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Women's Metabolic Clarity · Topic 4 of 15

Insulin Resistance and Blood Sugar

Blood sugar can change in midlife, even if you eat well. Let's understand why.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. What is insulin resistance, and why does it show up now?
  2. My A1C is 'normal.' Can I still have blood sugar problems?
  3. Does hormone therapy affect blood sugar?
Question 10 of 45

What is insulin resistance, and why does it show up now?

Short answer

  • Insulin is a hormone that moves sugar from your blood into your cells.
  • With insulin resistance, your cells do not respond as well. Your body has to make more insulin.
  • After menopause, women's risk for metabolic syndrome (a group of heart and sugar risks) goes up.
  • More belly fat and less muscle both play a part.

What to look out for

  • Energy crashes or strong cravings after meals.
  • Growing waist size.
  • Higher blood sugar, triglycerides or blood pressure on tests.

Top 3 things to act on or ask your clinician

  1. Ask: 'Can we check my fasting glucose and A1C?'
  2. Ask: 'Do I have signs of metabolic syndrome?'
  3. Ask: 'Would a fasting insulin test add anything for me?'
Sources for this answer
  1. Peer-reviewed Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88:2404-11. PMID: 12788835. DOI: 10.1210/jc.2003-030242
  2. Peer-reviewed Lovejoy JC et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008;32:949-58. PMID: 18332882. DOI: 10.1038/ijo.2008.25
  3. Peer-reviewed American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S20-S42. PMID: 38078589. DOI: 10.2337/dc24-S002
  4. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  5. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Question 11 of 45

My A1C is 'normal.' Can I still have blood sugar problems?

Short answer

  • Yes, it is possible. A1C shows your average blood sugar over about 3 months.
  • Insulin can rise for years before blood sugar goes out of range.
  • The ADA defines prediabetes as an A1C of 5.7% to 6.4%. Even 'high-normal' trends are worth watching.
  • One number is a snapshot. A trend over time tells more.

What to look out for

  • A1C or fasting glucose creeping up year to year.
  • Family history of type 2 diabetes.
  • Past gestational diabetes or PCOS.

Top 3 things to act on or ask your clinician

  1. Ask: 'What is my trend over the last few years?'
  2. Ask: 'Am I at higher risk because of my history?'
  3. Ask: 'How often should we re-check?'
Sources for this answer
  1. Peer-reviewed American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S20-S42. PMID: 38078589. DOI: 10.2337/dc24-S002
  2. Peer-reviewed Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88:2404-11. PMID: 12788835. DOI: 10.1210/jc.2003-030242
  3. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Question 12 of 45

Does hormone therapy affect blood sugar?

Short answer

  • Research reviews show hormone therapy may lower insulin resistance and new cases of diabetes in some women.
  • But hormone therapy is NOT approved to treat or prevent diabetes.
  • It has its own benefits and risks that need a personal talk with your clinician.
  • The Menopause Society says the choice should be based on your symptoms and health.

What to look out for

  • Using hormone therapy for the wrong reasons.
  • Claims that one treatment 'fixes' your metabolism.
  • Missing other blood sugar steps like sleep, food and movement.

Top 3 things to act on or ask your clinician

  1. Ask: 'How might hormone therapy affect my blood sugar, given my health?'
  2. Ask: 'What are my personal benefits and risks?'
  3. Ask: 'What other steps help my blood sugar?'
Sources for this answer
  1. Peer-reviewed Salpeter SR et al. Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab. 2006;8:538-54. PMID: 16918589. DOI: 10.1111/j.1463-1326.2005.00545.x
  2. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  3. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88:2404-11. PMID: 12788835. DOI: 10.1210/jc.2003-030242
  2. Peer-reviewed Lovejoy JC et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008;32:949-58. PMID: 18332882. DOI: 10.1038/ijo.2008.25
  3. Peer-reviewed American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S20-S42. PMID: 38078589. DOI: 10.2337/dc24-S002
  4. Peer-reviewed Salpeter SR et al. Meta-analysis: effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab. 2006;8:538-54. PMID: 16918589. DOI: 10.1111/j.1463-1326.2005.00545.x
  5. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  6. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  7. Expert commentary, not research Dr. Sara Gottfried on Huberman Lab: How to Optimize Female Hormone Health for Vitality & Longevity (podcast episode, Jan 2023)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Sleep and Night Sweats · Cortisol and Stress · Brain Fog, Mood and Anxiety · Thyroid · Bloodwork: What to Ask For · Heart and Bone Risk After Menopause · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity