Did You Know PCOS and Diabetes Have a Connection?

Have you ever heard of metabolic conditions which are gender specific? While this question may leave you bewildered, the answer is simpler than you think. PCOS i.e Polycystic Ovarian System, is one such issue. Predominantly inflicting women under the age of 30 years, PCOS is a condition that affects women’s ovaries causing an abnormal number of cysts to appear on the surface of the ovaries, thereby leading to irregular or no release of eggs. But that’s not it - PCOS doesn’t just impact a woman’s body, but also messes with her mind.

PCOS - Beyond Just An Ovarian Disorder

Needless to say, PCOS does affect the ovaries; however what is often neglected is the fact that at the core of it, it is an endocrine problem affecting the entire body.

How?

The master gland (pituitary) makes abnormally high levels of

• Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) and

• The male hormones (androgens)

which interfere with normal functioning of the ovaries, causing problems with ovulation often leading to infertility. But that’s not all, besides these, women may also go through:

• Weight gain & obesity

• Hair growth & acne

• High blood pressure & Heart disease

• NAFLD (Non alcoholic fatty liver disease)

• Sleep disorders (especially OSA) & Insomina

• Depression, Anxiety & eating disorders

• Sexual dysfunction

And diabetes.

Diabetes, as you’re aware, is a metabolic condition in which your body either doesn’t make enough insulin or can’t effectively use the insulin it does make.

Let’s First Understand Insulin Resistance

Contrary to what we believed few decades ago, diabetes is not just an insulin deficiency disorder. The major culprit is insulin resistance. Insulin resistance leads to an array of problems, from diabetes to high lipids to high blood pressure. So it’s safe to say that our understanding of diabetes has gone through a metamorphosis over the past few decades.

Doctors have also came to realise that insulin resistance can create a favorable environment for the most common female endocrine problem - PCOS.

In fact, based on the articles published in the journals Human Reproduction as well as Endocrine Review, insulin resistance is a key feature in both obese and lean PCOS. It is seen in 70-95% of patients with obese PCOS and 30-75% of those with lean PCOS.

Insulin resistance leads to PCOS, just as it leads to Type 2 Diabetes mellitus.

But How Does Insulin Resistance Lead to PCOS?

High levels of insulin send signals to the ovaries to increase production of androgens (male hormones). This excess in androgens leads to increased abdominal fat gain and this fat further worsens insulin resistance and leads to inflammation. This further triggers hyperinsulinemia (high levels of insulin in the blood). So it’s like an itch-scratch-itch cycle.

How Does PCOS Lead to Prediabetes or/and Type 2 Diabetes?

Remember, the primary function of insulin is to shift glucose from the blood to the body cells, thereby reducing blood sugar levels. Inside the cells, glucose is used for energy (ATP) production. With increasing insulin resistance, the body does not respond to insulin as efficiently as it should and hence the blood sugar levels start rising. This eventually leads to disturbance in glucose metabolism and often, the outcome is prediabetes which later leads to diabetes.

PCOS & gestational diabetes: It’s imperative to note that PCOS can also lead to gestational diabetes, which occurs when women develop glucose issues during pregnancy. As it is, this can be challenging & to worsen it further, there are chances of birth complications such as premature birth, breathing issues, jaundice, and more.

How to Diagnose PCOS?

While sometimes the symptoms are clear, mostly are less apparent. Whether it’s during your visit to a dermatologist for acne, hair growth, or darkening of the skin in body creases and folds such as the back of the neck (acanthosis nigricans), or a gynecologist for irregular monthly periods or your family doctor for weight gain, the diagnosis can happen based on any of these signs. Mind you, it’s not necessary for women to have all or only one symptom; it can vary.

Women often find out they have PCOS much later in life, when they experience difficulty in getting pregnant. However, it’s important to note that it can often begin at the first menstrual period or as young as age 11 or 12, or can develop during the growing ages between the 20s or 30s.

Treatment

The treatment ranges across lifestyle modification, stress reduction, weight losing strategies and hormonal pills to prescribing diabetes drugs like Metformin or often anti-androgenic drugs like spironolactone, etc.

Key Take-Aways

• PCOS affects both the body and the mind.

• Most patients have several hormonal irregularities especially varying degree of insulin resistance / dysregulation.

• Most patients, especially in our country are unaware of the problem unless confronted with menstrual irregularities or infertility issues.

• Early recognition and appropriate treatment initially can change the outcomes, preventing various complications later.

• Awareness & knowledge about the condition can help many young women prevent & identify the condition and seek early intervention.

(Dr Pradeep Gadge is the Chairman of Gadge Preventive Diabetes Care Centre)