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Insulin resistance, PCOS, preventing progression to T2

clare1_2_3

Member
Messages
18
Location
East Anglia, UK
Type of diabetes
Other
Treatment type
I do not have diabetes
Thanks for having me in the forum, what a great place you have here to support each other.

I am not diabetic currently but earlier this year I was diagnosed with PCOS. Though my HBA1C and fasting glucose were both fine when the GP tested me earlier this year (forgive me I do not have my results to hand but I can check them tonight) I have done a lot of reading around links between PCOS and insulin resistance and progression to T2 diabetes and this has me a little worried.

How would I be able to find out if I am indeed insulin resistant? I have searched the forum and understand that in the UK the NHS are very unlikely to test my insulin levels to see if they are high, and I have not been offered an OGTT. As I understand it, insulin resistance is very likely to progress to T2. But it seems madness that the NHS do not investigate whether someone has IR or not, even in high risk cases like PCOS? Any tips for how to approach this with my GP? Is it worth getting private blood testing for insulin level/calculation of HOMAir?

If I am indeed insulin resistant am I correct in thinking that the best cause of action is a lchf diet to prevent progression pre-diabetes and T2?

Behind this I also have my mother in mind, she is having her second fasting glucose test this Friday after a high reading 3 months ago. If it is high again she will be diagnosed T2. She has been having annual blood test (which we now think was HBA1C only, at least in recent years) for around 20 years, after being told she was pre-diabetic when taking part in a medical study. This year she had a foot ulcer that took many months to heal and I asked her to get a fasting blood glucose test as at all of her healthcare provider appointments (podiatrist, vascular consultant, orthotics etc) the first thing they asked her was 'are you diabetic?'. I am worried that she may also have had PCOS, related insulin resistance and this has led to her weight problem and potentially to T2 diabetes which could have perhaps been prevented.

Small amount of backstory for anyone interested, particularly any PCOS cysters in this forum: Last year I put on a lot of weight after a change of pill from mini pill to progesterone only pill. I am 38 years old and had been on the combined pill relatively happily for >20 years but had an ocular migraine so had to come off all estrogen containing birth control. I was on the new pill for 5 months last year Apr-Sept 2018 and had rapid weight gain, low mood and developed cystic acne. By the end of September 2018 I decided to stop the pill completely to see if that helped. My mood improved but I was still gaining weight and struggling with acne. By January 2019 I was a full 2 stone heavier than in May 2018, which was already about a stone over what I call my 'fighting weight' My cycles also went a bit haywire after stopping the pill, I had no cycles for 5 months and during this time visited my GP who, on the basis of the acne and the irregular periods and nothing of note wrong with my hormones, diagnosed me with PCOS. I am still seriously struggling to get the extra weight off but am 10lbs down since January 2019. I am fairly active, I run and swim regularly, and do not have an awful diet though I do like a sweet treat.

Thanks for reading if you got to the end - all thoughts and suggestions are most welcome.
 
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Hello @clare1_2_3 ,

PCOS and T2 here, as well as migraineur. I first switched to an IUD to tackle my migraines, but after a few years my body rejected it and I am now getting Depo Provera shots every 10 weeks to prevent the worst of the hormonal migraines. When the IUD was placed though, I gained 20 or 30 kilo's or so in a matter of months, and kept getting progressively bigger in the years after. I went to a dietician who told me to eat more carbs, which made a bad situation worse. Soon after that I was morbidly obese and diabetic. The OB/GYN who told me I had PCOS had also had my bloodsugars checked, and I seem to have been prediabetic at the time, but he just didn't mention it. So my T2 came as a bit of a surprise.

The test for insulin resistance is a pretty costly one, but if you have PCOS and weight problems, it's pretty safe to assume you are insulin resistant up to some degree or another. We can't diagnose here, but you can get some advice... Mine is "yes, go the LCHF route". If you're not diabetic yet, it could keep you from becoming one. As for your mom, she might not have had PCOS, quite simply because it is difficult to conceive and carry a child to term when you have that particular condition. I'm pretty sure I may have been pregnant once, but if so, it didn't last for more than a few weeks before it ended. However, with T2 in the family, there is an ever bigger chance that you're predisposed yourself, so another good reason to try LCHF. And maybe get your mum on board, because well... My toes used to ooze pus for years on end, even when I was prediabetic. I didn't know the sugar in my blood was feeding the infections. Once I got my bloodsugars under control and in the normal range, treating any kind of wound or infection became a breeze. At 40 I get UTI's more often than I'd like, but at the moment I can still treat them myself, just by drinking a lot and taking D-Mannose, without antibiotics in the mix.... That would've been unthinkable a few years ago.

https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ is my own little quick-start guide. You might want to print it off and have your mum read it too. Maybe you two can make a thing of it, help one another, keep motivated... It's so much easier when you have support nearby. In any case, there's so much information on the internet, all for free, so you might want to check dietdoctor.com for goodies to help that need for sweet treats and the like.

You'll be fine, you're in the right place for help.
Good luck!
Jo
 
Thanks so much Jo for your response.

My Mum has the toe issues too funnily enough. I think we are going to actually be more surprised if she it not diagnosed T2 at this point...

Was the IUD a hormonal one like the Mirena? If so sounds similar to my experience - those and the mini pill have similar hormones in them and I think are just not suited to some folk, like us as examples. Thankfully my ocular migraine was seemingly a one off. However the higher risk of strokes from estrogen containing drugs is not something I am willing to play lottery with. It's non hormonal methods only now for me.

I'm really nervous to entirely overhaul my diet if there is no need but equally I am not willing to sleepwalk along with my eyes closed and end up T2 when I could have done something to try and prevent it now. Vanity speaking, I also want to shift the weight I gained. So I wonder if a lchf experiment is the way forward rather than chasing a diagnosis in the first instance.

I can't believe your doctor never mentioned results in the pre diabetic stage. I always get mine printed out now having heard similar stories from the PCOS community. Scary.
 
Hello again,

Yes, it was a Mirena. I had them for years, and then one day it just didn't sit well anymore. I hated going to the doc's though, and thought it was just rather extreme IBS. Turns out I had been having contractions for half a year. Auch. Ah well. The shots are working alright, don't have much of an option if I want to have some semblance of migraine control. As a child I got my first period very early. I thought I was 10 or 11, but my mom told me I was 9. I had severe iron deficiency because I bled out about every 2 weeks. Very heavy, very irregular. And my GP at the time didn't think to look for a reason for all this, just put me on the pill and iron supplements instead. Guess it was a sign of the times though, my male doc wasn't going to examine a girl child there. Otherwise they might've found my issues sooner. Anyway.... I think my current GP assumed the OB/GYN who diagnosed me had told me about the results, so she never brougth them up either. Since the diabetes I've always asked for my results to be printed out, and I have quite the collection by now. It really does help, not just to see where you're at and where you're headed, but because quite a few docs don't take action when they see someone in the prediabetic range: they don't step in until it is T2 and that ship has pretty much sailed. There's so much ignorance yet about how to prevent T2 from happening: it's not a foregone conclusion, but a lot of healthcare workers think it is!

I know tossing out everything you think you know about nutrition -especially the fats in the diet- is a bit of an overwhelming thought, but you know what? It's not that big a deal, once you get the hang of it. Even eating out isn't much of a problem, depending on where you go of course. I eat out once or twice every weekend, usually have lunch somewhere when we're out photographing stuff, (zoo, streetphotography, that sort of thing), and I follow a ketogenic diet, which is a bit more extreme than regular LCHF: I don't eat more than 20 grams of carbs per day usually stay well below that. So it can be done, and done well. Also, since cutting the carbs and especially sugars, my palette changed... Food has more flavour now and I enjoy it so much more. I lost a lot of weight, got my diabetes under control, my rheumatism isn't anywhere near as bad as it used to be, depression's not overwhelming me every moment of every day... There's a lot to be gained here. All is not lost, far from it.


Jo
 
So many people find that eating low carb is what is needed for their metabolism to correct itself and weightloss just happens.
On the low carb forum I frequent there have been some success stories which include getting pregnant - sometimes naturally even after several rounds of IVF.
 
Thanks folks, I appreciate the responses very much.

Jo that sounds like a total nightmare with the IUD, I heard rather too many similar stories hence not going down the IUD route myself.

Diet wise I am a little brain washed against fat by going to WW in my 20s but am moving past that! I have been a pescatarian for many years, a vegetarian before that, but recently have started to eat some free range chicken. I am thinking the best way forward is to move towards other high welfare meats. I have done my bit for the planet and if my health demands meat then that may just have to be a sacrifice I make.

I should have mentioned - whilst I am very much interested in treating my PCOS naturally and staving off T2 diabetes, it is not with the intention of getting pregnant, I am very happy in the role of Aunty, Godmother and prefer to be a mom to rather more furry babies
 
Haha! You know, what I was told about PCOS was that it would mean jumping through burning hoops to get pregnant. (The insulin resistance bit was skipped over, as you know.) I was so happy! Finally I could get my mother-in-law off my back, who just kept nagging me about kids all the time. Ooh they'd be so beautiful, because I was pretty before i became fat. (Gee, thanks!) Neither me nor my husband wants kids. Actually they are too overwhelming for me, there's very, very few kids I can stand to be around without wanting to run into a sound-proofed pillow fort and hide for a decade or two, so yeah... This was rather convenient, I thought. It did shut my mum-in-law right up mind you, but the downside was a rather big one. Turns out there was more to it than relative infertility and hairy legs. Ah well.

The whole fat thing is a bit, you know... It takes getting used to, after having the EatWell plate and fats-are-the-devil drilled into you for practically your whole life. But fats don't have to be bad, and if you're more comfortable with the ones that are deemed "good fats", which are preferable in any case.... Olive oil, MCT/coconut oil, avocado (blech on its own, but really nice with a salad or whatever!), nuts and such are just fine. I'd stopped eating chicken on principle for about a decade, but with the T2 diagnosis I just did the same thing I did with eggs: Get the expensive ones. If they didn't have an wreched life, but a happy one with grass between their toes, then yeah, okay... In the Netherlands there's a starsystem that tells you what kind of life an animal had, so three stars is the only rating that'll cross the threshold. If it's going to be killed for my sake, I'll pay for a happy life prior to that, all too gladly.

What kind of fur babies? I'm mad about cats myself.
Jo
 

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Can I suggest you get a copy of The Diabetes Code by DrJason Fung. You can download it if you have a kindle. He mentions PCOS.
 
I have PCOS as well. I suspect I’ve had insulin resistance since my teens.
The only thing that worked for me was metformin and LCHF.
I still have a bunch of weight to loose but at the beginning I lost 60 pounds with out much effort. I fast from my evening meal till about 12:00 or 1:00 sometime longer.
All this has reduced the symptoms of PCOS, like acne, thinning hair, mood swings tiredness and PMS.
 

OMG yes the GP that diagnosed the PCOS more or less told me to come back 'when' I want to get pregnant without actually asking me if that was something I wanted. And to maybe eat less potatoes and that sort of thing Honestly the internet has been so much more informative though you do have to be selective with the sources. Your MiL certainly has a way with words

I love avocado, and nuts, and always happy to have an oily salad dressing Higher welfare meat was not really an option when I went vegetarian but so much choice available now and farm shops etc I will have to investigate.

I had a horse until last year and hope to get another one or at least help out with one again soon. I also kind of share my Mum's little terrier dog and take her to training classes and on walks. In the past I have had rabbits, guinea pigs, birds, fish.... Not personally had any cats as my partner is allergic but am always happy to pet other people's - Night is beautiful, black cats are the best I think
 

Sounds like lchf has been really positive for you, great result with the reduced PCOS symptoms. Were you diagnosed pre-diabetes at all or prescribed the metformin on the back of your PCOS to help with weight loss? Ideally I would prefer to avoid drugs but good to know options.
 

You could always check for cat-café's in your area. There's a couple in the Netherlands, and we visited our usual haunt this past Saturday. Half an hour's drive, but we were cuddling with 13 cats for 2,5 hours. I have had multiple cats in my life, a ferret, a mouse, hamster, guinea pig, bunny... But I just seem to get along really well with cats, we can read one another properly.

My MiL is a piece of work alright, but she means well. Just suffers from Foot In Mouth Disease. I love her, but sometimes I really wonder where her head is at, saying the things she does. Makes for funny annecdotes more often than not though.

Anyway, seriously... You've got options. Just takes a little while to get the hang of it. I eat a lot of eggs, meat/poultry/fish, above-ground veggies, cheeses.... I don't have to go hungry and I still lost weight, and my bloodsugars and cholesterol are those of a healthy person. So I thoroughly believe you're going to be just fine.
 

Thanks for so much helpful support and I appreciate the humour with it too (I think we do have a few cat cafes in the UK too!)
 
I was diagnosed in my Twenties with PCOS and late thirties with type 2. I was living life when diagnosed with PCOS and really didn’t research and care much about what it meant. I had no idea about insulin resistance.
It’s wasn’t presented as a option to take metformin before I was diagnosed with type two perhaps because I didn’t choose to have children. I know that here in Canada it is one of the first options to help with PCOS.
You need to research and make you own decision about medication, but my advice is, that it is not a failure to choose to take medication. Metformin is a mild treatment and with diet can be very effective.
 
Sorry the above is in reply
 
Looked up my bloods results:

HBA1C tested March 2019 38 mmol

Fasting glucose 4.3mmol/L in July 2019.
 
@clare1_2_3 , I am speaking here as a PCOS-type 2 aunty type. This is what I say to my actual nieces, and absolutely my own daughter.

Your HBA1c is at the high end of normal BG, which is not surprising considering the PCOS, which is a organ disease with insulin resistance (IR)at its base, which you know I take it.

When our bodies start producing high levels of insulin in order to cope with the high levels of glucose in our bodies, the first thing to start to break down, at least in terms of 'hick ups' is our fertility, or, the healthy functioning of our ovaries, and all the hormone 'stuff' that happens around that.

If you can, get your GP to be oriented towards the IR checking? As your tendency towards IR is not going to go away - this is a human body thing, and certain human bodies in the food environment we live in today are more susceptible. My feeling is you will need to be checking on your body's insulin levels for the rest or your life, to insure your health.

How to simply and most cheaply check your body's insulin production? Get your C-peptide checked, as part of your normal blood tests, which gives you a number, which can be checked and compared against normal/healthy insulin production. You will probably have to do this yourself. In short, you can watch your insulin production lower - which is what you want - along with lowering your sugar and carbs from food and drink. You don't need to talk to your medical professionals about your treatment with cutting carbs if they are not on board with this, and too many of us deal with medical professionals who are not on board with this. If they were I would not be on this forum with severe insulin resistance type two, because my medical professionals could have prevented me going this way decades ago when they had the chance. When I had the chance. Not a lot has changed in the three decades I have had IR, when it comes to what food causes too much glucose and insulin production, sadly, for complex reasons, not to do with insuring our health.

If you have an athletic/strong/muscular body type, which many women with PCOS do (ie higher levels of testosterone normally than the majority of women - about a quarter of the female population does), you will probably need to keep physically active too, so choose your methods of physical activity, and get to it, is my advice. You want to get any excess glucose into your muscles, and your muscles working well for you. This is something, like the carb/sugar levels of food and drink I have, is a daily consideration for me. And physical strength is part of physical fitness for sporty types of folks. If you have been sporty/physically able in the past, or even still, this can be your friend, as you will probably find physical activity relatively easy. And, because of that also, hopefully enjoyable!

Do be aware that the scientists who have been studying insulin's role in metabolic disease also talk about IR and cardio vascular disease risk, so in keeping type two at bay with diet and exercise (and no medical professional will argue with you if you use that standard phrase - they just get confused about the 'diet' part!), will also help you keep cardio vascular disease, and some cancers, at bay also.

Your body is in the throes of its first response to high glucose and high insulin - you are in a magnificent situation to do something about this with diet and exercise, however you choose to do that.

Metformin is a poor performer compared to diet and exercise when it comes to preventing, and treating, metabolic disease. Do be aware of that.
 
Ps, I re-read today your postings above @clare1_2_3 , and I'm sorry to be telling you in above that of course you have to keep an eye on the sugar and carb levels of the food you eat and what you drink, in your life. But I believe that you absolutely do.
 
I am on a low carb forum and we have had some smiles when women write ecstatic messages about being pregnant - often they have had years of disappointment, sometimes gone through IVF or been turned down for it and they hear there is a chance that low carb will help - then - sometimes only a few weeks later they are so shocked.
My sister came to visit me when I had just found out I was pregnant for the second time - and I joked that it might be infectious. She did moan about the food I served up for them during their stay - but my baby was born in November and her's arrived the following January.
 
Doctors dont like insulin tests because of the wide variation in norma test results, this means they can't fit you into the appropriate pigeon hole diagnosis.

There is a thing called HOMA-IR which gives an index between fasting insulin and glucose. You will probably have to self fund for this test and hunt out a lab that can do it.

Remember you can have normal HbA1c and fasting glucose with insulin resistance, so just low carbing may not break your IR.
You can infer IR from regular blood tests as IR pushes up Sodium, uric acid and blood pressure. Though many things also effect these numbers so not totally reliable.

This suject is also new to me but recent Fat Emperor podcast 41 covers this topic nicely.
 
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