the Story of PCOS & Obesity- Hyperinsulinemia vs Hyperglycemia

Posted by Ben White on February 17, 2019

By Dr. Alison McAllister, ZRT Laboratory

Many times when I am talking to a practitioner about a patient with PCOS and/or weight issues, I commonly get the response – “His/her blood sugar is normal.” However, when we are looking at the health of PCOS and weight-challenged patients, their insulin response is of primary importance — not just their blood sugar.

How Insulin and Blood Sugar Work in a Healthy Body

When we are fasting, both blood sugar and insulin levels should be at a steady state. Blood sugar is generally between 70–90 mg/dL and insulin levels between 1–8 µIU/mL. When we eat a meal, blood sugar increases. In response, insulin is produced by the pancreatic beta cells to help shepherd glucose into all cells to be used as energy. Within 2 hours, insulin and glucose levels should have essentially returned to normal.

Excess glucose that is not used for energy is stored as glycogen in the liver and muscle cells. Once these stores are full, the body stores extra glucose as fat in adipose cells — and we gain weight.

Insulin Resistance: The First Step

When we become insulin resistant, things change. The first tissue to become insulin resistant is generally our muscle cells — exercise improves insulin sensitivity. When tissues become insulin resistant, higher levels of insulin are needed to shepherd glucose into cells. Initially, this higher insulin production occurs only after meals when glucose levels spike. If glucose levels after meals continue to be elevated, eventually fasting insulin levels will be elevated to maintain normal glucose levels. This situation of high insulin is called hyperinsulinemia — and all of this occurs in the presence of normal blood glucose.

If we allow this hyperinsulinemia to continue, the body will lose the ability to manufacture enough insulin to control postprandial glucose levels.

If insulin levels cannot control postprandial glucose levels and lifestyle continues to favour high glucose foods, fasting glucose levels will also become chronically elevated and the patient will officially have non-insulin dependent diabetes (NIDD). In a non-controlled NIDD patient, high glucose will continue to spur high insulin levels until the pancreas no longer produces adequate levels — eventually progressing into an insulin-dependent AND insulin-resistant diabetic situation, sometimes known as type 3 diabetes.

PCOS, Hyperinsulinemia and Hormonal Dysfunction

Women with PCOS are commonly in a hyperinsulinemic state for years. It may be that they have defective insulin receptors that do not trigger adequate glucose management even at lower glucose levels. As a result, insulin appears to drive testosterone and DHEAS higher, since the production of these hormones is stimulated by excess insulin. This higher DHEAS and testosterone from both the ovaries and adrenal glands produce many of the symptoms of PCOS — increased facial and body hair, loss of scalp hair and acne.

The high insulin also contributes to irregular menstrual cycles and drives weight gain by increasing food cravings, decreasing satiety, increasing adipose deposition and changing cortisol metabolism. Women with PCOS also have altered cortisol and HPA axis functioning — many are found to have altered cortisol metabolism both systemically and within adipose tissues.

Our CardioMetabolic & Cortisol Test Kit measures insulin, HbA1c, lipid markers and cortisol together — providing a comprehensive picture of the metabolic and adrenal dysfunction that drives PCOS symptoms and weight gain.

How Do You Know if Someone Is Hyperinsulinemic?

Symptoms of hyperinsulinemia include:

Fatigue, which may be severe
Complaints of “hypoglycaemia” even in the presence of normal or high-normal glucose levels
Weight gain
Acne, increased facial/body hair, loss of scalp hair
Browning of the skin in areas of rubbing — neck and armpits (acanthosis nigricans)
Skin tags
Anxiety, depression, brain fog
Sugar cravings and a sensation of never being full

So the next time you see a PCOS patient or overweight patient who tells you they are not diabetic, consider that hyperinsulinemia might still be contributing to a lot of their symptoms.

Testing for PCOS and Metabolic Dysfunction

For women with suspected PCOS who want to understand the full hormonal picture — including testosterone, DHEAS, cortisol, estrogen, progesterone and thyroid alongside metabolic markers — our Hormone & CardioMetabolic Test Kit combines a comprehensive hormone panel with cardiometabolic markers in a single at-home collection.

For women where weight management and metabolic health are the primary concern, our Female Weight Management Profile Test measures the key hormones linked to fat storage and metabolism — including cortisol, estradiol, testosterone, progesterone, DHEA and thyroid markers — in a single at-home kit.

Originally by Dr. Alison McAllister, ZRT Laboratory. Reproduced with permission. Last reviewed: May 2026.

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