Tag: diabetes

Perimenopause is the not-so-silent prelude to menopause. It usually kicks off in your 40s (sometimes late 30s) and can last anywhere from a few years to over a decade. During this time, estrogen and progesterone—your key reproductive hormones—start fluctuating wildly before they eventually flatline in menopause (defined as going 12 consecutive months without a period).

It’s not just your period that’s affected. These hormones have far-reaching effects, especially on things like:

• Sleep
• Mood
• Metabolism
• Weight regulation
• And yes—blood sugar control

Wait, what does estrogen have to do with blood sugar?

A lot, actually.

Estrogen is a bit of a metabolic superstar. It helps the body respond to insulin—the hormone that moves sugar out of your blood and into your cells. As estrogen levels start to fall and fluctuate, your sensitivity to insulin drops, which can lead to rising blood sugar levels and even insulin resistance over time.

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Hormones and Glucose: A Messy Breakup

To understand how blood sugar and perimenopause are linked, we need a crash course in glucose metabolism.

How it normally works:

When you eat carbs—yes, even the innocent slice of sourdough—your digestive system breaks them down into glucose (aka sugar). This sugar enters your bloodstream and triggers the release of insulin from your pancreas. Insulin then acts like a key, unlocking your cells so glucose can enter and be used for energy.

What happens during perimenopause:

• Estrogen and progesterone levels go haywire, interfering with the body’s insulin response.
• Cortisol (your stress hormone) often rises due to poor sleep, anxiety, and hot flashes, further raising blood sugar.
• Muscle mass starts to decline, which decreases your body’s ability to burn sugar efficiently.
• Increased belly fat (thank you, hormone shifts) also raises your risk for insulin resistance.

The result? Your cells stop responding to insulin as well, sugar lingers in the blood longer than it should, and your risk for prediabetes and type 2 diabetes climbs—often without obvious symptoms.

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The Surprising Blood Sugar Symptoms You Might Be Ignoring

Think you’d know if your blood sugar was out of whack? Think again. Many symptoms of blood sugar imbalance are subtle—and eerily similar to classic perimenopausal symptoms.

Here’s what to look out for:

• Crashing energy in the afternoon (you feel like you could nap under your desk at 3 p.m.)
• Cravings for carbs and sugar, especially late at night
• Mood swings, anxiety, or irritability
• Weight gain—especially around the middle
• Brain fog or memory issues
• Waking up between 2-4 a.m. and struggling to fall back asleep

If you nodded “yes” to more than a couple, your blood sugar might be part of the picture.

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Perimenopause and Insulin Resistance: What’s the Connection?

Insulin resistance is when your cells stop responding to insulin properly, forcing your body to produce more and more of it. Over time, this leads to elevated blood sugar and, eventually, type 2 diabetes.

So what’s the link with perimenopause?

A 2020 study published in The Journal of Clinical Endocrinology & Metabolism found that declining estrogen levels were independently associated with reduced insulin sensitivity, even when controlling for age and weight (Dunaif et al., 2020).

Another study in Menopause journal showed that postmenopausal women had significantly higher fasting glucose and insulin levels compared to their premenopausal counterparts—even when body mass index (BMI) was the same (Kwon et al., 2021).

Translation? Hormones matter. And ignoring this shift can mean quietly moving toward a diabetic state without any obvious red flags.

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How to Know If Your Blood Sugar Is Off

The gold standard is testing—but not just once a year. You can ask your healthcare provider for:

• Fasting glucose (should be under 100 mg/dL)
• Hemoglobin A1C (shows your average blood sugar over 3 months; ideal is under 5.7%)
• Fasting insulin (a high level can signal insulin resistance, even before glucose rises)

You might also consider using a Continuous Glucose Monitor (CGM) for a couple of weeks. It’s a game-changer for seeing how your body responds to different foods, stress, and sleep patterns.

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7 Ways to Support Blood Sugar Balance During Perimenopause

Okay, now for the good stuff. You can absolutely take control here—and no, you don’t need to cut out every carb or live on kale smoothies. Here’s how:

1. Start with a Protein-Packed Breakfast

Forget the sugary granola. Aim for at least 20-30g of protein in the morning to stabilize blood sugar and reduce cravings all day long. Think eggs, Greek yogurt, protein smoothies, or leftover salmon if you’re feeling fancy.

2. Lift Weights. Seriously.

Resistance training builds muscle, which is key for blood sugar regulation. Just two or three strength sessions a week can dramatically improve insulin sensitivity (Roberts et al., 2013).

3. Walk After Meals

A 10-minute stroll after eating can lower post-meal blood sugar spikes by up to 30% (DiPietro et al., 2013). It also helps digestion and boosts your mood.

4. Cut Back on Ultra-Processed Foods

This doesn’t mean “never eat chips again.” But the more you focus on whole foods—veggies, lean protein, healthy fats—the better your body can manage sugar.

5. Prioritize Sleep

Hormonal insomnia is real. But poor sleep raises cortisol and insulin resistance, so get serious about sleep hygiene. Try magnesium, blue light blockers, and consistent sleep/wake times.

6. Use Apple Cider Vinegar Wisely

Taking a tablespoon of apple cider vinegar in water before meals has been shown to improve insulin sensitivity and lower post-meal blood glucose levels (Johnston et al., 2004).

7. Don’t Skip Meals

Skipping meals can cause blood sugar crashes and overeating later. Instead, eat balanced meals every 4-5 hours with protein, fiber, and healthy fats.

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When to Talk to Your Doctor

If you’re in your 40s and noticing changes—especially if diabetes runs in your family—don’t wait for a diagnosis. Ask for a full metabolic panel, even if you’re not technically “overweight” or symptomatic.

Bonus: Talk to your doctor about hormone replacement therapy (HRT). Recent studies suggest HRT can improve insulin sensitivity and reduce abdominal fat in some women (Sankar et al., 2022). It’s not for everyone, but it’s worth the convo.

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The Bottom Line: You’re Not Powerless

Perimenopause can feel like a betrayal of everything you thought you knew about your body. But here’s the truth: you’re not broken—you’re evolving. And with the right tools and knowledge, you can stay in the driver’s seat of your health.

Blood sugar balance isn’t just about avoiding diabetes—it’s about feeling better, thinking clearer, and living with more energy. And that’s something every woman deserves, especially during midlife.

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