107. Insulin Resistance, Blood Sugar & Hormones: What Your Doctor Might Be Missing

Insulin resistance and blood sugar imbalances can quietly disrupt ovulation, cause irregular cycles, worsen acne, and make fertility harder to achieve. In this episode of Cycle Wisdom, Dr. Monica Minjeur shares Becky’s journey to natural conception after uncovering hidden insulin issues. Learn how restorative medicine testing finds problems missed by standard labs, the differences between Myo-Inositol and Metformin, and practical nutrition strategies to balance blood sugar, improve hormones, and restore fertility naturally.

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Transcript

Monica: 0:00

Before we get into today's episode, I just wanna remind you about our upcoming Facebook Live event. Perimenopause thriving in the transition. This live event is going to be held on Tuesday, September 9th at 8:00 PM Central time. Go to our website, radiant clinic.com to register and then join us on our Facebook page live at the time of the event to tune in and learn all about how to thrive during the transition of perimenopause. If you're not sure that this event is for you, go back and listen to last week's episode number 1 0 6, where I talk all about perimenopause symptoms and signs, and how restorative reproductive medicine has a better way forward to help you thrive in the transition. If you're not able to catch us live and get your questions answered, do tune in as we will have it posted to our YouTube page after the event. Looking forward to chatting with you there and now onto today's episode. Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if your irregular cycles, stubborn, acne, or infertility weren't just hormonal, but also a sign that your blood sugar or insulin were out of balance? In today's episode, we're connecting the dots between insulin resistance and reproductive health. We'll discuss how elevated blood sugar impacts ovulation, hormone production, and inflammation, and why it's often missed in conventional medicine evaluations. We'll also dig into two common treatments used in our practice, Metformin and Myo Acetol, what the research says, how they work, and when one might be better than the other in addition to dietary changes that are recommended. So let's get started today with a story about Becky. Becky came to our clinic at 28 years old after two years of trying to conceive. She had irregular cycles, sometimes 35 to 60 days apart. She had painful cystic acne, not just on her face, but also on her chest and down her back, and she had gained about 15 pounds in the past year, even though she hadn't changed her lifestyle very much and was exercising regularly. She had been told by her OB doctor that she had thin PCOS, meaning she didn't have too much weight, but she did have A-P-C-O-S diagnosis when it came to trying to get pregnant. They were told we'll just keep trying and if that doesn't work over the next few months, we can do some letrozole or consider IUI. Okay. When Becky pushed for more answers, she was offered birth control to regulate her cycles, which she declined because she was trying to get pregnant, and then she was told that she could utilize Metformin without much explanation as to the why. Becky left her OB office feeling frustrated and decided she wanted a better plan forward. That helped her to understand why she was experiencing what she was, and have a clear path forward as far as how to heal her body. So as always, we started by helping Becky with charting her cycles and ran our full hormone panel, including a full two hour glucose tolerance test where we check blood sugar and insulin, both in a fasting state first thing in the morning, and then after drinking a sugary liquid to assess her body's response to sugar. Now, Becky was not diabetic, but her fasting insulin was elevated and she had other signs of insulin resistance. On that two hour glucose tolerance test, we met again with Becky to help adjust her nutrition with a focus on balancing her blood sugar. We added in Myo Acetol, which is a supplement that we'll talk about a little later in the episode, and continued to monitor Becky's ovulation with both labs and ultrasound, while simultaneously helping to manage the hormone imbalances that we were also seeing. Within four months, Becky's cycles had shortened to an average of 32 days each cycle. She was ovulating consistently, and her acne had significantly improved. Three months after that, Becky conceived naturally with the help of hormone balancing and regulating her insulin levels. She later said to us, I just needed someone who was going to look at the whole picture, not just treat each individual symptom with a bandaid approach. So what's the big link between blood sugar and hormones anyways? Insulin. Is a hormone. It is not just a blood sugar regulator, and insulin is secreted by our pancreas in our body in response to blood sugar being elevated. Now, something that women commonly don't understand is that yes, insulin will be secreted in response to the food we put into our bodies, but insulin will also trigger in response to sugars that are produced elsewhere in our bodies, most commonly from our liver. For example, if you have a prolonged period of fasting, so maybe overnight when you're not eating, your liver will still work to maintain an adequate blood sugar level so that your blood sugar doesn't crash, so your liver can produce blood sugar independently of what you're eating, and that insulin will still be spit out by your pancreas in order to try and regulate the blood sugar. When we have elevated insulin levels, it contributes to many different hormone disruptions. Things like increased androgens like testosterone, which can cause acne, hair growth in places we don't want it to be, and ovulation dysfunction. It can also disrupt this LH and FSH ratio. So the luteinizing hormone and follicle stimulating hormone should be in a good balance. And when we see that that is disrupted by increased insulin, it can lead to anovulation where you're not ovulating or even irregular cycles. And elevated insulin also creates inflammation in our bodies. It can worsen your PMS symptoms, increase cramping and can have a significant impact on our weight. Insulin in excess does get stored in our fat cells. And again, as we discussed last week with estrogen dominance during perimenopause, when we have excess insulin, it is stored in our fat cells, which increases the size of the fat cells, which causes us to gain weight. And so oftentimes this is why we see midsection weight gain in women who are dealing with insulin resistance. Insulin resistance also can cause sugar cravings because our blood sugars are spiking and decreasing and increasing very erratically. And then it can also cause those irregular cycles from the ovulation dysfunction, fatigue after meals as our body is trying to regulate the blood sugar and acne as well as facial hair growth. So how do we look for insulin resistance? How do I know I've even had this many women come to our clinic having had a traditional test, like a blood sugar test that was fasting, or even a hemoglobin A1C, and when they're told those are normal, they think, well, that can't be me. Unfortunately, the spectrum of insulin resistance is a little bit different. So typically what we see happen first is that in response to decreased insulin metabolism, we see that insulin will actually increase well before we see blood sugar start to increase. A hemoglobin A1C relies upon seeing elevated blood sugar readings before that will increase. So if you've got elevated A1C, we're already well past the stage of insulin resistance, so we wanna be able to pick up on this insulin resistance before it even turns into a blood sugar problem, which is then more likely to progress onto pre-diabetes and diabetes. So in our practice, we test that two hour glucose tolerance test like we mentioned with Becky. So we check your blood sugar and insulin when you are first fasting in the morning. So nothing to eat or drink. After 10 or 10 hours, we'll check a blood sugar and insulin. We check this first thing in the morning and then we have you drink a sugary drink. Or sometimes we'll have you take some jelly beans if that's more tolerable for you. After 30 minutes, we recheck your blood sugar and insulin again, and then we recheck it again every 30 minutes for up to two hours. Now over the course of that two hours, we're checking five different readings of your blood sugar and insulin levels. And then we utilize our standards to see does your insulin fall within the normal range? And more importantly, what is the pattern that we're seeing with both your blood sugar and your insulin? Oftentimes we can see that blood sugar gets very erratic. Sometimes it'll go high, sometimes it stays normal, and sometimes it actually drops really, really low in response to an excessive insulin response. And this can help to explain for many women. Why they feel pretty miserable after eating, especially if they have a meal that is either too high or too low in carbohydrates. Our goal with finding this is to restore ovulation, decrease inflammation, and really help to support whole body metabolic health because we know when your whole body is more healthy, all of the rest of the pieces work as they should. So if we find insulin resistance or glucose intolerance, meaning insulin resistance has advanced to the point where it's negatively affecting your blood sugar readings. What do we do? Step one is we always talk about nutrition. Now I am a big fan of not putting anybody on a diet, and I'm also a big fan of I want you to be able to eat with your family. Nobody has time to prepare more than one meal with their family, and so we give practical tips on how we can address those changes that need to be made in order to reduce your insulin spikes and help to level things out. So we talk about building healthy meals, specifically focusing on a good amount of protein, fiber, and healthy fats, and focus on having complex carbohydrates with every meal. We find that many times women who skip meals, especially breakfast, will struggle more with their blood sugar and insulin levels throughout the day. And as I had mentioned previously, if you don't have enough carbohydrates with a meal. Your brain will think that your blood sugar is crashing and your liver will step in and it will still spit out sugar. And so we are much better at helping to regulate that carbohydrate load by getting regular, consistent episodes of having carbs intake throughout our day. So as a general goal, what I typically tell my patients is that with protein, for most healthy women who are in ovulatory states, we want to try and aim for around 80 to a hundred grams of protein per day. Now, this number may need to change a bit depending upon your stage of life. Certainly, if you're pregnant, this changes and if you are an extreme athlete, this will change. But in general, it's a good starting point to say. I wanna aim for that 80 to a hundred grams of protein per day. When we have protein with each of our meals, it helps to regulate what happens with our insulin and our blood sugar. Having more protein helps to make it so that we don't have as rapid of a sugar spike, which means our insulin doesn't have to work as hard in order to offset that sugar that happens. We also wanna focus on carbohydrates. And for this, I usually will talk about what we wanna get in per meal or per snack, because if we just look at it overall throughout the day, it's a little more complicated. So if you are having a S. Snack anything that is between your three meals. We want to be sure to limit anything that is a sugary snack, juice, or caffeine on an empty stomach. If you are having anything between your meals for carbohydrates, I generally recommend to aim for something that has less than end, 15 to 30 grams of total carbohydrates. For your snacks, for your meals, we want you to focus on making sure that you get at least. 30 to 45 grams of carbohydrates per meal. Now, for many women, this does need to be adjusted, but what I oftentimes find is that women are getting not nearly enough carbs with their meals, sometimes none. Sometimes only 10 or 15 grams, and then it's causing your body to have to work really hard to get enough carbs produced in order to keep up with bodily functions, which then can make your insulin go on a roller coaster again. Okay, so the practical way that we talk about this is not undereating because too little food puts increased stress on your hormones. So I generally will tell people, don't feel like you have to upend everything all today, but to say, let's focus on what can we look at in your diet. Keep a food diary. There's lots of apps you can use that can help you to count your macronutrients, but keep a food diary for a week and then look back and just be curious and say, okay. What do I have going on here? I find one meal that I only ate seven grams of carbs. Oh, look, here's another meal that I had. 95 grams of carbs. And then start to break it down and say, okay, how could I improve to get that closer to that 30 to 45 gram range? So the two most common ways that we talk about making changes, the first is in your portion size. So if you have way too many carbs, maybe look back at that meal and say, okay, instead of having. Three slices of pizza. Maybe I'm gonna have two slices of pizza, or maybe I'm gonna change the thickness of the crust that's on that. That way I can still have pizza, still enjoy it with my family, but I'm just going to reduce the overall carb load that I have. And the second most common way that we find is very effective at helping to get a good amount of carbohydrates with each meal is to consider changing the brand of a product that you may be using. My favorite example to give on this is yogurt. So if you have a single serve size of yogurt, you can find some brands that have as much as 45 to 60 grams of carbs. Per container. Now, if you remember back, we're trying to focus on getting about 30 to 45 grams per meal. So if you're taking that yogurt and then adding granola or fruit on top of it, you're going way over that carb intake for that meal. On the flip side, there are other brands of yogurt, same flavors, same size, that only have six grams of carbohydrates per serving. Now, I admit there can be a flavor difference. However, if you can take that six grams of carbs, yogurt. You can still add some fruit to it, some granola if you'd like, and still come well within your 30 to 45 grams of carbs, keep a good amount of protein, and have a much better balance on the meal without sending you into those blood sugar spikes. Again, don't feel like you have to change everything overnight. Many people feel like, oh my goodness, this is gonna take a whole army just to figure this out. I usually tell women, start with one meal, whether that's breakfast or whether that's your favorite evening meal that you have with your family. Start with one meal and start to reverse engineer that and say, how can I make this more well balanced? Not just for me, but also for my family? Now, in some cases, just making these dietary changes is not enough, and so we do oftentimes add in either a supplement or a prescription strength medication to help with that insulin resistance. So one of the most common supplements we utilize in our practice when it comes to insulin resistance is myo acetol, or sometimes it's just called anatol. Many formulations of myo acetol are also combined along with D chiro acetol, and that is totally fine. Inital in acetol in general is a vitamin like compound naturally found in the body. Now, some people say it is. Similar to vitamin B eight, it's not exactly a vitamin because our body can actually produce it from glucose and it's actually another form of sugar, just not the table. Sugar that we're used to found in many foods in Acetol helps improve our body's sensitivity to insulin, which means that we don't need as much insulin in order to help regulate the blood sugar reading. We also have found that Myo Acetol helps with ovarian function, improving the signaling of follicle stimulating hormone, which can help improve ovulation function and egg quality. My acetol typically has fewer side effects than metformin, which we'll talk about in a moment. And studies have also shown that there's improved ovulation and pregnancy rates in women with PCOS. Now, Metformin, on the other hand, is a prescription medication and it is commonly used in PCOS or in cases of insulin resistance. It helps to not only improve insulin sensitivity, but it also can help to decrease the production of glucose that's happening from your liver on its own. So even when you're not eating, it can help to reduce the blood sugar readings. Now Metformin does come with some potential side effects, including nausea, diarrhea, and GI upset, and so we are a little bit more cautious with this, but it is an excellent medication that we do use in many of our patients who have significant problems, especially if we're seeing blood sugar and insulin impairment. So we oftentimes will utilize metformin when more aggressive support is needed. Myo Acetol oftentimes is the first line in many of the treatments that we utilize, especially with PCOS, if you're trying to conceive or in perimenopause or other conditions where we see some insulin resistance that may be impacting your symptoms. Both of these medications are considered safe in pregnancy, and some studies show that it may lower gestational diabetes. In some OB practices, metformin will be discontinued before 12 weeks of pregnancy, and studies oftentimes kind of go back and forth as to whether or not Metformin and or my acetol should be continued during pregnancy. But we know both are safe, at least throughout first trimester. Beyond that, we usually recommend whatever your OB suggests as far as ongoing care and treatment is just fine with us. So I hope this has been helpful as far as understanding more about insulin resistance, as well as some practical tips for things that you can do to help either treat your insulin resistance or proactively manage your blood sugar so that you don't develop insulin resistance. Imagine if fixing your cycle didn't start with just your ovaries and hormones, but with your blood sugar and insulin. Imagine feeling energized, confident in your body's signals, and finally seeing a real change, not only in your hormones, but in your metabolism working together for improved health. These treatment plans aren't a one size fits all, but we tailor them based on your labs, your symptoms, and your goals, and I would love the opportunity to work together with you and partner on your journey towards better health. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach, please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach, please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.