#1312 Defining Diabetes: PCOS

September 21, 2024Scott Benner

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode we PCOS.

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Scott Benner 0:00
Hello friends, and welcome back to another episode of The juicebox podcast.

Jenny's back, and we're going to do another defining diabetes episode today. So buckle up and we'll define PCOS. Nothing you hear on the juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan. A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made defining diabetes. Go to juicebox podcast.com up into the menu and click on defining diabetes to find the series that will tell you what all of those words mean, short, fun and informative that's defining diabetes. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juicebox at checkout. That's juicebox at checkout to save 40 percent@cozyearth.com if you're a US resident who has type one, or is the caregiver of someone with type one, you can write from your right, from your couch, right from your phone. You can add your help to type one diabetes research by completing the survey AT T 1d exchange.org/juice, box. This show is sponsored today by the glucagon that my daughter carries, gvoke hypopen. Find out more at gvoke glucagon.com. Forward slash juicebox. This episode of The juicebox podcast is sponsored by Eversense. The Eversense CGM is more convenient, requiring only one sensor every six months. It offers more flexibility with its easy on, easy off, smart transmitter, and allows you to take a break when needed. Eversense cgm.com/juicebox, I'd like to define PCOS, oh, for the kids. Yeah, yeah, excited.

Jennifer Smith, CDE 2:10
Okay, yeah, that's, I mean, I do a lot in women's health. And as you know, I've said many times before, a lot of women in that sort of time of life where they may very well be considering kids. So I'm surprised we didn't talk about PCOS before, but maybe we haven't. I

Scott Benner 2:28
just don't think we've specifically given it its own defining diabetes. Now wait, let me make sure we haven't. Hold on a second. That's a good point. Maybe Scott just isn't good at keeping his list up. Give me one second.

Jennifer Smith, CDE 2:39
The list is pretty low. I don't they don't even know how long the defining is it? We did quite a number of things. Oh,

Scott Benner 2:45
it's over 50 at this point. And But you just said something that just really made me think, like, let me just double check, because that's pretty smart, because we could pivot to another one if I'm if I'm wrong about this and that people will just get the laugh. Hold on a second. Nope, we haven't. Yay, good job, but I didn't know, honestly, something

Jennifer Smith, CDE 3:06
new to talk about. Oh, it's not really. It's not new by any means.

Scott Benner 3:09
No, is it something that many women might be suffering with, and their doctors never even give like a name or a voice to it. They just treat them like, Oh, you. You have tough periods or something like that,

Jennifer Smith, CDE 3:23
I would say I see that more and more and more, especially since in the years of having diabetes myself, I think it's really just been the past 10 ish years that I've heard more about PCOS, and especially just the past couple of years alone, more women who've actually had a more proper diagnosis of PCOS from providers who help them look further into some of the issues that they've had for a long time, maybe since they were a teenager, a young adult, you know. And I think I get to see it, especially, as I said, because some people end up trying and trying and trying to conceive, and at that point further testing, especially if you move into more fertility management, there are a lot more tests that end up being done just because you you are going to a specialist who should be evaluating All these things, hormone levels, you know? I mean, PCOS is, do you know what the acronym is, right? Actually,

Scott Benner 4:27
I know this one without looking. I know it's polycystic ovarian syndrome.

Jennifer Smith, CDE 4:34
Yeah, polycystic ovary, ovarian or ovaries, Ovary Syndrome, okay, so we know that it would affect hormones, right? Mainly because ovaries are the big thing that's impacted here, and they produce a lot of hormones in a woman's body. I mean, they're the little places that all the eggs that a woman has are kind of packed into, yeah,

Scott Benner 4:58
I think of it as an egg person. Course, that's a yes. There

Jennifer Smith, CDE 5:01
you go. Thank you. An egg bank.

Scott Benner 5:04
I also don't know why I think of it as anything, but that is how it pops up in my head I have here. PCOS is a common hormonal disorder that affects women of reproductive age. It is characterized by a combination of symptoms and physical findings that include irregular menstrual periods, excess androgen levels, polycystic ovaries. So

Jennifer Smith, CDE 5:27
a lot of the times, it's because the hormones, they're not regulated the right way in order for ovulation to happen on a monthly cycle, or that 28 to 32 day kind of normal cycle that we call normal, right? When somebody doesn't ovulate, essentially, you get these cysts. So that's where the polycystic many cysts, right? That's what the word means. Comes from these little like cysts that kind of hack around the ovaries. And you can actually in the right type of testing, in the right time of the month, you could actually see more of those SACS or cysts at certain times. So evaluation is really, really valuable. I think the other piece to proper diagnosis is talking to a woman who has symptoms that sound like it might be PCOS. But the other unfortunate thing is that PCOS is commonly thought to kind of also go along with a particular body type, being more overweight, obese, already having issues with different metabolic kind of systems, high cholesterol levels, blood sugar levels that are unmanaged. Insulin resistance is a hallmark of PCOS, kind of similar in type two diabetes, right? So when you talk about type one diabetes, I've had a number of women who, by visually looking and diagnosis of type one would never have been thought that that they could possibly have PCOS, and they do,

Scott Benner 7:01
yeah, I think Arden has it. And, yeah, she doesn't fit the stereotype. It's tough because, you know, years ago, when they're trying to figure things out, we don't really understand as much as we do. You start saying, Oh, well, a lot of these ladies look like this. So it must be you're having this problem. Because you're instead of saying, maybe my body style is like this because of the PCOS or other factors, you know, kind of put the cart before the horse. I want to read this, please. PCOS can also lead to long term health problems such as type two diabetes, heart disease and issues with fertility. The exact cause of PCOS is unknown, but factors like insulin resistance, inflammation and genetics are believed to play a role. Treatment typically focuses on managing individual symptoms. This is the problem, and may include lifestyle changes, medication and hormonal therapy. The problem is, is that we manage PCOS with Advil. Do you know what I mean? Like, oh, you know you're having a painful period, right? I think the reason that you're hearing more about it now, in a Zeitgeist again, is because of the impact that GLP medications are starting to have for people. If you take insulin or sofony ureas, you are at risk for your blood sugar going too low. You need a safety net when it matters most, be ready with G vo hypo pen. My daughter carries gevok hypopen everywhere she goes, because it's a ready to use rescue pen for treating very low blood sugar in people with diabetes ages two and above that. I trust low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, GEVO kypopen can be administered in two simple steps, even by yourself in certain situations. Show those around you where you store GEVO kypo pen and how to use it. They need to know how to use GEVO kypopen before an emergency situation happens. Learn more about why GEVO kypopen is in Arden's diabetes toolkit@gevoqglukagon.com toolkit at gvoke, glucagon.com/juicebox, gvoke shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma, or if you have a tumor in your pancreas called an insulinoma, visit gvoke. Glucagon.com/risk, for safety information. How many times have you thought it's time to change my CGM? I just changed it. And then you look and realize, my God, it's been 14 days already. A week, week and a half, feels like I just did this. Well, you'll never feel like that with the Eversense CGM, because Eversense is the only long term CGM with six months of real time glucose readings, giving you more convenience, confidence and flexibility. So if you're one of those people who has that thought that I just did this, didn't I, why don't they do this again? Right now? If you don't like that feeling, give Eversense a try, because with Eversense, you'll replace the sensor. Just. Once every six months via a simple in office. Visit Eversense, cgm.com/juicebox, to learn more and get started. Today. Would you like to take a break? Take a shower. You can with Eversense without wasting a sensor. Don't want anybody to know for your big day, take it off. No one has to know. Have your sensors been failing before 10 or 14 days? That won't happen with ever since? Have you ever had a sensor get torn off while you're pulling off your shirt? That won't happen with ever since? So no sensor to get knocked off. It's as discrete as you want it to be. It's incredibly accurate, and you only have to change it once every six months, ever since cgm.com/juice, box, which could be, yeah, yeah, because I think the GLP hits the inflammation and impacts the resistance hormonal issue, right? And, and, except, and, you know, I know this is about PCOS, so we're going to go back to, you know, going through the three hallmarks of it. But if I ask, how does a GLP impact PCOS? It says GLP is an incretin hormone that plays a crucial role in glucose, met metabolic why can I say the word? Why can't I say the words? I can say metabolism and has various effects on the body, which can impact PCOS in several ways. The ways are by reducing insulin or insulin sensitivity, weight management, hormonal regulation and impacting inflammation. And I've told this like brief story on the podcast a number of times since you know, glps have become more prevalent. But there is a Facebook group full of women who couldn't get pregnant their whole lives that went on GLP medications and were getting pregnant because they were so positive they were never going to have a baby that they didn't do any kind of birth control. Birth control, yeah, so, so kind of a ping pong back to it, irregular menstrual periods. That's such a kind way to say what happens. You know what I mean, right? Instead of saying irregular menstrual periods, shouldn't it sound say Mike Tyson hit me for seven days and I bled a lot while it was happening. You know what I mean? Because that's, I think, what it feels like infrequent, irregular or prolonged menstrual cycles are common, great, yeah. And then what happens then too, is you end up with low iron, low ferritin, you know, absolutely. And there's a cascading issue, I

Jennifer Smith, CDE 12:30
think it, it highlights how much just one little thing can get off in the body. Let's say it is the hormone production that's incorrect, coming from the ovaries, right? And you mentioned something before androgen, right? Androgens are, they're, you know, kind of a kind of hormone that's usually a lot higher for men, but are found in smaller amounts in women. And so an imbalance of that creates an imbalance in the cycle, which then it just, it's like, again, a ball at the top of a hill that you keep rolling, and it just keeps gathering more, right? And it impacts everything then. And I think the problem is that there's not, there aren't enough specialists to this particular condition, much like really knowledgeable type one clinicians, right? And so you really have to find a specialist who can take the time to sit down. What have your symptoms been? How long have you navigated this? You know? I mean, the other typical things are, again, as I said, sort of body being often heavier metabolic issue is beyond, you know, diabetes or whatever, acne or really significant skin breakout problems,

Scott Benner 13:50
body hair, right body hair, facial hair, like,

Jennifer Smith, CDE 13:53
from a woman's standpoint, should not be and has a lot of relevance to that androgen management In the body. So the right clinician is going to sit down and take a note of all of these and say, Okay, we've got more testing to do. We can test these hormones, blah, blah, blah, but as you said, it's typically just a way. You just have heavy periods and they're irregular, and there's no way to make them more regular. Well, why don't we try birth control? Birth control is going to regulate it all for you. And that's it's like a band aid, yeah, don't give me a band aid. Yeah,

Scott Benner 14:23
I don't. I don't go down that road because I'm, first of all, I'm not a woman, and I don't understand it enough to talk about it the birth control piece. But I have heard enough. I've heard a lot of women raise a red flag and say, Look, birth control really screwed me up. So, you know, I guess the, I guess the easy comparison is, you know, pharma companies figured out how to give men erections, but they can't seem to help women do these things. And right, this one falls heavy on me, because my, I think my daughter's impacted by this. And, you know, and at the same time, no one's looking into it, and we took her to a good. Doctor, and even that doctor is like, I don't know how to help you with this. You know, they just don't have any but anyway, I'm not saying glps are not, um, they're not a cure all, but I think that we're, yeah, right, but I believe we're in the the early days of understanding the things they are going to impact. I'm just started hearing conversations recently about how it might be helping people with arthritis. I don't even understand how that could be, but the inflammation piece, there's some people are using it for pain management. People live with pain for years, like for my entire lifetime, people have been running around yelling, inflammation. We got to get rid of inflammation. And it doesn't seem crazy to me that inflammation has to be at one of the hearts of how you end up with type one diabetes, and that I see a lot of women with type one diabetes talking about PCOS, like it just, it seems like there's a connection, kind

Jennifer Smith, CDE 15:54
of, what goes along with it is, what is, if you read anything, even in the simplest literature, about inflam inflammation, what's one of the biggest things that impacts it?

Scott Benner 16:05
Sugar, yeah, then you're feeding it on top of it, yeah,

Jennifer Smith, CDE 16:09
you're feeding it right. And then with PCOS, you have sort of a metabolic, poorly regulated glucose use, poorly regulated insulin sensitivity. And so you've got these changes in your blood sugar level that are just keeping inflammation high. And until you learn how to navigate the inflammation, which will help the insulin resistance, which will, I mean, again, it's a ball that, once it gets rolling in the right direction with the right information and or the right treatments or plans, you can really make a very big difference.

Scott Benner 16:44
I don't think you can really understand as a type one how screwed up it is that your body's not making insulin. Stick with me for a second, till you look at a CGM on a person whose body is making it and watch that their blood sugars really don't really rise very much at all, you know? And then you realize that if you don't pre bolus at the exact right time, your blood sugar is going to go from 85 to 150 in, you know, two revolutions of your Dexcom. And

Jennifer Smith, CDE 17:10
I think the other thing there too is watching when it does rise, how quickly the rise gets taken care of. On a the CGM of a person who doesn't have diabetes goes up, and it's like clockwork. You can almost time it to the point of the beta cells knowing exactly what they're doing, how to time everything, how much needed to go out like that's the piece that we can't as as much as we have with intelligent systems now and putting the right information in, we cannot mimic what the body was meant to do on its own. And then the the landing point, right? It controls that rise. You see it turn on a CGM, and it it's like a beautiful landing of a plane that you didn't think. You're like, this is gonna crash, and it doesn't crash. You

Scott Benner 17:56
have good insulin, insulin sensitivity. You're not type one, and your blood sugar just it doesn't get low, like, you know, it's and that is the point. Like insulin sensitivity is the way you think about it, because your type one is different. But what I'm talking about is, like a person who doesn't have diabetes, it sees the need, and it puts insulin in immediately. It quells the spike immediately, and it shuts it off immediately. And you know that stuff is it's just not happening for type ones and type twos as well. But listen, I'm just gonna go like, GLP has an anti inflammatory property. Chronic low grade inflammation is often associated with PCOS and can worsen symptoms by reducing inflammation, GLP can potentially alleviate some PCOS symptoms. So a GLP medications not the cure for PCOS, but right it is going to it's going to impact inflammation, hopefully also by improving insulin sensitivity and reducing hyperinsulinemia, high insulin left. Did I do it? GLP can help in lowering androgen levels. High levels of insulin can lead to an increase in androgen production, which is responsible for symptoms such as hirsutism, which means hairy and acne in PCOS. If GLP impacts weight management, it does it by slowing gastric emptying, include increases your satiety and reduces appetite, which can lead to weight loss. Weight Management is a key component in managing PCOS symptoms, because obesity can exasperate insulin resistance and other symptoms of PCOS. And then, of course, GLP one enhances insulin secretion in response to food intake and improves insulin sensitivity. Since insulin resistance is common in PCOS, GLP one could help in managing blood glucose levels more effectively. I think that's for a person who doesn't have type one,

Jennifer Smith, CDE 19:52
and it's also kind of the hallmark reason the resistance piece of that whole PCOS is a. Reason that the main medication that's long term been prescribed for it is Metformin. Metformin, right? Yeah. I mean, that's been used for years and years and years, and has gained footage in even type one and type one with PCOS. But I think it's a baseline for some people, it does a really great job. For other people, they may need something more impactful, something like a GLP, one, which, again, is your body doesn't technically make Metformin. Your body actually does make a GLP, right? It is something that is secreted in the body. It's just not happening the right way in some people. And

Scott Benner 20:40
I think we're done here. But I'm going to end with in case someone's listening from Lily or novo, or any of the other companies who are going to come along, and they're all going to come along, you got to look at these other things that glps are helping with, and find different dosing strategies for people who are being helped for other things. Because, like, I've shared with Jenny privately, like it's helping my daughter with so many issues, but it's quelling her appetite. Too much, too much. Yeah, she needs less of the medication, and they come pre dosed. So, you know, it's a

Jennifer Smith, CDE 21:11
one pop that's actually, as another side note to these companies, there are many people who really hate the way that is dosed in the one, it's like a spring loaded like, pop it in. And I can tell you that there are a lot of people that don't

Scott Benner 21:28
like that. Here's mine for later. So there you go, that I take for, for just weight management. There are times I pick the right spot and I'm like, Oh, a little pressure. That's not bad. It's over. And there are some times that after I do it, I go, God damn, it's like, because it feels like, you know, sometimes it can feel like you got shot. Yeah, listen, I know what they're doing. I understand why it's happening the way it's happening. It's money, but, of course, yeah, but let's get to the point where we're realizing I'm tired of it just being, you know, doctors on YouTube going, Hey, I'm using this now for my patients, for this and this and this and this, like, let them, because you're not fooling anybody. No, I'm going to tell you that the the YouTube is full of videos with hundreds of 1000s of views about how to take the medication out of this and microdose it. So just, why don't you just make it safe for people, for God's sakes, okay, that was it. I didn't know how that happened. Realize that was gonna happen. Sorry, that's all right. Little side note. I didn't know I was gonna get bitchy at the end. But there you

Jennifer Smith, CDE 22:26
go, PCOS, and a note to Yeah, you know, and

Scott Benner 22:29
a note to pharma, like, why don't you? There you go, make something that'll help people with more than just the diabetes and the weight loss, yeah. Give people options. How hard is that really? Oh, want to thank the Eversense CGM for sponsoring this episode of The juicebox podcast, and invite you to go to Eversense cgm.com/juicebox to learn more about this terrific device, you can head over now and just absorb everything that the website has to offer. And that way you'll know if Eversense feels right for you. Eversense cgm.com/juicebox, a huge thank you to one of today's sponsors, gvoke glucagon. Find out more about gvoke hypopen at gvoke glucagon.com, forward slash juice box. You spell that, G, V, O, k, e, g, l, U, C, A, G, o, n.com, forward slash juice box. A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made defining diabetes. Go to juicebox podcast.com, up into the menu and click on defining diabetes to find the series that will tell you what all of those words mean, short, fun and informative that's defining diabetes. Lots of people with autoimmune seem to have trouble with their thyroid, and that's why I've made the defining thyroid series, juicebox podcast.com. Click on defining thyroid the menu to find out more. If you're looking for community around type one diabetes, check out the juicebox podcast. Private, Facebook group juicebox podcast, type one diabetes, but everybody is welcome. Type one, type two gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out juicebox podcast. Type one diabetes on Facebook. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership, thank you so much for listening. I'll be back very soon with another episode of The juicebox podcast. The episode you just heard was professionally edited by wrong way recording, wrongwayrecording.com. You.