Insulin resistance is one of the most significant and most underdiagnosed conditions affecting Indian women's hormonal health. It is the engine behind PCOS for most affected women, a major driver of weight gain around the abdomen, a cause of irregular periods and infertility, and a precursor to Type 2 diabetes.

Yet most women who have it have never been told. The standard fasting blood glucose test can be entirely normal in women with significant insulin resistance — because the body is still maintaining normal glucose levels by producing increasingly large amounts of insulin. It is only when the insulin-producing capacity is overwhelmed that glucose rises.

Dr. Shachi Singh, consultant gynaecologist at Prakash Hospital, Sector 33, Noida, explains.

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What Insulin Resistance Is

Insulin's job is to facilitate the entry of glucose from the bloodstream into cells. When cells become resistant — less responsive to insulin's signal — the pancreas compensates by producing more insulin to achieve the same effect. This compensatory hyperinsulinaemia (elevated insulin) maintains normal blood glucose levels for years before eventually failing.

But elevated insulin itself causes harm independent of blood glucose: it stimulates androgen production from the ovaries (driving PCOS), promotes fat storage particularly in the abdomen, impairs ovulation, raises blood pressure, raises triglycerides, and lowers HDL cholesterol.

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Symptoms of Insulin Resistance in Women

• Weight gain concentrated around the abdomen — the "apple shape" rather than "pear shape"
• Difficulty losing weight despite diet and exercise
• Irregular periods (particularly in PCOS)
• Acne, excess facial or body hair (from elevated androgens driven by insulin)
• Fatigue and energy crashes — particularly after meals high in refined carbohydrates
• Sugar cravings and difficulty going long periods without eating
• Dark velvety patches of skin (acanthosis nigricans) in skin folds — neck, armpits, groin, under the breasts. This skin sign is a physical marker of insulin resistance and should prompt testing.
• Sleep disturbance

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Testing for Insulin Resistance

Fasting insulin + fasting glucose — HOMA-IR calculation: The most practically useful assessment. HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) = (fasting insulin x fasting glucose) / 22.5. A HOMA-IR above 2.5 suggests insulin resistance. This calculation requires both the fasting glucose AND the fasting insulin level — fasting glucose alone is insufficient.

Glucose tolerance test (GTT) with insulin: Measuring insulin (not just glucose) at 0, 1, and 2 hours after a 75g glucose load identifies abnormal insulin responses even when glucose values remain normal. The most sensitive clinical test.

HbA1c: Reflects average blood glucose over 3 months. Normal in early insulin resistance.

Fasting triglycerides and HDL: Elevated triglycerides with low HDL (the lipid pattern associated with insulin resistance) support the clinical picture.

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Management

Dietary change: The single most effective intervention. Low glycaemic index, high fibre, adequate protein, reduced refined carbohydrates — as described in detail in the PCOS diet blog.

Exercise: Both aerobic exercise and resistance training improve insulin sensitivity — aerobic exercise uses glucose immediately and resistance training builds muscle mass (muscle is the primary site of insulin-stimulated glucose uptake). Even a 30-minute daily walk significantly improves insulin sensitivity within weeks.

Weight loss: 5 to 10% body weight reduction produces dramatic improvements in insulin sensitivity and HOMA-IR.

Metformin: The most commonly prescribed medication for insulin resistance in PCOS. Inhibits hepatic glucose production and improves peripheral insulin sensitivity. Reduces androgens, may restore ovulation, and reduces progression to Type 2 diabetes. Generally well tolerated — main side effects are gastrointestinal (nausea, diarrhoea, particularly when first started — taken with food and started at low dose).

Inositol (myo-inositol and D-chiro-inositol): Supplements with a growing evidence base for improving insulin sensitivity in PCOS. Well-tolerated with no significant side effects. Used as an adjunct or alternative to Metformin, particularly in women who do not tolerate Metformin.

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Gynaecological Care in Noida and Greater Noida

Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, assesses and manages insulin resistance in women with PCOS and hormonal disruption across Noida and Greater Noida.

To book a consultation with Dr. Shachi Singh, call: +91 97023 46853

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This blog is for informational purposes only.