How to Prevent Diabetes if you have PCOS

Nearly 50% of women with polycystic ovary syndrome (PCOS) develop pre-diabetes or type 2 diabetes before the age of 40. This is alarming statistic highlights the need for aggressive interventions that can reduce the chances of women with PCOS developing diabetes. The good news is that diabetes can be prevented. The first step is getting educated about why PCOS can lead to diabetes and what you can do about it. Below are some of the best proven ways to lower your risk for developing diabetes if you have PCOS.

The Connection Between PCOS and Diabetes

The connection between PCOS and type 2 diabetes is real. Type 2 diabetes, once known as adult-onset or non-insulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body’s main source of fuel. Type 1 diabetes (also known as insulin dependent) is typically diagnosed in childhood and results when your body doesn’t produce any insulin.

The majority of people who have PCOS have high insulin levels. Over time, prolonged exposure to high insulin can result in your body resisting the effects of insulin. You may have heard the example that insulin acts as a key to unlock your cell doors to let glucose in where it will be used as energy. Over time those doors can become more and more resistant to the actions of insulin. This can cause blood glucose levels to stay high. Elevated glucose levels can then cause damage to tissues and nerves.

Common Signs and Symptoms of Diabetes

Many times people who get diagnosed with diabetes may not even realize they have it. Here are some of the most common signs and symptoms to look for and to discuss with your doctor.

  • Increased thirst
  • Frequent urination
  • Increased hunger
  • Weight loss
  • Fatigue
  • Blurred vision
  • Slow-healing sores or frequent infections
  • Headaches
  • Lightheadedness, dizziness or shakiness

Best Ways to Prevent Diabetes

 

Know Your Numbers

Knowing your risk for diabetes is important. There are four separate tests that can be used to diagnose type 2 diabetes or pre-diabetes, some more reliable than others. Here’s what these tests are and what they mean.

Glycated hemoglobin (HA1C) test. This blood test detects your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the higher the number. An HA1C level of 6.5% indicates that you have diabetes. An A1C between 5.7% and 6.4% indicates prediabetes. Below 5.7% is considered normal.

Some argue that HA1C is not accurate enough to be a reliable indicator for diagnosing diabetes in those with PCOS and that it may miss many people who may in fact have diabetes.

Random blood sugar test. A blood sample will be taken at a random time (fasting or non-fasting). A random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.

Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If it’s 126 mg/dL or higher, you have diabetes.

Oral glucose tolerance test (OGTT). This test is considered the best test for detecting impaired glucose tolerance and diabetes in those with PCOS. Since women with PCOS seem to have a rapid conversion from pre-diabetes to developing diabetes, The Androgen Excess and PCOS Society recommends all women with PCOS be screened with an OGTT yearly and if normal, repeat every 2 years. Those who have impaired glucose levels should be screened annually.

For this OGTT test, you fast overnight then you drink a sugary liquid within a 5 minute window. Blood sugar levels are then tested periodically for the next one to three hours, depending on the type of test your doctor orders. An OGTT is usually done in pregnancy as a way to screen for gestational diabetes. A blood sugar level less than 140 mg/dL is normal. A reading of more than 200 mg/dL after two hours indicates diabetes. A reading between 140 and 199 mg/dL indicates prediabetes.

Modify What You Eat

Modifications to how you eat and when you eat are one of the primary treatment approaches for women with PCOS -and also one of the best ways to reduce the risk for type 2 diabetes. Eating more fiber-rich fruits and vegetables is one way to start. Women with PCOS who ate a diet rich in fruits, vegetables had significant improvements in insulin sensitivity.

A study published in the Journal of Clinical Nutrition compared a low glycemic index diet with a conventional diet in women with PCOS.  Both diets consisted of equal amounts of calories coming from carbohydrates, protein, and fat. Women with PCOS who followed the low GI diet had greater improvements in insulin sensitivity. Those with high insulin levels at the start of the study saw a 2-fold reduction in body fat loss following the low GI diet.

Low GI foods are whole foods that are rich in fiber and protein and packed with vitamins, minerals, and antioxidants. Examples include oats, quinoa, beans, legumes, fruits eaten with skin on like apples and berries, and vegetables.

Need recipes or meal plans to help you put this all together? Check out The PCOS Nutrition Center Cookbook: 100 Easy and Delicious Whole Food Recipes to Beat PCOS

PCOS cookbook recipes

Available in paperback or ebook!

Engage in Regular Physical Activity

Along with changes to the foods you eat, exercise is an important part of lowering insulin and reducing your risk for diabetes. Try to engage in 30 minutes or more of moderate-intense exercise most, if not all days of the week. Be sure to include at least two days of resistance training. Not motivated? Check out these tips to get you moving more. Simply adding more movement into your diet by parking your car further away from the door or taking the steps instead of elevator, can also make a difference over time.

Pressed for time? And who isn’t? Research shows that taking just a 10 minute walk immediately after eating a meal can significantly lower glucose more so than taking a 30 minute walk at another time. A small study published in Diabetologia found that taking shorter, more frequent walks immediately after meals significantly reduced blood glucose by around 12% in individuals with type 2 diabetes compared with a single 30-minute walk.

Get More and Better Sleep

Sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to those without the syndrome. Sleep loss or OSA can worsen insulin resistance. If you struggle to get a good night sleep, check out these tips. If you do snore or have any of these symptoms, ask your doctor about a sleep study to determine if you have sleep apnea.

Supplement your Diet

It’s been suggested that women with PCOS have a defect in their ability to properly use inositol.  Inositol acts as a secondary messenger, relaying signals that regulate insulin levels in the body. Supplementing with a combination of myo and d-chiro inositols (DCI) improved insulin sensitivity in women with PCOS better than myo or DCI alone. You can read here about how the inositol supplement Ovasitol alone helped me to lower my HA1C from 5.4% to 4.9% in just 6 months!

Many individuals who take inositol find that it significantly lowers carbohydrate cravings, allowing you to make wise food choices for yourself. Bonus: Inositol has been shown to regulate cycles and restore hormone balance too making it a great choice for those with PCOS.

Other supplements that may help lower glucose and insulin include cinnamon, coQ10, magnesium, and berberine.

Consider Insulin Sensitizing Medications

If despite following a healthy eating plan and exercising you still haven’t seen improvements in lab values indicating diabetes risk, talk to your doctor about using an insulin sensitizing medications such as metformin. If you do take metformin, be sure to supplement your diet with vitamin B12 as metformin can affect the absorption of this important vitamin.

Bottom line: Those suffering from PCOS are at an increased risk for developing type 2 diabetes but that doesn’t mean you are doomed to get it. Lifestyle modifications are the primary treatment approach for preventing diabetes. The lifestyle modifications discussed here are effective ways to prevent diabetes that are within your control.

Sources

  1. Celik C, Tasdemir N, Abali R, Bastu E, Yilmaz M. Progression to impaired glucose tolerance or type 2 diabetes mellitus in polycystic ovary syndrome: a controlled follow-up study. Fertil Steril. 2014 Apr;101(4):1123-8.
  2. Malin SK, Kirwan JP, Sia CL, González F. Pancreatic β-cell dysfunction in polycystic ovary syndrome: role of hyperglycemia-induced nuclear factor-κB activation and systemic inflammation. Am J Physiol Endocrinol Metab. 2015 May 1;308(9):E770-7.
  3. Marsh K, Steinbeck K, Atkinson F, Petocz P, Brand-Miller J. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92:83-92.
  4. Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Europ rev med pharmacol sci. 2012;16(5):575-581.
  5. Reynolds, A.N., Mann, J.I., Williams, S. et al. Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study. Diabetologia (2016) 59: 2572.
  6. Negar Naderpoor, Soulmaz Shorakae, Barbora de Courten, Marie L. Misso, Lisa J Moran, Helena J. Teede. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update. 2015;21(5):560-74.
  7. Fernandez RC, Moore VM, Van Ryswyk EM. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep. 2018 Feb 1;10:45-64.
  8. Dashti S, Latiff LA, Zulkefli NABM. A Review on the Assessment of the Efficacy of Common Treatments in Polycystic Ovarian Syndrome on Prevention of Diabetes Mellitus. J Family Reprod Health. 2017 Jun;11(2):56-66.
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