vicious circle at times!

{Got your own questions? Email us at AskDMine@diabetesmine.com}

  

Carmen, type 2 from Montana, writes: I have PCOS (Polycystic Ovary Syndrome) and diabetes. Some people have said I may have a more difficult time controlling my blood glucose levels due to the PCOS, but how do I tell the difference? If I’m taking my meds, but my BG is still off, it could be something I ate, the PCOS, or something else—like stress? Any tips on treating specifically for the PCOS? 

Wil@Ask D’Mine answers: I’m sorry that you have more than one chronic headache on your plate, but if it’s any consolation, you’re not the Lone Rangerette: More than a quarter of premenopausal women with T2D also have PCOS. OK, so not quite a quorum, but a heck of a lot of people, nonetheless. Does this large group have a harder time with BG control than the other three quarters?

Before we dig into that, a recap on PCOS: It’s a hormonal imbalance in women that interferes with the usual menstrual cycle. And in fairness to fact, I should point out that women with Polycystic Ovary Syndrome don’t actually have cysts in their ovaries. Really? Yes. Really. OK… so why the heck is it called polycystic if there aren’t any cysts? I don’t know for sure, but it’s possible that it started because PCOS’s hormonal imbalance results in eggs not being released from the ovaries, and these non-released eggs develop fluid-filled sacks around them called follicles, which appear like strings of pearls in ultrasounds.

Pearls, cysts. Who knows?  

But doesn’t this cause a lot of confusion? Especially for women diagnosed with PCOS? Yes. Yes, it does. So much so, in fact, that an independent panel convened by the National Institutes of Health (NIH) back in 2013 recommended giving the syndrome a new name. But there doesn’t seem to have been any traction on that since. 

Anyway, the still-called PCOS results in levels of male hormones that are higher than usual for the fairer sex, and that, in turn, causes a host of negative issues for the female body including: Deregulated menstrual cycles, decreased fertility, increased heart disease risk—in addition to the female-unfriendly side effects of hair loss on the head, along with hair growth on the face and body. 

Bummer. 

The cause of PCOS is still unknown, but there’s a strong connection between it and our old friend insulin. An estimated 65-70% of women with PCOS also suffer from insulin resistance, and it seems that high levels of insulin exasperate the PCOS symptoms. 

So does insulin resistance cause PCOS? Or does PCOS cause the insulin resistance? Which is the chicken and which is the egg? We’re not sure. And what makes it even more complicated is that a large percentage of women with POCS are overweight or obese, and people who are overweight or obese run a higher risk of insulin resistance.

So now we have a chicken, an egg, and a… well, I don’t know what. A rooster sperm, I guess. But with three inter-linked factors (PCOS, insulin resistance, and weight) no one has yet been able to unsnarl the relationships.

Of course, insulin resistance is viewed as the formational process of type 2 diabetes, and, in fact, where you find PCOS you find a lot of diabetes. So much so, that both the Canadian and the American Diabetes Associations call for screening for diabetes in women who are diagnosed with PCOS.

What’s done to try to fix PCOS? Birth control pills are frequently used to help slap the menstrual cycles back in line and to re-balance the girl hormones. And ironically, the type 2 starter drug metformin is used to lower insulin leels by decreasing insulin resistance. Additionally, the controversial TZD-class of anti-insulin resistance diabetes drugs have also shown promise in treating PCOS. 

OK, now back to your specific questions. First, will it be more difficult to control your blood sugar because you have PCOS? I don’t think so. While PCOS is definitely associated with insulin resistance, I couldn’t find any evidence that PCOS insulin resistance is any fiercer than the insulin resistance found in type 2 diabetes for someone who doesn’t have PCOS. Nor could I find anything suggesting that the hormone imbalances of PCOS would result in more erratic blood sugar levels or responses. So I don’t think you’re any worse off than one of your diabetes sisters who doesn’t have PCOS, at least blood sugar control-wise. 

Well… I guess that’s a rather broad statement, isn’t it? After all, no two cases of diabetes are the same, running the gamut from kept in control by simply dropping sugary beverages to needing multiple daily insulin shots. I guess what I was trying to say is that if you’re taking your meds and your BG is still off, I don’t think it’s the PCOS. Instead, round up the usual (diabetes) suspects. As you suggested, a BG bump could come from eating a meal with a sugar content that exceeds what your meds can process. Or it could be stress. Or a shift in activity. Or the effect of alcohol. Or… at least 42 other factors. But it doesn’t seem that PCOS, on its own, causes individual blood sugar spikes—although we are talking about hormone problems here, so anything is possible.

Any tips on treating PCOS? Hell, no. Not being a doctor, I’m not qualified to give treatment advice on anything, much less on a women’s hormonal health issue that’s far, far away from my area of expertise. However, I was struck by one interesting thing as I looked into the entire issue of diabetes and PCOS for you: Apparently, as PCOS’s symptoms are exasperated by high levels of insulin, docs treating PCOS look for ways to reduce insulin levels. To do this many docs recommend weight loss, low carb diets, and exercise.

And that’s a trio you can’t go wrong with for controlling blood sugar as well, giving you twice the bang for your buck.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. Bottom Line: You still need the guidance and care of a licensed medical professional.