Recently I was diagnosed with Polycystic Ovary Syndrome and endometriosis, so my gynecologist sent me to an endocrinologist who did some testing. He told me that I have hyperinsulinism and insulin resistance, and he is starting me on Glucophage. Does this mean I have diabetes or not? I asked the nurse, and she said I don’t have diabetes. When did some research I found nothing, other then it is linked to diabetes. My blood sugar goes anywhere from 50-587mg/dl [2.7-32.6 mmol/L]. What does all this mean? Can you help me?

Your story has me confused so I can only imagine how you must feel. Please schedule an appointment by phone or in person to talk further with your endocrinologist about what your diagnosis is and why he is prescribing Glucophage [metformin].

JS
Additional comments from Dr. David Schwartz:

The Polycystic Ovary Syndrome (PCOS) is being better recognized as often being a component to a larger issue that can be associated with insulin resistance (hyperinsulinemia) which indeed can be associated with type 2 diabetes, elevated blood lipids (cholesterol and triglycerides), high blood pressure, and even excess male hormone production, which is in part the cause of irregular menstruation, facial or other excess body hair, and acne sometimes seen in these affected women. This larger condition has been given the name of the Metabolic Syndrome and is also referred to as “Syndrome X.” There is much evidence to suggest that the excess insulin/insulin resistance is a primary suspect that can lead to all of the other components.

Metformin (Glucophage) is used to limit the amount of excess glucose sugar produced by the liver; in turn this will limit the amount of insulin the pancreas needs to provide. Metformin may even have some mild insulin “sensitizing” effects. In addition, not uncommonly, people will have diminished appetite and can lose weight while on metformin. There is evidence that metformin can limit the production of excess male hormones in women affected with PCOS. Therefore, it is a very good option when treating the woman with PCOS, even if there is not frank diabetes. But with a random glucose around 500 mg/dL, then I would suspect that you do indeed have diabetes, if those values are confirmed.

DS
Additional comments from Dr. Jim Lane:
Insulin resistance is a significant factor contributing to type 2 diabetes. However, not all people with insulin resistance have diabetes. In the case of polycystic ovary syndrome, this condition is associated with insulin resistance. The syndrome is associated with menstrual irregularities, elevated lipids, mild to moderate hyperandrogenism, and insulin resistance. Treatments that allow for a decrease in the insulin resistance have a beneficial impact on the syndrome. One way of decreasing insulin resistance is through weight loss. Another way is by using the drug metformin (trade name Glucophage). It should also be said up front that patients with polycystic ovary syndrome are at increased risk for type 2 diabetes.

JTL

[Editor’s comment: If you have had several blood sugar levels in the 500’s, you have far surpassed the criteria needed to diagnose diabetes. See Classification and Diagnosis of Diabetes. I can’t imagine why an endocrinologist’s nurse would say you don’t have diabetes if she had access to the numbers you mention. As Jane mentioned, you definitely need to talk to your endocrinologist!

WWQ]