Metabolism: Insulin Resistance, Metabolic Syndrome, & PCOS

Insulin Resistance: Your cells stop responding well to the insulin hormone, which is made by your pancreas. Since your cells don’t respond well to insulin (whose job is to help move sugar (glucose) from your blood into your cells so you can use it for energy), your body needs to make more and more insulin to get the same job done. This leads to high insulin levels in your body and over time the system gets overworked and your blood sugar starts to rise.

Why Is Insulin Resistance a Problem?

  • It can lead to prediabetes and type 2 diabetes.

  • Increase your risk for heart disease, stroke, fatty liver, and hormonal problems like PCOS

  • Makes it harder to lose weight, especially around the abdomen

Causes of Insulin Resistance?

  • Obesity

  • Sedentary lifestyle

  • Poor diet (high in refined carbs and sugars)

  • PCOS

  • Hormonal imbalances

  • Sleep disorders (sleep apnea)

  • Chronic stress

  • Genetics (Family history of diabetes)

How to Fix Insulin Resistance?

  • Exercise regularly (walking, strength training)

  • Eat less sugar and processed carbs

  • Lose weight (even just 5-10% of your body weight)

  • Sleep better

  • Reduce stress

  • Medications (Metformin and GLP-1s)

Metabolic Syndrome: A cluster of at least 3 of the following 5 risk factors:

  1. Abdominal obesity (waist: >40in in men & >35 in women)

  2. Elevated fasting glucose (>100 mg/dL)

  3. High triglycerides (>150 mg/dL)

  4. Low HDL cholesterol (<40 mg/dL in men & <50 mg/dL in women)

  5. High blood pressure (>130/80)

Why Is Metabolic Syndrome a Problem?
It significantly increases the risk of:

  • Type 2 Diabetes

  • Heart disease

  • Stroke

  • Fatty liver disease

Causes of Metabolic Syndrome?

  • Obesity

  • Sedentary lifestyle

  • Poor diet (high in refined carbs and sugars)

  • PCOS

  • Hormonal imbalances

  • Sleep disorders (sleep apnea)

  • Chronic stress

  • Genetics (Family history of diabetes, hypertension)

How to Fix Metabolic Syndrome?

  • Exercise regularly (walking, strength training)

  • Eat less sugar and processed carbs

  • Lose weight (even just 5-10% of your body weight)

  • Sleep better

  • Reduce stress

  • Medications (Metformin and GLP-1s)

PCOS: Polycystic Ovary Syndrome is a common hormonal disorder that affects 1/10 women of reproductive age. It involves hormonal imbalances and metabolic issues, often leading to irregular periods, infertility, acne, weight gain, and excessive androgens. A major risk factor for insulin resistance and type 2 diabetes. You need 2 of 3 to be diagnosed with PCOS:

  1. Irregular or absent ovulation

  2. Hyperandrogenism (elevated androgens)

  3. Polycystic ovaries on ultrasound (>12 follicles or increased ovarian volume)

Common symptoms of PCOS:

  • Irregular or missed periods

  • Ovarian cysts

  • Excess facial/body hair (hirsutism)

  • Acne (especially jawline/chin)

  • Weight gain or difficulty losing weight

  • Hair thinning or male-pattern hair loss

  • Inuslin resistance/prediabetes

  • Mood swings, anxiety, depression

  • Skin tags or darkened skin

Treatment?

  • Hormonal birth control

  • Metformin

  • Spironolactone

  • Fertility medications

How to Fix Metabolic Syndrome?

  • Exercise regularly (walking, strength training)

  • Eat less sugar and processed carbs

  • Lose weight (even just 5-10% of your body weight)

  • Sleep better

  • Reduce stress

  • Medications (Metformin and GLP-1s)

 Common Questions

    • Tired after meals

    • Cravings for sugar or carbs

    • Gaining weight around the belly

    • Skin darkening in neck or armpits (acanthosis nigricans)

    • Skin tags around the neck, underarms, or groin area

    • High triglycerides

    • Low HDL

    • High blood sugar

    • High fasting insulin levels

  • When too much fat is stored in the liver in people who drink little to no alcohol. It is often linked to metabolic health issues such as insulin resistance, PCOS, metabolic syndrome, obesity, prediabetes and type 2 diabetes, high blood pressure, high triglycerides, low HDL, sedentary lifestyle, sleep apnea, rapid weight loss or malnutrition , certain medications such as steroids

  • When you lose weight too quickly, a large amount of fat is broken down all at once. These fats flood the liver. The liver tries to process them but if overwhelmed it ends up storing the fast instead leading to a fatty liver.

    Also rapid fat breakdown can produce inflammatory molecules (cytokines) and oxidative stress which can trigger liver cell injury progressing to NAFLD.

    Extreme dieting or malnutrition reduces muscle mass and essential nutrients like choline which is needed for fat export from the liver. This makes it harder for the liver to function properly and can promote fat buildup.

    Bariatric surgery can cause rapid fat loss and hormonal shifts and some patients may experience a worsening of liver inflammation or fibrosis shortly after surgery.

Type 2 Diabetes

Is a chronic condition where your body does not use insulin properly and/or does not make enough insulin to keep blood sugar (glucose) in a normal range. Over time, this leads to high blood sugar levels, which can silently damage many organs. Chronically high blood sugar levels silently damage blood vessels and nerves, leading to many complications. Type 2 Diabetes is more lifestyle-related and is preventable, though genetics play a role too.

    • Insulin resistance

    • Obesity

    • Family history of diabetes

    • Sedentary lifestyle

    • Poor diet

    • Chronic stress

    • Poor sleep

    • PCOS

    • History of gestational diabetes

    • High blood pressure

    • High cholesterol

    • High triglycerides

    • Kidney disease (can lead to dialysis, transplant)

    • Retinopathy (can lead to blindness)

    • Neuropathy (numbness, burning, tingling in hands/feet)

    • Heart disease

    • Stroke

    • Peripheral artery disease (poor circulation, can lead to amputations of hands/feet/legs)

    • Erectile dysfunciton

    • Nonalcoholic fatty liver disease

    • Hearing loss

    • Cognitive decline/dementia

    • Increased infection risk

  • High blood sugar damages the tiny filtering units (glomeruli) in your kidneys. Over time, this causes leakage of protein into the urine (proteinuria). Eventually, it can lead to chronic kidney disease and end-stage renal disease requiring dialysis or a kidney transplant.