Are you frustrated with how your body is not changing (or moving in the opposite direction you want it to) despite your best attempts to live a healthy lifestyle? You aren’t alone. It is one of the most common concerns I hear from the women I work with. And despite what you may have been told, the successful solution is not to just eat less and exercise more.

So why is this happening to so many women? I find it is often due to insulin resistance that is often caused by the hormonal changes and resulting muscle mass decline that happens in peri/menopause.

Insulin resistance is a major contributor to the annoying abdominal weight gain so many women experience, as well as high blood pressure, elevated cholesterol and overall increased inflammation leading to achy joints and many of the common chronic health conditions that can happen as you get older.

The good news: you do not have to simply accept feeling this way because you are over 40. I believe this is such an important topic for all women to know about. Even if you don’t currently have insulin resistance, it is still important for you to know what it is, how to check for it, and what to do to prevent it from happening.

In order to make the information more easily digested (bad pun intended), I am going to break the topic up into 3 newsletters (hopefully in a way that is interesting and makes sense):

This week I am going to talk about what insulin resistance is and what to test to to see if you have it.

Next week I will share some of the natural approaches that are helpful to prevent and treat insulin resistance.

The third week will be about a hot topic (I think it was the hottest one of 2023!) that is related to insulin resistance: Ozempic and the other similar drugs in its class. I will discuss how it works, the pros and cons, and what I believe is essential to do along with it if someone makes an informed choice to take it.

Let’s start with a quick discussion on what insulin is, what it does, and what happens when insulin resistance develops.

  • All of the carbohydrates you eat get broken down into simple sugars when they are digested and released into your blood stream.

  • The presence of sugar in your blood sends a message to your pancreas to produce insulin. The more sugar there is, the more insulin that is needed.

  • Insulin is like a key that opens the lock in the outer wall of your cells. When it binds, sugar is able to move out of your blood and into your cells where it can be used to make energy. That’s why it’s rarely productive to really restrict all carbs - they are a very efficient source of energy for your body.

  • Insulin resistance occurs when insulin stops being able to bind efficiently to the cell wall. In response, your body will produce more and more insulin in order to increase the chances that something will bind so that blood sugar levels don’t get too high.

    I think of it like when my kids are trying to get my attention, but I’m busy so they keep repeating “Mom! Mom! Mom!” until finally I stop and ask “What?!?” .

  • Type 2 diabetes results if the body can no longer produce more insulin or the receptors become so unresponsive (mom has fallen asleep and isn’t replying at all ) that blood sugar levels increase.

  • Many of the women I work with have normal blood sugar levels, but their body is working hard producing lots of insulin in order to do that. Even though they don’t have diabetes, the elevated insulin levels still have a domino like effect on the function of lots of different areas in the body.

What blood work can be done to check if you have insulin resistance?

Many medical doctors only look at your blood glucose. This will be elevated if someone has type 2 diabetes, but it will completely miss all of the people who are insulin resistant and have normal blood sugar (which is the majority of the women I see). So you can’t rule out insulin resistance if that is the only piece that has been checked.

HOMA-IR is a calculation for insulin resistance that requires testing fasting insulin and fasting glucose.  It is a measure of how much insulin is being produced in order to keep the glucose where it is, relative to what is considered ideal.

Since insulin resistance also contributes to elevated cholesterol and inflammation, I also look at a fasting cholesterol panel and inflammatory markers like ESR and CRP.

I think it’s important for everyone to be tested for insulin resistance versus waiting until you have elevated blood sugar and type 2 diabetes. Having that information allows you to be proactive and take steps to reverse it. By doing that, it's possible to improve your metabolism, reduce blood pressure and cholesterol, and increase energy.

Your health is a bit like a puzzle. Sometimes it takes looking at the right pieces—and the right blood work—to understand what may be contributing to how you’re feeling.

If you feel like something is off, keep looking for answers. Learn more about how I work with women in midlife to assess the bigger picture, identify where to focus, and create a strategy to help you feel better.

Dr. Jennifer Haessler, ND