PCOS and Insulin Resistance

Insulin resistance is a syndrome that arises in individuals with a metabolic condition in which there is resistance to the action of insulin. Because of this resistance, the pancreas in response to a sugar load must secrete more insulin. It is characterized by a decrease in the ability of insulin to stimulate glucose uptake to muscle and fat cells, as well as to inhibit glucose production by the liver. The results of this disorder yield individuals who have higher levels of insulin (hyperinsulinemia) in their blood stream.

The syndrome causes many metabolic and cardiovascular disorders, including glucose intolerance non insulin-dependent diabetes mellitus (Type 2 Diabetes), hypertension, alterations in lipid levels in the blood stream, atherosclerosis and other consequences of developing diabetes mellitus. It is believed to be caused by a combination of an inherited tendency and lifestyle abuse. Up to 40 - 60% of women with PCOS demonstrate some degree of impaired glucose tolerance as a result of insulin resistance.

The insulin resistance and hyperinsulinemia are primary events in PCOS that somehow lead to hyperandrogenism and the subsequent reproductive endocrine abnormalities. It appears likely that an inherent, probably genetically determined ovarian defect is present in women with PCOS that makes the ovary susceptible to insulin stimulation of androgen (male-like hormone) production.

Hyperinsulinemic insulin resistance will be determined by obtaining a blood sample after a 12 hour fast for insulin, glucose and C-peptide levels. A glycosolated hemoglobin (HbA1C) will also be determined. A glucose/insulin ratio of < 7.0 will be used to define insulin resistance. A hepatic profile will be monitored at monthly intervals to follow liver function. The correction of hyperandrogenism in women with PCOS may be achieved by interventions that improve insulin sensitivity and reduce circulating insulin. Such measures include, but are not limited to weight loss, dietary modifications and insulin-sensitizing medications like metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos).

The use of anti-diabetic drugs in PCOS represents a novel use of these agents. The management of PCOS should include diet control. Caloric restriction, weight loss, and exercise are essential for the proper treatment of the insulin resistant patient with PCOS. This is not only important in the primary treatment of PCOS but in maintaining efficacy of drug therapy.

 

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