If you’ve ever been told that your blood sugar is “normal” and assumed that means insulin resistance isn’t something you need to think about, you wouldn’t be the only one.
For years, the condition we now call Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly PCOS, was primarily associated with irregular periods, fertility challenges, acne, unwanted hair growth, and “cysts” on the ovaries.
But that never told the whole story.
In fact, one of the reasons PCOS was officially renamed PMOS in 2026 was to better recognize something researchers have understood for years: **metabolic health is a central part of this condition.**¹
And insulin is right in the middle of it.
You don’t need to have diabetes to experience insulin resistance. You don’t need to have high blood sugar. And you don’t need to live in a larger body.
Understanding how insulin works can help make sense of why seemingly unrelated PMOS symptoms are often more connected than they appear.
Whenever you eat carbohydrates, your body breaks many of them down into glucose, which enters your bloodstream.
In response, your pancreas releases insulin, a hormone that essentially helps move glucose out of your bloodstream and into your cells, where it can be used for energy.
When your cells become less responsive to insulin, your pancreas has to release more insulin to get the same job done. This is called insulin resistance.²
Here’s where it gets interesting: your body can compensate for insulin resistance for quite a while.
Your pancreas may simply produce additional insulin to keep your blood glucose within a normal range.²
That means you can potentially have normal blood sugar alongside elevated insulin levels.
Over time, if the body can no longer compensate effectively, blood glucose may begin to rise, potentially progressing to impaired glucose tolerance, prediabetes, or type 2 diabetes.³
So while blood sugar and insulin are closely related, they aren’t exactly the same thing.
Quite a lot.
Insulin resistance is common among people with PMOS, and a 2026 review published in the Journal of Clinical Investigation estimated that it may be present in up to 70% of affected individuals.²
But insulin doesn’t only affect blood sugar.
It also interacts with the reproductive system.
When insulin levels remain elevated, insulin can stimulate ovarian cells involved in androgen production. Hyperinsulinemia may also increase the ovaries’ response to luteinizing hormone (LH), further encouraging androgen production.²
At the same time, high insulin levels can reduce the liver’s production of sex hormone-binding globulin (SHBG), a protein that binds circulating sex hormones. Lower SHBG can leave more biologically active androgens circulating in the bloodstream.²,⁵
This creates a connection between metabolic and hormonal symptoms.
Higher androgen activity is associated with several familiar features of PMOS, including:
In other words, something happening with your metabolism can show up as something that looks entirely hormonal.
That’s part of what makes PMOS such a complex condition.
Insulin resistance and androgen excess may also reinforce one another.
Insulin resistance can contribute to higher androgen activity, while androgen excess may negatively influence body composition and insulin sensitivity.²,⁵
This can create a feedback loop where metabolic and reproductive features of PMOS become increasingly intertwined.
It’s also one reason why simply treating individual symptoms, such as acne or irregular periods, doesn’t always address the complete picture.
For some people, supporting metabolic health can become another important part of managing their hormonal symptoms.
A normal blood sugar result is good news. And it’s also worth remembering that not everyone with PMOS has insulin resistance. PMOS can look very different from one person to the next, which is why understanding your own metabolic health is much more useful than assuming insulin resistance is automatically part of your diagnosis.²,³
For some people with PMOS, the body may produce additional insulin to keep blood glucose within a healthy range.² For others, insulin resistance may not be a significant feature at all.
Rather than viewing this as something to worry about, think of it as an opportunity to learn more about your individual PMOS picture.
Current international guidelines recommend assessing glycemic status when PMOS is diagnosed and periodically thereafter based on individual risk factors.³ When testing is appropriate, a 75-g oral glucose tolerance test (OGTT) is considered the most accurate way to assess glycemic status in people with PMOS, regardless of BMI.³
Knowing where you stand can be empowering. If your metabolic markers are healthy, you can focus on maintaining the habits that support them. If there are areas that could use some support, identifying them gives you the opportunity to make changes early.
And many of the habits that support metabolic health are valuable far beyond PMOS: eating balanced meals, building muscle, moving regularly, prioritizing sleep, and managing stress.³
PMOS doesn’t have to be a reason to fear food or blood sugar. It can be an opportunity to better understand how your body works, recognize what you need, and build habits that support your health for years to come.
This is worth emphasizing.
You can have PMOS and insulin resistance in a smaller body.
You can have PMOS without insulin resistance.
And two people with the same PMOS diagnosis can have very different metabolic profiles.²,³
While higher body weight can worsen insulin resistance in some individuals, research shows that metabolic risk in PMOS is not explained by body size alone.³
That’s why current guidelines recommend assessing glucose metabolism in people with PMOS regardless of BMI.³
PMOS care should be individualized rather than based on assumptions about what someone with insulin resistance is “supposed” to look like.
This is another area where social media can make things unnecessarily complicated.
If you have PMOS, you don’t automatically need to eliminate carbohydrates, avoid fruit, fast for long periods, or follow an extremely restrictive diet.
Current international guidelines don’t identify one specific diet as superior for everyone with PMOS. Instead, they recommend sustainable healthy eating tailored to individual preferences, goals, and needs.³
For everyday blood sugar support, that can look surprisingly simple.
Try building meals around a combination of protein, fibre-rich carbohydrates, vegetables or fruit, and healthy fats. Higher-fibre carbohydrate sources such as oats, beans, lentils, whole grains, and vegetables can form part of a balanced PMOS-friendly eating pattern.³
Pairing carbohydrates with protein, fat, and fibre can also help create more satisfying, balanced meals.
The goal isn’t perfect blood sugar.
It’s creating eating habits you can realistically maintain.
Exercise is one of the most useful tools we have for supporting insulin sensitivity and overall metabolic health.³
And it doesn’t have to mean intense workouts every day.
Walking, resistance training, cycling, swimming, yoga, recreational sports, or whatever form of movement you genuinely enjoy can count.
International PMOS guidelines recommend physical activity as part of healthy lifestyle management and emphasize that there are benefits even without weight loss.³
Resistance training can be particularly interesting from a metabolic perspective because skeletal muscle is a major site of glucose disposal in response to insulin.⁶
Simply put: your muscles aren’t only there to make you stronger. They’re also an important part of how your body handles glucose.
Blood sugar conversations tend to focus almost entirely on food, but metabolism doesn’t happen in a vacuum.
Sleep, stress, physical activity, hormones, genetics, and other factors all influence metabolic health.
PMOS itself is associated with a higher prevalence of obstructive sleep apnea, independent of BMI, and international guidelines recommend assessing symptoms such as snoring, waking unrefreshed, daytime sleepiness, and fatigue.³
That doesn’t mean one bad night’s sleep will suddenly cause insulin resistance.
It means that supporting metabolic health can be broader than simply asking, “What should I stop eating?”
Sometimes the more useful question is:
“What can I add to my routine that helps my body function well?”
Maybe that’s a protein-rich breakfast.
Maybe it’s a walk after dinner.
Maybe it’s finally prioritizing resistance training.
Maybe it’s getting more consistent sleep.
Small habits still count.
Lifestyle habits are an important foundation for PMOS, but they aren’t the only tools available. Depending on your individual presentation, medications and targeted nutritional support may also have a role to play.³
Metformin is one of the most established medications used in PMOS and may be considered for metabolic outcomes, including insulin resistance, glucose, and lipid profiles, depending on individual circumstances.³
Inositol is widely used for metabolic and hormonal support in women with PMOS. A 2026 umbrella review of 13 meta-analyses found that inositol supplementation was associated with improvements in insulin resistance, fasting insulin, several androgen markers, and reproductive outcomes, including ovulation.⁸ The review found moderate-quality evidence supporting several of these outcomes, making inositol an increasingly interesting option for supporting both metabolic and reproductive health in PMOS.
Chromium is an essential trace mineral involved in carbohydrate and lipid metabolism, with growing research around its role in blood sugar regulation and insulin sensitivity. A 2025 meta-analysis of 10 randomized controlled trials involving 683 women with PCOS found that chromium supplementation significantly reduced fasting insulin and several lipid markers while improving insulin sensitivity measured by QUICKI. The analysis also reported an increased incidence of ovulation, suggesting chromium may have benefits that extend across both metabolic and reproductive health.⁹
Cinnamon has also attracted research interest for its potential role in supporting glucose and insulin metabolism. A 2024 systematic review and meta-analysis of 12 randomized controlled trials in women with PCOS found that cinnamon supplementation significantly improved fasting blood sugar and insulin resistance, while also producing improvements in total and LDL cholesterol.¹⁰ These findings build on earlier research and suggest that cinnamon may be a useful nutritional tool for supporting metabolic health and blood sugar regulation.
Berberine is a plant-derived compound that has been studied for its effects on glucose and lipid metabolism as well as reproductive health. Research in women with PCOS has found improvements in measures including fasting glucose, insulin, cholesterol, and other metabolic markers, while a more recent 2024 meta-analysis of randomized controlled trials found that berberine used as an adjunct therapy may also improve ovulation and pregnancy rates.¹¹,¹² Berberine can interact with medications and may not be appropriate for everyone, including during pregnancy, so supplementation should be discussed with a qualified healthcare practitioner.
Recent research continues to strengthen our understanding of how nutrients and plant compounds such as inositol, chromium, cinnamon, and berberine may support metabolic health, insulin sensitivity, and, in some cases, reproductive outcomes in PMOS.⁸⁻¹² These options can be considered alongside foundational lifestyle strategies and established medications, with the best approach depending on your individual symptoms, metabolic markers, reproductive goals, and health history.
The important point is that there isn’t one universal “PMOS protocol.”
And that’s actually a positive thing.
Not everyone with PMOS has insulin resistance, and not everyone needs the same nutritional supplements, medications, or lifestyle changes. Understanding your own symptoms, metabolic markers, reproductive goals, and health history can help you and your healthcare team identify where support may be most useful.
Rather than trying everything at once, think of these options as tools in a larger toolbox. The goal is to find the combination that makes sense for your body, your health goals, and your life.
For a long time, conversations about PMOS focused heavily on ovaries.
Then they focused on fertility.
Then weight.
But we’re increasingly understanding that PMOS is much more interconnected than any one of those things.
Your ovaries don’t exist separately from your metabolism. Your insulin doesn’t exist separately from your hormones. And your blood sugar isn’t something that suddenly becomes relevant the day you’re diagnosed with diabetes.
That’s exactly why the **”Metabolic” in Polyendocrine Metabolic Ovarian Syndrome matters.**¹
Insulin resistance may influence hormone production, ovulation, and long-term metabolic health, which makes supporting insulin sensitivity relevant even when your current blood sugar results look perfectly normal.²,³
The good news is that supporting metabolic health doesn’t have to mean completely overhauling your life.
Consistent movement, balanced meals, adequate sleep, stress management, appropriate medical care, and individualized nutritional support can all become pieces of the puzzle.³
The goal isn’t to eat perfectly or obsess over every glucose spike.
It’s to understand your body a little better and give it the support it needs for the long run.
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