Elevated insulin levels have been helpful to predict response to medication and may indicate women needing higher doses of metformin or the use of a second medication to significantly lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulin-level/22.5). Management
The primary treatments for PCOS include lifestyle changes and use of medications.Goals of treatment may be considered under four categories:

Lowering of insulin resistance
Restoration of fertility
Treatment of hirsutism or acne
Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancerIn each of these areas, there is considerable debate as to the optimal treatment. One of the major factors undelying the debate is the lack of large-scale clinical trials comparing different treatments. Smaller trials tend to be less reliable and hence may produce conflicting results. General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause. As PCOS appears to cause significant emotional distress, appropriate support may be useful.
Allopurinol is a medication used to decrease high blood uric acid levels. It is specifically used to prevent gout, prevent specific types of kidney stones and for the high uric acid levels that can occur with chemotherapy. It is taken by mouth or injected into a vein.Common side effects when used by mouth include itchiness and rash. Common side effects when used by injection include vomiting and kidney problems. While not recommended historically, starting allopurinol during an attack of gout appears to be safe. In those already on the medication, it should be continued even during an acute gout attack. While use during pregnancy does not appear to result in harm, this use has not been well studied. Allopurinol is in the xanthine oxidase inhibitor family of medications.Allopurinol was approved for medical use in the United States in 1966. It is on the World Health Organizations List of Essential Medicines. Allopurinol is available as a generic medication. In 2020, it was the 42nd most commonly prescribed medication in the United States, with more than 15 million prescriptions. Medical uses
Gout
Allopurinol is used to reduce urate formation in conditions where urate deposition has already occurred or is predictable.