PCOS Insulin Resistance Symptoms in Females: Skin Signs, & How to Test

Insulin resistance is one of the most widespread but least diagnosed health challenges in women. Many females experience symptoms as persistent fatigue, unsuccessful body weight loss, acne, dark spots under the skin, or irregular periods, without ever suspecting that all of the above-mentioned symptoms might have the same problem as the root cause.

The human body makes insulin, which assists in transporting glucose from the blood to the cells. This process allows cells to produce energy.

Insulin resistance occurs when cells in muscles, fat, and the liver do not respond properly to insulin, causing glucose to remain elevated in the bloodstream.

When cells become unresponsive to insulin, glucose remains in the bloodstream. If the pancreas cannot produce enough insulin to compensate, blood sugar levels rise.

Insulin is a hormone made by the pancreas that helps move sugar (glucose) from the blood into the body’s cells to be used as energy. Whenever you eat carbohydrates, your blood sugar rises, and insulin is released. When insulin works properly, blood sugar stays balanced, and the body gets energy without storing too much fat.

Insulin resistance happens when body cells do not respond well to insulin. Even though insulin is present, glucose cannot enter the cells easily, so sugar stays in the blood.

This forces the body to produce even more insulin over time, worsening insulin resistance and metabolic dysfunction. This cluster of metabolic issues, including high blood pressure, abnormal blood lipids, and elevated blood sugar, is often referred to as insulin resistance syndrome.

In women, high insulin levels disturb hormonal balance. Excess insulin stimulates the ovaries to produce more of a hormone called androgen (male hormones), leading to complex conditions like PCOS. This can cause irregular or missed periods, acne, unwanted facial or body hair, thinning hair on the scalp, and fertility problems.

High insulin also affects hormone-binding proteins, increasing the impact of testosterone and making symptoms worse. Certain risk factors make insulin resistance more likely, such as being overweight, having a sedentary lifestyle, or having a family history of type 2 diabetes or PCOS, which increases the risk of developing insulin resistance.

Reviewing a patient’s medical history helps identify these risk factors and guides further testing. Insulin resistance also leads to an increased risk of developing type 2 diabetes and other metabolic conditions.

Insulin resistance can develop without obvious symptoms. Nevertheless, there are early signs of trouble conveyed by your body. Other symptoms, such as subtle changes in energy or mood, may also occur and can be easy to overlook.

Have you ever asked yourself, Why do I feel tired after eating sugar? Here’s what happens:

Sugar causes a rapid rise in blood glucose, triggering an excessive insulin release. This often leads to a sudden blood sugar drop, resulting in fatigue and cravings.

Missing these early signs can lead to persistently high blood sugar levels over time. Common symptoms of insulin resistance include:

• Fatigue

• Shakiness

• Headaches

• Mood swings

Excess weight is a common risk factor for insulin resistance, and after consuming sugar or refined carbohydrates, you may feel extremely sleepy.

This leads to what is often called the “cravings loop.” There are times when you feel the urge to eat carbohydrates despite having just had a meal. The craving feels sudden and intense. It happens because insulin rapidly lowers blood sugar after a spike, triggering hunger and cravings.

So you crave:

• Bread

• Rice

• Sweets

• Snacks

These foods are often high-GI foods, meaning they have a high glycemic index and cause rapid spikes in blood sugar and insulin levels. The glycemic index ranks foods based on how quickly they raise blood glucose, and high-GI foods are more likely to trigger cravings and contribute to insulin resistance.

• Most women complain of a lack of concentration, especially in the afternoon.

• You may experience difficulty concentrating or memory loss.

• This happens when glucose cannot enter brain cells efficiently.

Insulin resistance often shows visible signs on the skin before the blood tests confirm it. These skin changes happen when high insulin levels affect how cells grow, heal, and produce pigment. Some of the possible risk factors are;

Insulin resistance can also be associated with other complications, such as fatty liver disease, which may not be immediately apparent but are important to monitor.

Acanthosis nigricans is one of the most common and noticeable skin signs of insulin resistance. It appears as dark, thick, velvety patches of skin, usually in body folds such as the neck, underarms, groin, elbows, or knees.

These skin changes develop when high insulin levels stimulate excess skin cell growth and increased pigment production, making the skin look darker and textured.

Common areas include:

• Back of the neck

• Armpits

• Groin

• Under breasts

Skin tags are small, soft, flesh-colored or slightly dark growths that commonly appear on the neck, underarms, eyelids, or under the breasts. They are harmless but are often linked to insulin resistance.

High insulin levels can trigger excessive growth of skin cells, leading to the formation of these tags. When they appear suddenly or in large numbers, they can be an early visual sign that blood sugar and insulin levels may be imbalanced.

Common areas include:

• Neck and nape of the neck

• Underarms (armpits)

• Eyelids

• Under the breasts

• Groin and inner thighs

• Upper chest and collarbone area

These areas are prone to friction and moisture, which, along with high insulin levels, can increase the likelihood of skin tag formation.

Polycystic Ovary Syndrome (PCOS) and insulin resistance are closely connected. Insulin imbalance often comes first and contributes to hormonal problems.

Studies show that up to 70% of women with PCOS have some level of insulin resistance. This can happen even in women who are lean and have normal fasting blood sugar levels.

Because of this, PCOS is often missed or wrongly diagnosed. Many tests focus only on high blood sugar, while insulin levels are not checked. Healthcare professionals may use blood tests to diagnose prediabetes in women with PCOS, including fasting glucose, A1C, and oral glucose tolerance tests.

It is also important to assess triglyceride levels and cholesterol levels, as these are key markers of metabolic health in women with PCOS and insulin resistance. Monitoring blood pressure, including high blood pressure, is crucial due to the increased risk of metabolic syndrome and cardiovascular disease in this population. As a result, insulin resistance may go unnoticed even though it is the main cause of the hormonal imbalance.

In the early stages of insulin resistance, blood sugar levels can still appear normal. This happens because the pancreas works extra hard and releases large amounts of insulin to keep blood sugar under control.

Even when insulin levels stay high for a long time, common tests like fasting glucose or HbA1c may not detect the problem. As a result, high insulin levels can remain hidden. This undetected excess insulin can quietly harm ovarian function for years, long before diabetes is ever diagnosed.

When insulin levels remain very high, insulin begins to interfere with hormonal regulation, not just blood sugar control. High insulin directly stimulates the ovaries to produce excess male hormones (androgens like testosterone).

At the same time, insulin reduces the production of sex hormone-binding globulin (SHBG) in the liver, which normally helps control and balance testosterone levels. As a result, more free and active testosterone circulates in the body.

This hormone imbalance interferes with normal ovulation, making it irregular or stopping it completely. This can lead to missed periods, long or irregular cycles, and abnormal bleeding. Because ovulation does not happen regularly, progesterone levels remain low, worsening the hormonal imbalance and causing estrogen dominance. These changes are responsible for the common symptoms seen in PCOS linked to insulin resistance.

Most hallmark PCOS symptoms are caused by underlying insulin resistance.

• Missing or abnormal periods: Anovulation or delayed ovulation interferes with the cycle regularity.

• Too much hair on the face or chest (hirsutism): The presence of coarse hair is encouraged by high levels of androgens.

• Deep, cystic acne: Androgens enhance the production of oil and inflammation.

• Problems with fertility: Irregular ovulation decreases the fertility and implantation rates.

The symptoms are not single problems; they are linked manifestations of hormonal malfunction caused by insulin.

Key Takeaway: To many women, PCOS is not merely a reproductive disease- it is an insulin-resistance-based metabolic health condition. Abnormal cycles are something that may be one of the first indicators. Early diagnosis of insulin resistance and early treatment may prevent the development of gestational diabetes and heart disease, and improve fertility.

Many women struggle with persistent abdominal weight gain despite dieting, exercising, or maintaining an otherwise healthy lifestyle. In cases of insulin resistance, this type of fat behaves very differently from typical weight gain. Excess weight, especially around the abdomen, is a common sign of insulin resistance.

This pattern is often referred to as the “insulin belly” and is a hallmark sign of insulin resistance-related belly fat in females. Achieving and maintaining a healthy weight is important for women with insulin resistance.

Insulin is a powerful storage hormone. Under certain health conditions, insulin rises after meals and then falls, allowing the body to switch between fuel storage and fat burning.

In insulin resistance, insulin levels remain chronically elevated, even when blood sugar appears normal. When this happens, the body receives a constant signal to store energy.

Fat-burning processes such as lipolysis are effectively shut down, meaning stored fat cannot be accessed for fuel. This metabolic “lock” explains why women with insulin resistance often feel as though their body is working against them.

Key takeaway: For women, belly fat caused by insulin resistance is fundamentally different from ordinary weight gain. The insulin belly forms because chronically high insulin locks fat into the abdominal region and prevents fat burning. Addressing insulin resistance, not simply cutting calories, is the key to reducing visceral fat, restoring metabolic health, and achieving sustainable weight loss.

Insulin resistance cannot be confirmed through symptoms only and requires blood testing. You need to know what is happening in your blood.

The most important tests to consider are these (Mydiagnostics):

• Fasting Insulin- Frequently neglected but very crucial.

• HOMA-IR- HOMA-IR is one of the most widely used and clinically validated indices for insulin resistance.

• HbA1c -Your 3-month blood sugar level.

• Lipid Profile - Includes cholesterol levels (LDL, HDL) and triglyceride levels; high triglycerides and low HDL are typical.

Measuring blood pressure is also important in assessing metabolic health and insulin resistance, as high blood pressure can be associated with metabolic syndrome.

Order your Comprehensive Metabolic Panel or PCOS Screening with Mydiagnostics. Home collection available.

Naturally, insulin resistance in females can be reversed by taking care of the underlying causes of chronically high insulin. Lifestyle changes are the foundation for improving insulin resistance. Proper diet, regular physical activity, sleep, and stress management are some of the strategic changes that can be implemented to enhance insulin sensitivity.

Engaging in moderate activity, such as brisk walking, is especially important for managing insulin resistance, as it helps facilitate glucose transport into muscles and supports metabolic health. In some cases, other medications may be prescribed alongside lifestyle changes to help improve insulin sensitivity. The goal of these interventions is to reduce insulin resistance and improve insulin resistance for better overall metabolic health.

The food order, food composition and food quality are significant in the regulation of insulin levels. One important concept to consider is the glycemic index, which ranks foods based on how quickly they raise blood glucose levels.

Choosing foods with a low glycemic index can help manage insulin resistance by preventing rapid spikes in blood sugar and insulin. High GI foods, on the other hand, cause quick increases in blood glucose and should be limited to reduce the risk of worsening insulin resistance and developing type 2 diabetes.

Eating foods rich in protein at the beginning of meals will ensure the stabilization of the blood sugar level and decrease the spikes of insulin. Protein slows gastric emptying and activates gastric hormones that enhance insulin sensitivity. Make sure to avoid highly processed foods to prevent other risk factors of insulin resistance.

Dietary fibre, in particular, non-starchy vegetable fibre, is an inherent blood sugar buffer. Fibre retards the absorption and digestion of carbohydrates, avoiding spikes in blood glucose levels following meals. This causes reduced insulin secretion and enhanced insulin sensitivity with time.

Vegetables also feed gut bacteria, decrease inflammation and supply the necessary micronutrients in glucose metabolism. Fibre food consumption can make a woman feel full longer, make her lose weight and is central to restoring insulin sensitivity.

Regular physical activity, including moderate activity such as brisk walking, is essential for improving insulin resistance. Engaging in these activities helps increase insulin sensitivity and supports better blood sugar control.

Exercise and moderate activity improve insulin sensitivity independent of weight loss, making it a powerful tool for metabolic health. Muscle tissue acts as a glucose sink, absorbing excess blood sugar.

The muscle tissue serves to absorb extra glucose out of the bloodstream instead of necessitating large insulin quantities, and is known as a metabolic sponge or glucose sink. The bigger the body of muscles, the better your body manages the blood sugar.

Exercise enhances insulin sensitivity up to 48 hours after strength training. In women, muscle construction is beneficial in fighting the muscle wasting associated with age, metabolism, and belly fat. Excessive, high-stress cardio without recovery may worsen cortisol levels, whereas resistance training consistently improves insulin sensitivity.

The significant but frequently neglected causes of insulin resistance are chronic stress and sleep deprivation. The first point is the role of cortisol in blood sugar spikes.

Cortisol, the main hormone of stress in the body, increases blood sugar to give the body instant energy in the event of perceived danger. In situations where stress is chronic (emotional stress, insomnia, overtraining and so on), cortisol levels are maintained high. The result of this is a recurrence of blood sugar spikes and augmented insulin discharge.