If you live with diabetes, you may notice that your glucose (blood sugar) levels are less predictable during menopause than they were before. This isn’t a coincidence — menopause can affect insulin sensitivity and blood sugar management.

Menopause and general aging can increase your risk of developing type 2 diabetes if you don’t already have it. Having type 1 or 2 diabetes can also influence the age at which you reach menopause. Women who were diagnosed with diabetes in their 20s or 30s are at an increased risk of early menopause, while women diagnosed with diabetes at 50 or older tend to reach menopause later.

In this article, we’ll explore the connections between menopause and diabetes and give you tips for supporting stable blood sugar during menopause.

Why Blood Sugar Can Be Less Predictable During Menopause

Menopause officially starts when you haven’t had a menstrual period for 12 consecutive months, but hormonal changes can start years before that, during a phase called perimenopause. During perimenopause, your ovaries gradually stop producing the hormones estrogen and progesterone.

Changes in these hormones can cause a variety of menopause symptoms and may also change how your body responds to insulin. Insulin is a hormone from the pancreas that helps balance your blood sugar levels by moving glucose from your blood into your cells. Your cells can then use that glucose for energy. When the body no longer responds to insulin in the way it should, it is known as insulin resistance. Type 2 diabetes is when insulin resistance leads to constant high blood sugar.

Hormonal changes in menopause can affect your health in a few ways that affect blood sugar control.

Insulin Sensitivity

Fluctuating sex hormones can directly contribute to decreased insulin sensitivity. While estrogen and progesterone production declines during menopause, the ovaries continue producing androgens (hormones like testosterone). Low estrogen and high androgen levels in menopause can contribute to developing insulin resistance.

Body Weight and Fat Distribution

It’s natural to gain weight as you get older and approach menopause, especially in the belly area. You also start to lose muscle mass during this time. Increased body fat can increase inflammation in your body, which contributes to developing insulin resistance or a reduced insulin response.

Sleep

You might start to have trouble sleeping as you approach menopause. Not getting enough sleep or having poor sleep (partly due to other menopause symptoms like hot flashes and night sweats) can contribute to high blood sugar and insulin resistance.

Stress

Sleep problems, mood swings, and other common menopause symptoms can make you feel more stressed on a day-to-day basis. Stress hormones like cortisol and adrenaline can affect your blood sugar levels, cause insulin resistance, and make diabetes harder to manage.

Common Blood Sugar Patterns in Menopause

If you’re already living with diabetes, you might notice distinct changes in how your blood sugar behaves, which may change the way you manage diabetes. You might notice the following changes.

Less Stable Blood Sugar

Your blood glucose levels might rise and fall unpredictably because of menopause-related hormone changes. When blood sugar changes rapidly and seemingly without reason, it can be harder to manage your blood sugar to prevent diabetes complications.

Higher Fasting Glucose

Some women with diabetes might notice a higher fasting glucose level than they had before menopause. Your fasting glucose level describes how much sugar is in your blood after several hours without eating and is usually measured in the morning. Because your blood sugar should be at a low point in the morning, a high fasting glucose level indicates high blood sugar in general.

Treatment Modifications

Both of these patterns can be linked to declining estrogen. As estrogen levels drop, your body can become less responsive to insulin, leading to insulin resistance. If you take insulin, your doctor may need to make adjustments to your treatment over time.

How To Stabilize Your Blood Sugar During Menopause

More research is needed into how menopause affects diabetes and what specific steps women in menopause can take to prevent or manage diabetes. Here are some strategies that may help.

Measure Your Blood Sugar More Often

Checking your blood sugar frequently can help you identify trends in how your blood sugar behaves. This can also help you distinguish signs of high or low blood sugar from the typical symptoms of menopause, like hot flashes or heart palpitations.

A continuous glucose monitor (CGM) lets you keep track of your blood sugar levels without pricking your finger multiple times throughout the day. Your healthcare provider can help you choose a glucose monitor and teach you how to use it.

Adjust Your Routine

You may need to adjust your routine to help lower your blood sugar and manage or prevent insulin resistance. Your doctor might advise you to take the following steps to manage menopause symptoms and diabetes at the same time:

• Make sleep a priority — Good sleep hygiene (including a consistent sleep schedule and lack of distractions at bedtime) can reduce menopause-related insomnia while also regulating blood sugar and reducing insulin resistance.
• Balance your diet — Healthy eating (including fewer processed foods and more fruits, veggies, and whole grains) helps prevent insulin resistance and menopause complications like osteoporosis.
• Manage stress — Take the time to rest and balance your work with relaxation to decrease stress hormones and their impact on insulin production.
• Be active — Exercise helps regulate your blood sugar, supports bone health, and may also help boost your mood in menopause.

Menopause Hormone Therapy and Diabetes Prevention

According to the journal Endocrine Reviews, some research suggests that menopause hormone therapy may help prevent or delay type 2 diabetes in menopausal women. Menopause hormone therapy involves taking hormones (either estrogen alone or with progesterone) to provide some hormones your ovaries stop making.

Menopause hormone therapy isn’t right for everyone and isn’t prescribed for diabetes prevention alone, but it may reduce unpleasant menopause symptoms while possibly supporting your body’s ability to use insulin and regulate blood sugar. Your doctor can tell you more about your options for menopause hormone therapy, including pills, patches, vaginal rings, and gels.

Talk to Your Doctor

If you’re approaching perimenopause or menopause and don’t have diabetes, talk to your doctor about your risk of developing type 2 diabetes. They may offer tips to help lower your risk as your hormones change.

If you already have diabetes and are in perimenopause or menopause, your doctor can help you navigate any changes in your blood sugar. They might recommend changes to your current diabetes care plan, such as prescribing metformin to manage insulin resistance.

Your doctor can also suggest nonhormonal treatments and lifestyle changes to regulate your blood sugar, reduce menopause symptoms, and help you cope with any changes to your overall health.