Understanding the Blood Sugar–Hormone–Acne Axis

It’s easy to assume that unless you have diabetes or insulin resistance, blood sugar isn't something to worry about. But that’s far from the truth. You can have unstable blood sugar - and its downstream effects - long before it shows up in conventional labs.

And one of the ways it shows up is on your skin.

When you eat a meal high in refined carbohydrates or sugar - think pastries, sweetened coffee drinks, or even just white toast without enough protein or fat..your blood sugar rises. In response, your pancreas secretes insulin to shuttle glucose into cells for energy or storage.

In a healthy system, blood sugar rises moderately, insulin brings it down efficiently, and everything stays in balance.

But when your blood sugar is frequently spiking..whether from skipped meals, excessive caffeine, high-sugar foods, or chronic stress..your body is producing more insulin more often. Over time, this can lead to insulin resistance, but even before that happens, elevated insulin has several direct and indirect effects on the skin. Let’s dive into it below…

1. Increased Androgens

Insulin stimulates the production of androgens, particularly DHEA and testosterone, from both the ovaries and adrenal glands. These androgens increase the size and activity of sebaceous (oil) glands in the skin, leading to more sebum production. This excess oil can mix with dead skin cells and bacteria to clog pores and create the perfect environment for breakouts - especially deeper, cystic types.

2. Suppressed SHBG

Insulin also suppresses the liver’s production of sex hormone-binding globulin (SHBG), a protein that binds to excess hormones in the bloodstream. Lower SHBG = more free androgens circulating = more potential for breakouts.

3. Chronic Inflammation

Repeated blood sugar fluctuations increase systemic inflammation. Since acne is inherently an inflammatory skin condition, this creates another layer of dysfunction that makes breakouts more likely, and harder to resolve.

Early Signs Blood Sugar is Dysregulated (Even If Labs Look “Normal”)

You don’t need to have diabetes for blood sugar to be a problem. Many people with acne have subclinical blood sugar dysregulation that flies under the radar. Some signs to watch for include:

• Cravings for sugar or carbs shortly after eating

• Energy crashes or needing caffeine in the afternoon

• Feeling shaky, irritable, or anxious when going too long between meals

• Waking up around 2–4 a.m. consistently

• Acne that worsens after a high-sugar day or during times of poor sleep/stress

• Polycystic ovary syndrome (PCOS) or irregular menstrual cycles

And many MANY more things!

This is where lab testing comes in. Depending on the case, I often recommend looking at:

• Fasting insulin

• Hemoglobin A1c

• Testosterone (total and free)

• DHEA-S and SHBG

• Comprehensive hormone panels (such as DUTCH testing)

• GI-MAP stool analysis to explore gut health and inflammation which also play a big role when it comes to metabolic health

Labs help guide a root-cause strategy. But you don’t need labs to start taking supportive action.

6 Practical Strategies to Support Blood Sugar

1. Start Your Day with a Protein-Rich Breakfast

Skip the smoothie bowls and fruit-only breakfasts. Instead, aim for 25–30 grams of protein within 60 minutes of waking. This helps stabilize cortisol and insulin for the rest of the day.

Examples: eggs with sautéed veggies, grass-fed beef patties with sweet potato, chia pudding with collagen and hemp seeds.

2. Pair Carbs with Protein and Fat

Eating carbs alone spikes blood sugar much more than when they’re eaten with protein and fat. A simple example: Instead of having just an apple, pair it with almond butter or some turkey slices.

4. Walk After Meals

Just 10–15 minutes of walking after eating can reduce the glucose spike from that meal, helping your body use sugar more efficiently - and improving insulin sensitivity over time.

5. Focus on Sleep and Stress Regulation

High stress and poor sleep dysregulate cortisol, which directly impacts blood sugar stability. Prioritize a consistent bedtime, limit screen time at night, and support your nervous system throughout the day with grounding practices.

6. Swap Caffeine on an Empty Stomach for a Nourishing Morning Routine

Drinking coffee before food can spike cortisol and disrupt blood sugar regulation..especially in those already dealing with stress or acne. Instead, hydrate with minerals or lemon water first, eat a protein-forward breakfast, and then enjoy your coffee or matcha mid-morning, ideally after food.

MEDICAL DISCLAIMER - All content on this website is provided for educational and informational purposes only. It is not intended as a substitute for advice and recommendations provided by your healthcare provider.