PCOS & Diabetes: Does hormonal imbalance also spike blood sugar levels?

Polycystic ovary syndrome (PCOS) is a common hormonal condition affecting women of reproductive age. PCOS is the most prevailing and evident cause of the rise in infertility cases currently.

In India, around 3.7 to 22.5% of women suffer from PCOS, while the worldwide range is estimated around 6 to 26%. Interestingly, experts warn that women who are diagnosed with PCOS are at higher risk of developing Type 2 diabetes and vice versa. 

Diabetes is a condition that is characterised by high levels of glucose present in the blood. Whereas, PCOS is a condition that is categorised as an imbalance in the reproductive hormones that eventually leads to a varied range of symptoms like higher levels of androgens (also known as male hormones), causing irregular or absent periods along with excess facial or body hair growth. 

Polycystic ovary syndrome and diabetes might seem like two poles apart in terms of health issues, but they are often interwoven. How are insulin resistance and PCOS connected?

The link between diabetes and PCOS—know from experts 

PCOS and diabetes are becoming increasingly common among women in India and across the globe. According to a study published in the JAMA Network, among the sample size of 9824 women who participated in the study, around 3.3% of women with PCOS suffered from diabetes, 9.1% had impaired fasting glucose, and 11.5% had impaired glucose tolerance. “PCOS and diabetes are increasingly common, often linked by insulin resistance. While PCOS is typically associated with weight gain, lean PCOS can affect normal-weight women,” explains, Dt. Nisha, Consultant - Dietary, Nutrition & Lactation, Motherhood Hospitals, Gurgaon.

Dt. Nisha, Consultant-Dietary, Nutrition & Lactation, Motherhood Hospitals, Gurgaon

She adds, “Insulin resistance disrupts the hormone balance, leading to PCOS symptoms like irregular periods and infertility. Diabetes, on the other hand, can worsen PCOS symptoms, as high blood sugar impacts hormone regulation. Hence, early diagnosis and management are vital for both conditions.”

PCOS can lead to long-term complications like diabetes 

Insulin resistance is a core feature of Polycystic Ovary Syndrome (PCOS), affecting 50-80% of women with the condition. It contributes to hormonal imbalances by increasing androgen production, disrupting ovulation, and exacerbating symptoms like irregular periods, acne, and hirsutism.

To understand the deeper connection between both conditions just ahead of World Diabetes Day, we had a Q&A session with our experts:

Q. How does insulin resistance lead to hormonal changes seen in women with PCOS, and what impact does it create on symptoms like irregular periods? 

Women who are diagnosed with PCOS are at higher risk of developing Type 2 diabetes and vice versa. This can be due to underlying insulin resistance. 

Dr. Usha B R, Fertility Consultant, Laparocopy & Robotic Surgeon, Fortis Hospital Bannerghatta Road

According to, Dr. Usha B R, Fertility Consultant, Laparoscopy & Robotic Surgeon, Fortis Hospital Bannerghatta Road, “Elevated insulin levels in PCOS stimulate ovarian androgen production, leading to cyst formation and disrupted ovulation. Insulin resistance also enhances luteinizing hormone (LH) production, further disrupting ovulation.”

This hormonal imbalance perpetuates the cycle of ovarian dysfunction, exacerbating PCOS symptoms. 

Q. What role does elevated insulin play in the development of ovarian cysts and the disruption of normal ovulation in women with PCOS?

The key connection between conditions like diabetes and PCOS is insulin resistance. Listing out factors for the development of ovarian cysts due to insulin resistance, Dt. Nisha shares, “In both of these conditions, the cells in the body tend to become resistant to insulin. This causes your pancreas to produce insulin in excess." Some of the common factors include: 

Insulin resistance: High levels of insulin in the body can significantly stimulate the ovaries to produce more hormones, particularly androgens. This further leads to symptoms of PCOS like irregular or missed periods and excess growth of facial hair.

Obesity and weight gain: Being overweight is one of the common risk factors in both conditions, such as diabetes and PCOS. Weight gain that is potentially caused due to various factors like poor metabolic functions and insulin resistance can significantly aggravate these conditions. Excess weight can worsen your insulin sensitivity while leading you to a vicious cycle.

Inflammation: Low-grade inflammation is more common in conditions like diabetes and PCOS. Those diagnosed with diabetes and PCOS are more likely to experience chronic inflammation. 

Over time, this can impair their body’s ability to use insulin effectively and efficiently. Inflammation is mainly caused by the excess production of substances known as cytokines. This particular substance can contribute to complications like insulin resistance and hormonal imbalances.

Hormonal imbalances: The increased levels of insulin in the body can lead to the overproduction of hormones called androgens in those with PCOS. This can negatively affect the female reproductive hormones. This further leads to experiencing several symptoms, such as irregular periods and difficulties in ovulating. Poor management of blood sugar levels in those with diabetes, particularly type 2 diabetes, can affect the production as well as the regulation of the necessary hormones.

Q. Why are women with PCOS at higher risk for developing metabolic conditions like type 2 diabetes, and how is this linked to insulin resistance?

Women with PCOS are at heightened risk for developing metabolic disorders such as Type 2 diabetes due to insulin resistance. This resistance disrupts the glucose uptake, raising blood sugar levels and the risk of diabetes. “Regular screening and management of insulin resistance are crucial to preventing long-term metabolic complications,” suggests Dr. Usha. While there are some common factors, like obesity and inflammation, those are also linked to insulin resistance in the body.  

Q. Can making simple lifestyle tweaks help or just medication work better for improving the insulin resistance and symptoms of PCOS? 

Women should follow a well-balanced lifestyle consisting of good eating habits, regular exercise, and maintaining an optimum weight to manage diabetes and symptoms of PCOS.

According to Dr. Usha, “Managing insulin resistance through lifestyle changes such as diet, exercise, weight loss, or medication (like metformin) can improve the symptoms of PCOS. 

Understanding the link between PCOS and diabetes is vital—so, are you ready to charge of your hormones today that could help prevent complications tomorrow?   

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