Understanding PCOS and its Link to Insulin Resistance

As a dietitian, I see firsthand how often PCOS and insulin resistance go hand in hand. At Diabetes Digital, 93% of our patients identify as women, and nearly 10% of them have PCOS. That’s not a coincidence—there’s a strong connection between insulin resistance and PCOS, and it’s something that isn’t talked about nearly enough. Research suggests that insulin resistance plays a central role in the development and progression of PCOS, leading to hormonal imbalances and a higher risk of Type 2 diabetes. 

In our latest episode of the Diabetes Digital Podcast, we sat down with our incredible dietitian, Nikki Sahebghalam, who specializes in diabetes and women’s health. We had an in-depth conversation about PCOS—what it is, how it’s diagnosed, and most importantly, how you can manage it in a way that actually works for your body. If you prefer to listen, check out the episode here.

The Link Between Insulin Resistance and PCOS

PCOS (Polycystic Ovary Syndrome) is one of the most common endocrine disorders, affecting about 1 in 10 women—though nearly 70% of cases go undiagnosed. Many of our patients with diabetes or prediabetes also have PCOS because insulin resistance is a major factor in both conditions. Insulin resistance happens when the body doesn’t respond effectively to insulin, leading to higher blood sugar and insulin levels. Over time, this imbalance can contribute to inflammation, hormonal issues, and a higher risk of developing Type 2 diabetes.

PCOS in Women of Color: Why the Disparities?

PCOS doesn’t affect all women equally. Research shows that Black, Indigenous, and People of Color (BIPOC) are more likely to experience delayed diagnosis, higher rates of insulin resistance, and increased barriers to care. This isn’t just about genetics—it also has to do with access, systemic healthcare bias, and a medical system that often overlooks the unique needs of BIPOC women.

Another layer to this is cultural food traditions. A lot of mainstream PCOS advice completely ignores the foods that many people grew up eating. Telling someone to cut out rice, beans, or plantains isn’t helpful if those foods are a core part of their diet. Instead of restriction, the focus should be on adapting traditional meals to support blood sugar balance while still honoring culture, which is what we do here at Diabetes Digital. This kind of approach actually works long-term.

Symptoms of PCOS: It’s More than just Irregular Periods

Many people associate PCOS with menstrual irregularities, but the condition comes with a wide range of physical and emotional symptoms. Some common ones include:

• Physical symptoms: Irregular or absent periods, heavy bleeding, acne (especially around the chin), excess facial or body hair, hair thinning, weight fluctuations, and darkened skin patches around the neck or armpits.
• Emotional symptoms: Increased anxiety, depression, and heightened PMS symptoms due to hormonal imbalances.

For many, PCOS is diagnosed in their 20s or 30s, but symptoms often start in the teenage years. If you suspect you have PCOS, getting screened is key to early management.

How is PCOS Diagnosed?

The diagnostic criteria for PCOS, known as the Rotterdam Criteria, require at least two of the following:

1. Irregular ovulation – Having fewer than nine periods per year, extremely short or long cycles, or no period at all.
2. Hyperandrogenism – Elevated androgens (like testosterone) on lab tests or physical signs such as excess hair growth, acne, or hair thinning.
3. Polycystic ovaries – Enlarged ovaries with multiple small follicles, detected via ultrasound.

Since PCOS can present differently in each person, working with a healthcare provider for thorough evaluation is crucial.

Common Nutrition Myths about PCOS

We’ve all seen the endless PCOS advice online—especially on social media. Some of it is helpful, and some of it is just plain wrong. In our conversation with Nikki, we tackled some of the biggest myths:

• “You need to cut out carbs completely.” Nikki made it clear—carbs are not the enemy. While managing blood sugar is important, cutting out carbs entirely isn’t necessary. Instead, pairing carbs with protein, fiber, and healthy fats can help stabilize blood sugar levels.
• “Weight loss is the only way to manage PCOS.” PCOS affects people of all body sizes. Nikki emphasized that sustainable, health-promoting behaviors—like balanced nutrition, movement, and stress management—are far more effective than focusing solely on weight loss.
• “You have to avoid dairy and gluten.” While some people with PCOS may feel better avoiding dairy or gluten, there’s no conclusive evidence that these foods directly worsen PCOS symptoms. Nikki recommended paying attention to your own body’s response rather than following blanket restrictions.

The Best Way to Eat for PCOS

Instead of focusing on what to avoid, Nikki encourages her patients to think about what they can add to their diet:

• Protein: Aim for at least 30 grams at breakfast to stabilize blood sugar throughout the day.
• Fiber: Helps with digestion, blood sugar control, and hormone regulation.
• Healthy fats: Supports hormone production and satiety.
• Complex carbs: Whole grains, legumes, and starchy vegetables provide steady energy.

Skipping meals or under-eating is also a common issue among those with PCOS. Nikki stressed that eating regularly every 3-4 hours can make a huge difference in stabilizing blood sugar and hormone levels.

Exercise and PCOS: What Actually Helps?

One of the best ways to improve insulin sensitivity and lower inflammation? Movement. But not all exercise is created equal when it comes to PCOS. Nikki highlighted the importance of strength training for increasing muscle mass, which in turn helps the body use glucose more efficiently. But that doesn’t mean other forms of movement aren’t beneficial. Walking, yoga, and even higher-intensity workouts can be helpful depending on the individual. The key is consistency and choosing activities that feel good for your body.

She also noted that how you structure your day matters. For example, skipping breakfast, having coffee on an empty stomach, and then doing a high-intensity workout is a recipe for a cortisol spike. Instead, she recommends eating something before exercise, even if it’s just a small protein-rich snack.

Stress, Sleep, and PCOS: The Missing Pieces

PCOS isn’t just about food and exercise—stress and sleep play a huge role too.

Nikki pointed out that poor sleep can worsen insulin resistance and hormonal imbalances, making PCOS symptoms even more challenging. Prioritizing 7-9 hours of good-quality sleep per night is crucial. She also shared that she personally tries to reduce screen time before bed, listens to calming music (holiday jazz is a current favorite!), and drinks chamomile tea to wind down.

For stress management, Nikki encouraged patients to think about what “fills their cup.” That might mean resting more during their menstrual phase, engaging in social or creative activities during their follicular phase, or simply setting boundaries with work and personal commitments.

Supplements for PCOS: What’s Actually Worth Taking?

Nikki touched on one of the most well-researched supplements for PCOS: inositol, specifically in a 40:1 ratio of myo-inositol to D-chiro-inositol. Studies have shown it can:

• Improve insulin sensitivity.
• Regulate menstrual cycles.
• Support ovulation.
• Reduce excess androgen levels.

While other supplements like omega-3s, vitamin D, and magnesium may also be beneficial, Nikki emphasized working with a healthcare provider before starting any new supplement regimen.

How to Work with a Dietitian for PCOS

PCOS can feel overwhelming, but you don’t have to navigate it alone. Nikki and our team at Diabetes Digital specialize in helping people with PCOS find sustainable, science-backed strategies that work for their lifestyle.

If you’re looking for personalized support, you can take our quick quiz at [Diabetes Digital] to get matched with one of our expert dietitians—including Nikki!

Final Thoughts

PCOS and diabetes are deeply connected, but managing them doesn’t have to feel impossible. As Nikki shared, focusing on balanced nutrition, movement, stress management, and adequate sleep can make a real difference.

If this conversation resonated with you, share this post with a friend and be sure to check out the full podcast episode!

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