Why I Pay Attention to Insulin Resistance in Midlife

One of the most common reasons women come to see me is because they're tired.  Something I've noticed over my years of practice is that women don't always realize just how tired they've been until they start feeling better.

We're really good at pushing through, aren't we? We get used to feeling exhausted, dealing with afternoon energy crashes, or relying on coffee to get us through the day.

And when we reach perimenopause or menopause, it's easy to assume that changing hormones are responsible for everything we're experiencing.  There's often more to the story though - poor sleep, low iron, thyroid concerns, and changes in blood sugar regulation can all play a role in our energy level.

One of the things I pay particular attention to with my patients in perimenopause and beyond is insulin resistance, because it can develop gradually, often before blood sugar levels become noticeably elevated.

What is insulin resistance

Let's start with what insulin actually does.

When you eat foods containing carbohydrates, they're broken down into glucose in your digestive tract, which then enters your bloodstream. Your pancreas releases insulin, a hormone that helps glucose move into your cells, where it can be used for energy or stored for later.

When your cells become less responsive to insulin, your body needs to produce more of it to accomplish the same job.  This is called insulin resistance.

Initially, your pancreas may be able to compensate by producing additional insulin, keeping blood sugar levels within the normal range.  Over time, however, if your body can no longer keep up with the increased demand, blood sugar levels may begin to rise.

What does insulin resistance have to do with changing hormones?

Estrogen plays a role in how our bodies regulate glucose and respond to insulin.  As estrogen fluctuates during perimenopause and eventually declines after menopause, insulin sensitivity can change.

In addition, changes in muscle mass, body fat distribution, physical activity, stress, and sleep can all influence how effectively our bodies manage blood sugar.

And because sleep disturbances become more common during the menopause transition, this can create another challenge. Inadequate sleep can reduce insulin sensitivity and affect the hormones involved in appetite regulation.

It's rarely just one thing.  That's why I believe it's so important to look at the bigger picture rather than attributing every midlife symptom to changing hormones.

Could insulin resistance be affecting how you feel?

Insulin resistance often develops over years without obvious symptoms.  

Some women who are experiencing changes in metabolic health may notice symptoms like:

  • Low energy or afternoon fatigue

  • Increased cravings or difficulty feeling satisfied after meals

  • Changes in weight or increased abdominal fat

  • Other metabolic concerns, such as elevated triglycerides or blood pressure

None of these symptoms, on their own, tell us that someone has insulin resistance though.

Fatigue, for example, can be related to iron deficiency, thyroid dysfunction, inadequate sleep, or a long list of other concerns.

That's why symptoms can prompt us to look more closely, but they don't replace an appropriate assessment.

Why addressing insulin resistance is so important

Blood sugar regulation isn't just about preventing weight gain or avoiding an afternoon energy crash.

It's an important part of long-term metabolic and cardiovascular health.

Over time, insulin resistance can contribute to the development of prediabetes and type 2 diabetes. It's also associated with changes in blood pressure, cholesterol, and other cardiovascular risk factors.

Persistently elevated blood glucose can damage blood vessels and contribute to inflammation and vascular dysfunction.

Since cardiovascular disease becomes an increasingly important health consideration after menopause, metabolic health is something I believe deserves attention well before someone develops diabetes.

Helpful Testing

One of the challenges with identifying insulin resistance is that blood sugar levels can remain normal for quite some time while the body compensates by producing more insulin.

These are valuable tests that I frequently order to assess metabolic health:

  • Fasting glucose measures the amount of glucose in your blood after fasting.

  • Hemoglobin A1c (HbA1c) provides an estimate of your average blood glucose over approximately the previous two to three months.

  • Fasting insulin can provide additional information about how much insulin your body is producing in the fasting state.

Five ways to support better blood sugar regulation in midlife

The good news is that there are several well-supported strategies that can make a meaningful difference in your blood sugar regulation. 

1. Start your day with protein

One of the habits I regularly encourage is eating at least 30g of protein with breakfast. 

Protein supports muscle maintenance, helps you feel satisfied after eating, and can help moderate the blood sugar response to a meal.

Think eggs with Greek yogurt, a protein smoothie, or cottage cheese with fruit.

2. Include more fibre-rich foods

Fibre is another important part of supporting metabolic health.  It also supports digestive health, satiety, and healthy cholesterol levels.

Foods such as vegetables, berries, beans, lentils, nuts, seeds are sources of fibre.

Rather than focusing only on removing foods from your diet, think about what you can add.

Can you include some berries or chia seeds with breakfast? Add lentils to a soup? Include an extra serving of vegetables at dinner?  Small changes add up.

3. Take a walk after eating

When we move, our muscles use glucose for energy.  Even a 10-15 minute walk after eating can help reduce the rise in blood sugar that naturally occurs following a meal.

4. Prioritize strength training

If there's one form of exercise I believe deserves more attention in midlife, it's strength training.  Our muscles are a major site for glucose uptake and storage.  Regular strength training can improve insulin sensitivity over time.

And as we age, maintaining muscle becomes increasingly important, not just for blood sugar regulation, but also for strength, bone health, mobility, and maintaining our independence.

5. Don't underestimate sleep and recovery

We can't talk about metabolic health without talking about sleep.  Insufficient or disrupted sleep can affect insulin sensitivity, appetite regulation, and our ability to make consistent nutrition choices.

If hot flashes, night sweats, stress, or other issues are interfering with your sleep, addressing those concerns is also part of supporting your metabolic health.

Where should you start?

If you've been feeling exhausted, noticing changes in your weight, or wondering whether your blood sugar regulation could be affecting your health, you don't have to figure everything out on your own.

A thorough assessment can help identify whether insulin resistance, changing hormones, poor sleep, nutritional deficiencies, or other factors may be contributing to how you're feeling.

And when it comes to making changes, I always encourage women to start with the foundations.

Start with a protein-rich breakfast. Take a short walk after dinner. Make strength training a regular part of your week.

Simple doesn't mean insignificant. And consistency matters far more than perfection.

Want help putting these habits into practice?

Knowing what to do and actually making those changes part of your everyday life are two different things.

That's one of the reasons I also offer FASTer Way VIP nutrition and fitness coaching alongside my naturopathic practice.

The program helps take the guesswork out of healthy eating and exercise, with personalized nutrition goals, support to make reaching those goals easier, effective 30-minute strength workouts, and my ongoing coaching to help you navigate challenges and build sustainable habits.

Many of my patients use this program alongside their individualized care, but it's open to anyone looking for nutrition and fitness support.

Learn more about my nutrition and fitness coaching →

And if you're concerned that insulin resistance or another underlying issue might be affecting your health, individualized naturopathic care can help you explore what's contributing and develop an strategic plan to address it. 

Explore my naturopathic services →

Here's to having more energy than you ever imagined, and feeling your best for years to come!