Ya’ll are all on the right track. One of cortisol’s functions is to increase blood sugar (AKA anti-insulin action). So it stands to reason that people with CAH (who are oversupressed), or anyone undergoing long term steriod use, may have elevated blood sugars. Elevated blood sugars = increased insulin levels. For some unknown reason, if the body is exposed to high levels of insulin for too long the insulin receptors begin to downregulate (there are less of them to respond to insulin) which means that even more insulin has to be produced to cause the same response. It’s this vicious little cycle (are there are many more steps that are way too complicated to go into!) that’s difficult to break. Ultimately, it can lead to diabetes.

As to the androgens and PCOS, for some reason high levels of insulin cause the ovaries to produce more androgens. That’s one of the reasons why type 2 diabetics are more likely to develop PCOS. That’s also why some docs are now trying to treat people who have PCOS and elevated insulin levels with metaformin- perhaps if you can decrease insulin levels, you can decrease androgen production and get rid of the PCOS!

The actions of all these hormones are so intertwined it’s absolutely nuts trying to keep things straight. Not to mention, researchers haven’t exactly figured out the extent to how they all affect one another yet.

MarthaF