Insulin Resistance — Signs, Symptoms and Treatment

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If you have PCOS, understanding insulin resistance isn’t optional — it’s essential. Yet here’s the frustrating reality: the vast majority of cysters have insulin resistance, regardless of body size, yet few are tested for it.

This gap between what’s happening in your body and what’s being assessed in your doctor’s office is costing you answers, delaying your healing, and leaving you struggling with symptoms that could be addressed.

Let’s change that. It’s time to truly understand this crucial hormone and how it’s affecting your health.

What Is Insulin and Why Does It Matter?

Insulin is one of your body’s most important hormones, secreted by your pancreas — that vital organ tucked behind your stomach. Think of insulin as your body’s master metabolic conductor, orchestrating multiple essential functions:

Energy delivery: Every cell in your body requires glucose (sugar) for energy. Insulin is the key that unlocks your cells’ doors, allowing glucose to enter your cells, where it can be used for fuel.

Carbohydrate and protein processing: Insulin controls how your body handles the carbohydrates and proteins you eat, determining whether they’re used immediately for energy, stored for later, or converted to other substances.

Fat metabolism and storage: Insulin is intimately involved in how your body stores and burns fat. High insulin levels signal your body to store fat rather than burn it, which is why insulin resistance makes weight loss so challenging.

When this system works properly, it’s elegant and efficient. But when it breaks down, the consequences ripple through every aspect of your health.

Understanding Insulin Resistance: When the Lock No Longer Fits the Key

Insulin resistance is a condition in which your cells cannot correctly recognise or use insulin. Imagine insulin as a key trying to unlock your cell doors. In insulin resistance, the locks have changed — the key no longer fits smoothly, and glucose struggles to enter your cells where it’s needed.

Here’s what happens: Your cells have specialised receptor sites on their surfaces where insulin molecules bind, like pieces of a jigsaw puzzle fitting perfectly together. In insulin resistance, these receptor sites malfunction. They become less responsive to insulin’s signal, essentially ignoring the hormone’s message to open up and accept glucose.

The result? Glucose accumulates in your bloodstream because it can’t enter your cells efficiently. Your brain detects these rising blood sugar levels and responds by pumping out more and more insulin, desperately trying to overcome your cells’ resistance and normalise your blood sugar.

This creates a state called hyperinsulinemia — too much insulin circulating in your blood. Your blood sugar might look relatively normal (which is why standard glucose tests miss this), but only because your pancreas is working overtime, flooding your system with excessive insulin to compensate.

Who Develops Insulin Resistance and Why?

Some people are genetically more susceptible to insulin resistance. Asian and Black women, for example, tend to develop it more readily, often at lower body weights than their white counterparts. But genetics isn’t destiny — environmental factors play a massive role.

The perfect storm for insulin resistance includes:

Dietary patterns: A diet heavy in refined sugars, processed carbohydrates, empty calories, unhealthy fats, and ultra-processed foods progressively reduces your body’s insulin sensitivity. Each meal high in refined carbs demands an insulin surge. Over time, your cells become desensitised to insulin’s constant knocking, much like you’d eventually tune out an alarm that sounds too frequently.

Chronic stress: When you’re under constant stress, your body releases cortisol, which directly increases blood sugar and promotes insulin resistance. Your body literally cannot distinguish between the stress of a deadline and the stress of being chased by a predator — both trigger the same hormonal response that interferes with insulin function.

Sedentary lifestyle: Physical inactivity is perhaps one of the most underestimated contributors to insulin resistance. Your muscles are major consumers of glucose, and movement — especially strength-building exercise — dramatically improves insulin sensitivity. When you don’t move regularly, your cells become sluggish and less responsive to insulin.

Inadequate sleep: Sleep deprivation is profoundly disruptive to metabolism. Even a few nights of poor sleep can significantly impair insulin sensitivity. Your body needs those restorative hours to regulate hormones, process glucose effectively, and maintain metabolic health.

Inflammation: Chronic low-grade inflammation — often stemming from gut dysfunction, food sensitivities, environmental toxins, or chronic infections — directly interferes with insulin signalling and promotes resistance.

The PCOS-Insulin Resistance Connection: A Vicious Cycle

Here’s the critical statistic: conservatively, between 44-70% of women with PCOS have insulin resistance, regardless of whether they’re overweight or slender. Some research suggests the number may be even higher — up to 95% when properly tested.

If you’re carrying excess weight, your risk increases further. And if you have diabetes, you’re certainly insulin resistant. But remember: normal weight does not equal normal insulin sensitivity. You can be slim and profoundly insulin resistant.

How insulin resistance drives PCOS:

Insulin resistance doesn’t just coexist with PCOS — it’s often the underlying engine driving the syndrome. Here’s the devastating two-fold effect:

1. Insulin Increases Testosterone Production

Excess insulin directly stimulates your ovaries to produce more testosterone. Your ovarian cells have insulin receptors, and when they’re constantly bombarded with high insulin levels, they respond by ramping up androgen (male hormone) production. This is why insulin resistance leads to the high testosterone levels that cause many of PCOS’s most distressing symptoms.

2. Insulin Reduces SHBG Production

Simultaneously, insulin suppresses your liver’s production of Sex Hormone Binding Globulin (SHBG). Think of SHBG as testosterone’s chaperone — it binds to testosterone in your bloodstream, keeping it inactive and controlled. When insulin resistance reduces SHBG levels, more testosterone floats freely in your blood, unbound and biologically active.

The combination is devastating: you’re producing more testosterone while having less ability to neutralise it. This flood of free testosterone wreaks havoc on your ovaries, your skin, your hair follicles, and your metabolic health.

3. The Vicious Cycle Perpetuates Itself

Here’s where things get particularly cruel: excessive free testosterone in your blood can further increase insulin resistance, creating a self-perpetuating cycle. The more insulin-resistant you become, the more testosterone you produce. The more testosterone you produce, the more insulin-resistant you become. Round and round it goes, each rotation making the problem worse.

The Full Impact: How Insulin Resistance Affects Your Body

Due to its dual effect on both testosterone and SHBG, insulin resistance can both cause and amplify virtually every sign and symptom of PCOS:

Central obesity: Insulin resistance is a major culprit behind the stubborn weight gain around your abdomen that so many women with PCOS experience. High insulin levels signal your body to store fat — particularly visceral fat around your organs — rather than burn it. This is why calorie restriction alone often fails for women with PCOS. You’re fighting against a powerful hormonal signal telling your body to hold onto every calorie.

Anovulation and infertility: Insulin resistance prevents your ovaries from developing and releasing eggs properly. The hormonal chaos — elevated insulin, elevated testosterone, disrupted LH and FSH ratios — interferes with the delicate orchestration required for ovulation. Without ovulation, pregnancy becomes impossible, and periods become irregular or absent.

Skin and hair issues: The excess testosterone driven by insulin resistance causes the visible symptoms many women find most distressing: acne, excessive facial and body hair (hirsutism), and scalp hair thinning or loss.

Metabolic dysfunction: Beyond PCOS itself, insulin resistance sets you on a path toward severe metabolic disease if left unaddressed.

Beyond PCOS: The Wider Hormonal Disruption

Emerging research suggests insulin’s role in PCOS may be even more fundamental than we initially understood. There’s compelling evidence that insulin directly stimulates excessive androgen production from your adrenal glands (not just your ovaries) and fundamentally disrupts the hypothalamic-pituitary-gonadal (HPG) axis — the intricate communication network between your brain and ovaries that governs reproduction.

This means insulin resistance isn’t just aggravating existing PCOS — it may be a primary cause of the syndrome itself in many women.

Do You Have Insulin Resistance? The Tell-Tale Signs

You might be thinking: “This all sounds concerning, but how do I know if I have insulin resistance?” Excellent question. Your body provides numerous clues:

Physical Signs:

• Weight distribution: Fat accumulation around your abdomen (apple shape) rather than your hips and thighs
• Skin tags: Small, soft growths, often around the neck, armpits, or under the breasts
• Acanthosis nigricans: Darkened, velvety patches of skin, typically on the neck, armpits, groin, or under the breasts — this is a strong indicator of insulin resistance
• Persistent acne: Particularly along the jawline, chin, and lower face
• Hirsutism: Excessive hair growth on the face, chest, abdomen, or back
• Scalp hair thinning: Hair loss in a male pattern, particularly at the crown or temples

Reproductive Signs:

• Irregular periods: Cycles longer than 35 days, or absent periods (amenorrhoea)
• Difficulty conceiving: Anovulation is a direct consequence of insulin resistance
• PCOS diagnosis: If you have PCOS, assume you have insulin resistance until proven otherwise

Metabolic Signs:

• Sugar cravings: Intense, frequent cravings for sweets or refined carbs
• Energy crashes: Particularly the dreaded 3-4 pm slump, or feeling shaky and weak if you skip meals
• Dizziness or lightheadedness: Especially when standing up or between meals
• Post-meal drowsiness: Overwhelming fatigue after eating, particularly after carbohydrate-rich meals

Systemic Signs:

• Intestinal bloating: Chronic digestive discomfort and gas
• Brain fog: Difficulty concentrating, poor memory, mental fatigue
• Mood disturbances: Depression, anxiety, irritability, mood swings—particularly in relation to eating patterns
• Chronic fatigue: Persistent tiredness that doesn’t improve with rest
• Sleep disturbances: Difficulty falling asleep, staying asleep, or waking unrefreshed

Clinical Markers:

• Elevated triglycerides: A type of fat in your blood
• High blood pressure: Insulin resistance contributes to hypertension
• Metabolic syndrome: A cluster of conditions including increased blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels
• Type 2 diabetes or prediabetes: The end stage of prolonged insulin resistance

If you recognise yourself in several of these signs, insulin resistance is very likely playing a role in your symptoms — and in your PCOS.

The Testing Problem: Why Your Doctor Is Missing It

Here’s where the healthcare system consistently fails those with PCOS: the standard tests most doctors order completely miss insulin resistance in its early and middle stages.

What’s typically ordered:

• Fasting blood glucose test (usually the sole test)
• Two-hour glucose tolerance test (on occasion)
• HbA1c (occasionally)

Why these miss the mark: These tests primarily measure glucose levels, not insulin levels. As we’ve discussed, in insulin resistance, your glucose often looks normal because your pancreas is producing massive amounts of insulin to keep it that way. By the time your glucose becomes elevated enough to show up on these tests, you’ve already been insulin resistant for years, possibly decades.

Tests you may actually need:

• Fasting insulin test: Measures your insulin levels after an overnight fast
• Fasting glucose test: Conducted simultaneously with fasting insulin
• HOMA-IR calculation: Your doctor can calculate this insulin resistance score from your fasting glucose and insulin levels
• Glucose-insulin tolerance test: Measures both glucose and insulin at multiple time points (fasting, 1 hour, 2 hours) after a glucose load—this is the gold standard
• HbA1c: Provides a 2-3 month average of blood sugar levels
• Lipid panel: Particularly triglycerides and HDL cholesterol
• SHBG level: Often suppressed in insulin resistance

Don’t let your doctor dismiss testing because you’re not overweight or because your standard glucose test was “normal.” Insist on comprehensive insulin testing. Your health depends on it.

The Dangers of Untreated Insulin Resistance

If insulin resistance is not addressed in its early stages, you face a dramatically increased risk of developing serious, life-altering conditions:

Cardiovascular disease: Insulin resistance is a major independent risk factor for heart disease and stroke. It promotes inflammation, damages blood vessels, increases blood pressure, and creates an unfavourable lipid profile.

Type 2 diabetes: Insulin resistance is the pathway to diabetes. Your pancreas can only work overtime for so long before it becomes exhausted and can no longer produce enough insulin to overcome your cells’ resistance. At that point, your blood sugar rises and stays elevated — that’s diabetes.

Metabolic syndrome: A cluster of signs and symptoms — increased blood pressure, high blood sugar, excess abdominal fat, abnormal cholesterol — that dramatically increase your risk of heart disease, stroke, and diabetes.

Fatty liver disease: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with insulin resistance. Your liver begins accumulating fat, which can progress to inflammation, scarring, and even liver failure.

Sleep apnoea: Insulin resistance contributes to sleep-disordered breathing, which further worsens insulin resistance—another vicious cycle.

Endometrial cancer: PCOS cysters have a significantly elevated risk of endometrial cancer driven by insulin resistance.

Cognitive decline: Emerging research links insulin resistance to increased risk of Alzheimer’s disease and cognitive impairment later in life.

These aren’t distant, abstract possibilities — these are real health consequences that develop over time when insulin resistance remains unaddressed.

The Empowering Truth: You Can Reverse Insulin Resistance

Now for the genuinely good news: insulin resistance is not a life sentence. Unlike some conditions that progressively worsen regardless of intervention, insulin resistance is remarkably responsive to lifestyle modifications. You have tremendous power to improve your insulin sensitivity and reclaim your health.

1. Nutrition: Your Most Powerful Tool

A well-balanced food plan is the cornerstone of improving insulin sensitivity. This isn’t about restriction or deprivation — it’s about choosing foods that support stable blood sugar and reduce the constant insulin demands on your body.

Key principles:

• Prioritise whole, unprocessed foods
• Build meals around protein, healthy fats, and fibre-rich vegetables
• Choose complex carbohydrates with low glycemic impact
• Eliminate or drastically reduce refined sugars and processed carbohydrates
• Eat regular, balanced meals—skipping meals stresses your system
• Consider the timing of your carbohydrates (protein and fat first can blunt insulin response)

The food plan I recommend throughout Conquer Your PCOS Naturally is specifically designed to address insulin resistance, whether or not you have PCOS. These aren’t arbitrary rules — they’re evidence-based strategies for restoring insulin sensitivity and hormonal balance.

2. Movement: Building Insulin-Sensitive Muscle

Physical activity is stunningly effective at improving insulin sensitivity. Movement—particularly strength-building exercise—makes your muscles more responsive to insulin’s signal.

What works:

• Resistance training: Building muscle mass is one of the most effective ways to combat insulin resistance. Muscle tissue is metabolically active and highly insulin-responsive.
• Regular walking: Even moderate activity, such as walking after meals, significantly improves glucose uptake.
• HIIT (High-Intensity Interval Training): Short bursts of intense activity can dramatically improve insulin sensitivity.
• Consistency matters more than intensity: Regular moderate activity beats occasional intense exercise.

The goal isn’t punishment or exhaustion — it’s sustainable movement that builds strength and metabolic resilience.

3. Sleep: The Underrated Metabolic Reset

Eight hours of quality sleep per night has been shown to help insulin work optimally. Sleep is when your body repairs, resets, and rebalances hormones. Even a few nights of inadequate sleep can significantly impair insulin sensitivity.

Prioritize:

• Consistent sleep and wake times
• A dark, calm, cool sleeping environment
• Limiting screen time before bed
• Managing stress and worry that interfere with sleep
• Addressing any sleep disorders (like sleep apnoea, common in PCOS)

4. Stress Management: Calming the Cortisol Storm

Increased stress directly causes insulin resistance through cortisol’s effects on blood sugar. Managing your stress levels isn’t a luxury; it’s a metabolic necessity.

Effective approaches:

• Mindfulness meditation and deep breathing
• Regular time in nature
• Creative pursuits and hobbies
• Strong social connections
• Professional support (therapy, coaching) when needed
• Boundaries around work and obligations
• Practices that genuinely restore you

5. Targeted Supplementation: Supporting Your Biochemistry

Specific nutrients have been shown to reduce insulin resistance and support healthy metabolism:

Evidence-based supplements:

• Omega-3 fatty acids (fish oil): Reduce inflammation and improve insulin sensitivity
• Chromium: Enhances insulin signalling and glucose metabolism
• Magnesium: Involved in insulin action; deficiency worsens resistance
• Inositol (particularly myo-inositol and D-chiro-inositol): Improves insulin sensitivity and ovulation in PCOS
• Vitamin D: Deficiency is associated with insulin resistance
• Berberine: Powerfully improves insulin sensitivity (consult a practitioner)
• Alpha-lipoic acid: Antioxidant that improves insulin sensitivity

Supplementation should complement, not replace, foundational lifestyle changes. Work with a knowledgeable practitioner to determine what’s right for your specific situation.

6. Address Underlying Contributors

Don’t overlook factors that perpetuate insulin resistance:

• Gut dysfunction: Heal intestinal permeability, address dysbiosis, reduce inflammation
• Food sensitivities: Identify and eliminate inflammatory triggers
• Chronic infections: Address underlying issues like SIBO, candida, or other infections
• Environmental toxins: Reduce exposure to endocrine-disrupting chemicals
• Hormonal imbalances: Sometimes thyroid or adrenal support is necessary alongside insulin work

The Path Forward: Hope and Healing

There is so much that can be done to address and overcome insulin resistance. This isn’t about perfection — it’s about consistent, sustainable changes that support your body’s natural ability to heal and rebalance.

Every positive change you make matters. Each meal of balanced, whole foods improves your insulin sensitivity. Each night of restorative sleep helps your body reset. Each stress management practice calms your cortisol response. Each movement session builds insulin-responsive muscle.

These changes aren’t just about lab values; they’re about how you feel every single day. More stable energy. Clearer thinking. Better mood. Fewer cravings. Improved sleep. Regular periods. Better skin. And yes, improved fertility and overall health.

You’re not powerless against insulin resistance. You’re not destined for diabetes or metabolic disease. You have agency and tools. The question isn’t whether you can improve; it’s how much you’re willing to invest in your own healing.

Your body is remarkable and resilient. Given the proper support, it knows how to heal. Trust that process, be patient with yourself, and commit to the consistent actions that serve your health.

The journey from insulin resistance to insulin sensitivity is absolutely possible — and absolutely worth it.

From PCOS to perfect health, with love,

Dr. Rebecca Harwin
The PCOS Expert
Chiropractor & Bestselling Author of
Conquer Your PCOS Naturally
www.ConquerYourPCOSNaturally.com

P.S. For more success strategies and scientific secrets, head to our Facebook page and hit ‘like’. There is so much more I have to share with you to balance your PCOS hormones!

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