How PCOS, ignorance of red flags landed this 29-year-old with diabetes

There was a time when 29-year-old Shalini Singh had a fasting blood sugar of 450 mg/dL and weighed 85 kg. Now, she is svelte at 57 kg, calorie counting each meal, refusing processed food, choosing millets, sticking to her cardio routine, sleeping by 10 pm and saying no to anything that taxes her body. Her strict routine is the result of her Type 2 diabetes that could have been prevented had she been aware of her triggers and been diagnosed early enough.

“My diabetes happened because I was unaware of what led to it. My hypothyroidism (a condition of an under-performing thyroid gland which doesn’t make enough hormones to meet your body’s needs) and childhood obesity triggered my PCOS (polycystic ovary syndrome) in my adulthood. This, in turn, led to diabetes. Looking back, I know I had been experiencing PCOS symptoms such as hair loss and weight gain since adolescence. There were many missed opportunities for an earlier diagnosis. Also, different specialists did not ask the right questions at the right time, delaying my diagnosis,” says Shalini, who doesn’t want her future family life affected.

What’s PCOS and how many women are affected by it?

PCOS is a common condition in young women who have few, unusual or very long periods because of excess male hormones called androgens. It usually starts during adolescence but symptoms may fluctuate over time and can cause cysts in the ovaries. The commonest female endocrine disorder, it is a leading cause of infertility (because the cysts affect egg production from the ovaries), with a worldwide range of 6-26 per cent. In India, up to 22.5 per cent of women suffer from this condition as per a 2019 meta-analysis.

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When patients like Shalini report missed, absent or heavy flow periods, accompanied by weight gain and/or abnormal hair growth or loss, doctors usually check for PCOS and hypothyroidism. As Dr Subhash Kumar Wangnoo, senior consultant, endocrinologist and diabetologist, Indraprastha Apollo Hospital, New Delhi, explains, “Hypothyroidism, PCOS and Type 2 diabetes are correlated and women in their reproductive age have to be alert about the first two and address them aggressively as soon as possible to prevent onset of diabetes. That’s why Shalini developed her condition the way she did.” Dr Wangnoo sees around 80 cases of women with PCOS and Type 2 diabetes every month.

What are red flags for PCOS?

The first red flag that Shalini and her family failed to notice is her sugar craving. “I could not complete any meal without a soft drink and became overweight as a class V student,” she says. Back then, nobody thought that childhood obesity could complicate her PCOS and diabetes later in life. Then she battled liver complications. Soon after, she was diagnosed with hypothyroidism, which might have triggered her liver condition in the first place. “The thyroid gland and the liver interact through a complex network of hormones and enzymes,” says Dr Wangnoo.

The second red flag was when Shalini had her periods in class VIII. “ The bleeding would be heavy, there were a lot of blood clots and I would mostly sleep in pain,” says Shalini. What she didn’t know is that every girl should consult a gynaecologist when she has her first period. “They should definitely see a gynaecologist if they have a family history of Type 2 diabetes. Women with hormonal imbalances linked to PCOS are likely to develop obesity with elevated levels of blood sugar and cholesterol later. They begin with the disadvantage of insulin resistance. So they should watch their weight, shun junk food, have a balanced diet and do regular physical activity,” says Dr Wangnoo.

Which diet works for PCOS Which diet works for PCOS

The third red flag was an uncoordinated treatment approach. While a thyroid specialist tapered off her medication once her test results became normal, unaware that it could impact her PCOS, Shalini herself went on and off medication for heavy bleeding. She got alarmed only when she continued to bleed for 50 days. “That’s when I consulted a gynaecologist and was diagnosed with PCOS. An ultrasound revealed three cysts in and around my ovaries. Once my bleeding stopped, she tested me for diabetes and was shocked to find my fasting blood sugar at 450 mg/dL. I was only 16 then. Since then I have been on Metformin for diabetes and birth control pills to regulate periods. Now my endocrinologist correlates my medication with that of thyroid too,” she adds.

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Most young girls get confused with irregular menstrual cycles, assuming they take some time to stabilise. “Watch out for repetitive patterns and get tested for PCOS. Since androgens are high in PCOS, look out for excessive hair growth, acne or male pattern baldness in teen years. Do not ignore unexplained weight gain, especially around the lower abdomen. Insulin resistance is usually indicated by darkening of the skin around the neck and armpits. We need to diagnose early by getting an ultrasound done,” says Dr Nupur Gupta, director, obstetrics and gynaecology, Fortis Hospital, Gurugram.

A new fitness routine

While Shalini became regular with her medication and follow-ups, keeping to daily diet and sleep discipline seemed difficult during her days as a student in IIT Delhi. Her cysts came back all over again. Now she has learnt to prioritise her body and made certain lifestyle corrections that are crucial to managing both PCOS and diabetes. “I wake up at 5 am, go for a brisk walk lasting 30 minutes before doing aerobic and cardio exercises. I eat only home food, which is low carbohydrate and gluten-free. I have millet chapatis, plenty of non-starchy greens, lean proteins and healthy fats. Alcohol and fruit juices are out. And I finish my dinner by 7 pm,” reveals Shalini. Even a 10 per cent reduction in body weight can improve symptoms of PCOS, including insulin resistance and blood sugar levels. “I wish I had known what to do in my teen years. Now it is a trapeze act between my thyroid levels, PCOS and blood sugar,” says Shalini who doesn’t want to cram herself with drugs ever again.