Blood Sugar Risk

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Is Your Blood Sugar at Risk?

Blood sugar imbalances often play a significant role in women’s health concerns. Blood sugar levels correlate with mood, weight, stress, inflammation, and disease processes. Finding balance is a foundational tool for wellness and disease prevention.

Yet, you might not even know you are at risk for changes in your blood sugar, as imbalances can begin well before they appear on routine lab work. Women are particularly vulnerable to blood sugar issues because of changing hormones throughout the lifecycle. Because all hormonal systems are connected, changes in estrogen and progesterone will influence blood sugar balance.

Today’s article will dive into what women need to know about blood sugar balance and how to achieve it with lifestyle and integrative medicine tools. Keep reading as we explore:

• Blood sugar basics for women’s health
• The blood-sugar hormone connection in perimenopause and PCOS
• Blood sugar testing
• How to act sooner vs. later

Blood Sugar Basics

Although we are using the informal term blood sugar in this article, we are talking about blood glucose. Glucose is the primary form of energy in the body; it fuels all cells. The body has many mechanisms to maintain balanced blood sugar and a continuous supply to cells.

After eating carbohydrates, glucose is absorbed into the bloodstream, raising blood sugar. The pancreas releases insulin, which helps move glucose into cells, allowing blood sugar to come back down.

When blood sugar spikes very high (hyperglycemia), more insulin is released. Over time, high insulin leads to more fat storage. The repetitive flooding of insulin makes cells resistant to its messages, creating insulin resistance.

Low blood sugar (hypoglycemia) may follow high blood sugar, causing cravings, intense hunger, irritability, and dizziness.

Instead of extreme peaks and valleys throughout the day (blood sugar dysregulation), we’re looking for rolling hills (blood sugar regulation).

Symptoms of blood sugar dysregulation include:

• Increased cravings and hunger, even after eating
• Increased snacking
• Weight gain
• Fatigue
• Poor sleep
• Fatigue
• Mood swings
• Increase hormonal symptoms, such as PMS, irritability, hot flashes, and more

Over time, dysregulation promotes insulin resistance and increases the risk of diabetes, cardiovascular disease, and other chronic diseases. On the other hand, blood sugar balance helps to prevent insulin resistance, weight gain, cardiometabolic changes, inflammation, and chronic disease.

The Blood Sugar – Hormone Connection

While blood sugar is heavily influenced by what (and how) you eat and other lifestyle habits, hormones also play a significant role. Let’s look at what happens to blood sugar in perimenopause and PCOS.

Perimenopause

In perimenopause, what you had dialed in in your 20s and 30s for nutrition and exercise suddenly doesn’t work anymore. You may notice blood sugar and weight increasing, without changing to your routine. What gives?

It turns out it’s the hormonal changes in perimenopause, and not age, is a risk factor for mid-life blood sugar changes. In perimenopause declining estrogen and progesterone contribute to elevated blood sugar, decreasing muscle mass, insulin resistance, and abdominal obesity, a pattern consistent with metabolic syndrome.

In a study comparing post-menopausal to pre-menopausal women, post-menopausal women had higher blood glucose, hemoglobin A1C (more on this below), and inflammatory markers.

Furthermore, it’s not only declining sex hormones that drive metabolic changes, but the metabolic changes also affect estrogen balance. Blood sugar imbalances can make menopausal symptoms worse. For example, insulin resistance is associated with increased hot flashes.

A woman’s risk for chronic disease increases dramatically after menopause as she loses metabolic protection that reproductive hormones provide. Intentionally working to balance blood sugar helps to mitigate that risk.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome, PCOS, is the most common endocrine disorder in pre-menopausal women. It’s characterized by polycystic ovaries, elevated androgens (like testosterone), and irregular or absent menstrual cycles.

Insulin resistance is a piece of the PCOS picture for most women. High androgens drive insulin resistance, and insulin resistance drives higher androgens in a vicious cycle. The hormone and blood sugar imbalances make weight loss and fertility challenging for many. It also increases the risk of gestational diabetes and type 2 diabetes.

Nutrition and lifestyle strategies to balance blood sugar are foundational as an integrative approach to PCOS treatment.

Blood Sugar Testing

You may receive a fasting blood glucose check at your annual physical, but it is possible to have a normal fasting blood glucose result but still experience blood sugar dysregulation. Let’s look at some additional testing that provides a more complete picture.

• Fasting blood glucose – While we want this to be under 99 mg/dL, an ideal fasting value is around 80 or 85. If you notice this trending up each year, it’s time to intervene.

• Hemoglobin A1C – This blood test estimates average blood sugar levels over the previous 3-months. Normal levels are considered below 5.7%, although optimal levels might be closer to 5%.

• Fasting insulin – A fasting insulin blood test looks at insulin levels after a 12-hour fast. High levels may indicate insulin resistance. The standard lab range is around 2 to 25 uIU/mL, yet from a functional perspective, we would like to see this value on the low end of the range.

• HOMA-IR – The Homeostatic Model of Insulin Resistance (HOMA-IR) is a calculation using insulin and glucose levels to estimate insulin resistance. A value of less than 1.0 is ideal, suggesting insulin sensitivity. Values above 1.9 indicate early insulin resistance and progress from there.

• Continuous glucose monitor – While fasting blood glucose only gives one data point, us a continuous glucose monitor (or CGM) provides continuous data. It can be an extremely helpful tool for learning how your body responds to various foods, meals, exercise, etc., so you can personalize your approach to blood sugar control. Read more about CGMs for women’s health here.

There is always some nuance and skill in interpreting lab results and putting them in the context of your overall health, lifestyle, and goals. Please work with your TārāMD clinician for personalized testing, interpretation, and guidance.

How to Balance Your Blood Sugar

Blood sugar imbalances most often occur slowly, over time, and with multiple contributing factors. Hormones play a significant role, as do nutrition, exercise, sleep, and other factors you have a lot of control over.

It’s important to act sooner vs. later; the earlier you catch blood sugar imbalances and insulin resistance, the easier it is to reverse. If you’re in perimenopause or have an underlying hormonal condition like PCOS, balancing blood sugar becomes even more critical.

Here are some ways to promote blood sugar balance:

• What you eat – Food is the foundation of blood sugar balance. Eat regular, balanced, whole-food meals. Choose high-fiber carbohydrates and dress them up with fat and protein. Read more here.

• How you eat – Eating in a relaxed state promotes better digestion and metabolism. Slow down with meals, chew, and try not to pair eating with stressful activities, like driving, working, or reading the news.

• Exercise – Exercise is powerful for metabolic health because it allows glucose into muscle cells without insulin. Take walking breaks throughout the day and after meals to break up sedimentary time and decrease blood sugar levels. Additionally, building lean muscle will improve insulin sensitivity.

• Try supplements – While the lifestyle factors are foundational, adding targeted supplements can provide extra support for blood sugar control, especially during phases of hormonal change or imbalance. Some supplements to consider for blood sugar balance and metabolic support include:
  • Berberine
  • Creatine
  • Alpha lipoic acid
  • Inositol
  • Cinnamon

• Talk with your doctor about BHRT – Bioidentical hormone replacement therapy may support metabolic health during perimenopause and menopause (and possibly other life phases) by replacing the lost hormones that promote health. Speak with a menopause specialist (Fenske holds certification from The Menopause Society) about the benefits of treatment and to determine if you are a good candidate. Learn more here.

Blood sugar influences women’s hormones, and in turn, hormones affect blood sugar. Learning what works for you to keep blood sugar stable is foundational for all aspects of health and even more critical for women in perimenopause or with PCOS and other endocrine conditions. You don’t need to figure it out independently; the TārāMD team is here to help you dial in the details.

References

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