Written by Laura Tarbell, Board Certified Wellness Coach, Functional Nutrition Practitioner, Precision Nutrition Level 1 Coach, Clean Health Level 3 Personal Trainer, Advanced STOTT Pilates Instructor, IFBB Pro Bikini Competitor, and Contest Prep Specialist

Photography by Paul Buceta

Hair & Makeup by Monica Kalra

PART FOUR of a six-part series dedicated to learning how to navigate midlife hormonal and metabolic chaos, with vitality, to live your menopausal years to the fullest.

Maintaining proper blood sugar metabolism is essential for a lifetime of excellent health. While this is influenced by a number of genetic and environmental factors, growing evidence suggests that hormonal changes during perimenopause can throw blood sugar levels out of whack. Women may then not only find themselves grappling with the ebb and flow of sex hormones but also battling the metabolic disruption of blood sugar, insulin, and carbohydrate balance. This trio greatly influences everything from mood swings to energy levels. By knowing perimenopause’s hormonal impact, and how to apply smart carbohydrate and lifestyle choices to maintain proper blood sugar levels, you’ll be empowered to find your sweet spot of sugar regulation during this transition.

Let’s begin by defining what blood sugar is and why it’s important. Blood sugar, or blood glucose, refers to the concentration of glucose present in the bloodstream. Glucose is the preferred and most efficient energy source for the body’s cells. Its levels are tightly regulated to ensure proper functioning of various organs and systems. The primary source of glucose is the food we eat, especially carbohydrates. When we consume carbohydrates, the digestive system breaks them down into glucose, which is then absorbed into the bloodstream. The pancreas plays a crucial role in maintaining blood sugar levels as it releases the hormone insulin, which shuttles glucose out of the bloodstream and into cells for energy. To better understand this process, think of the cell as a car and the cell’s receptor as the gas tank. Insulin is the key to open the gas tank so that you can fill it up with gasoline, or blood sugar. However, we don’t want the tank to overflow. So in response to blood glucose levels, cellular energy demands, and hormonal signals, sugars can also be shuttled to the liver or muscles for storage as glycogen for later use. 

One of the physiological changes that happens with age is that we are more prone to developing insulin resistance (IR). In IR, cells become less sensitive to insulin’s signals, leading to a buildup of glucose in the bloodstream. The pancreas then works extra hard in an attempt to correct the elevated blood glucose by pumping out more and more insulin. 

Over time this is dangerous because if not corrected, the pancreatic beta cells that make insulin can wear out. Eventually, the pancreas no longer produces enough insulin to overcome the cells’ resistance. The result is higher blood glucose levels, and, in addition to feeling hangry, moody, inflamed, and having difficulty losing weight, can lead to pre-diabetes or type 2 diabetes. 

Why You Should Care About High Insulin And Blood Glucose Levels

The body’s ability to switch between glycolysis (“sugar burning”), and lipolysis (“fat burning”), is known as metabolic flexibility. This is influenced by energy needs, hormonal signals and nutrient availability and is crucial for maintaining energy balance. The more efficiently and effectively your body flips the switch from burning carbs to burning fat, the more sustained energy you’ll have and the more fat you’ll burn, resulting in improved body composition(1). But if blood glucose levels are always high, the body remains in a constant sugar burning state and never switches into fat burning. 

The Stress Connection

The role of the liver in glucose regulation is important. It keeps excess sugar either tucked away or releases it into the blood stream depending on its hormone interaction. Hormones are like signals that unlock certain liver processes. Depending on which kind of signal arrives, the liver will either release or stash more sugar. When cortisol, our body’s main stress hormone, arrives, it signals to the liver to release sugar into the bloodstream to provide energy. This process is part of the body’s natural fight-or-flight response. And while acutely, blood sugar elevation is beneficial, say for a hard training session, persistent high levels of cortisol can lead to cortisol dysregulation and ultimately elevated blood sugar. 

How Muscle Helps Blood Sugar Management

In addition to age, the loss of muscle mass drives up glucose levels. The average adult will lose about three to eight percent of their muscle mass(2) every decade after age 30­­–a loss that accelerates to five to 10 percent after the age of 50(3). Muscle acts like a sponge for glucose as glucose is an important fuel for contracting muscle. Skeletal muscle is responsible for more than 80% of glucose uptake after eating(4). Research shows an inverse association of skeletal muscle mass with blood glucose levels(5). So if you want to lower glucose levels, focus on building more muscle! 

What Does Estrogen Have To Do With It? 

Estrogen has an impact as it stimulates the cells that line blood vessels to deliver insulin to muscles, lowering blood sugar and protecting against type 2 diabetes, researchers from UT Southwestern Medical Center report(6). Therefore, fluctuating and ultimately declining sex hormones make it harder to manage blood sugar and we have a tendency to become more carbohydrate sensitive and insulin resistant.

For athletes, carbs are an essential training nutrient. So more than ever, in midlife and beyond, the quality and timing of your carb choices is important. Getting the majority of your carbs from processed sources, like breads or brownies, is not going to cut it. Your body needs nutrient-dense foods to maintain a healthy gut-microbiome, regulate blood sugars, support sex, adrenal and thyroid hormones, and provide ample amounts of energy for exercise and daily activities. The “goldilocks” total daily intake of carbs is nuanced and unique to each individual. You can adjust carb intake depending on activity level. Dr. Stacy Sims, MSC, PHD, one of the world’s leading researchers on females and author of ROAR and NEXT LEVEL, suggests that to avoid low energy availability in your workouts and daily activities, you should consume: 

• 1.13-1.4 g/ lb/day of carbohydrates for light or non-training days.

•  1.6-1.8 g/ lb/day of carbohydrates for moderate to high-intensity training that lasts
60 to 120 minutes.

• 2-2.7 g/ lb/day of carbohydrates for endurance training involving two to five hours of intense training (e.g. distance running, cycling, swimming)(7).

There are a variety of tools available to track the maintenance of healthy glucose metabolism, such as Regular Blood Work, Using a Continuous Glucose Monitor (CGM), and The Finger-Prick Test.

Ideal Glucose Levels

For blood glucose levels through blood work, CGM, or finger prick, optimal functional levels lie between 70-90 mg/dL. (Note: This may not be the range listed on your lab work. Different regions may show different ranges, but the optimal functional range never changes.)

For A1C, ideal levels are 5.6 or below. However, an A1C of 5.6 (considered “normal”) may actually mean a postprandial glucose of 114, a number far too high if you’re looking to achieve optimal functional health.

For insulin, optimal functional numbers range from two to five. ‘Normal’ ranges can be much larger, but remember, normal does not necessarily mean optimal for good health and weight control. 

When to test: The best way to find out how your body is handling sugars is through Glycadian Rhythm Testing. In this, you’ll test glucose when you wake and then two hours after each meal. Sugars should have a natural rise of about 20-30 mg/dl above your set fasted point around the one hour mark post meal, and go back to your set point around two hours post meal.

5 Quick Tips To Control Blood Sugar Levels

1. Eat Plenty Of Fiber

What you eat matters. Consume 45-60g of fiber a day to help control blood sugar spikes. How much you eat matters too! This is called glycemic load. Eating a serving of blueberries may not have a huge effect on your sugar levels but eight servings of blueberries will! 

2. Be Active Around Carb Intake

Studies show that a 30-minute brisk walk within 30 minutes after a meal can lower your blood sugar 50 times more than being sedentary(8).

3. Stay Hydrated

Drinking water can help to reduce your blood sugar levels by diluting the amount of sugar in the bloodstream. Adequate intake of water also helps to alleviate the dehydration that comes with excess urination caused by high glucose levels. 

4. Reduce Toxic Exposure

Constant exposure to toxins such as processed foods, BPAs, fire retardants and pesticides cause inflammation and stress in the body (refer to Part Three of Master Midlife for more on this). 

5. Manage Stress

Cortisol and blood sugars have an interdependent relationship. When one
rises, so does the other. High-fasted morning glucose levels can indicate a high cortisol awakening response. Start your day in a calming manner, get some sunlight and stay off devices for the first 20-30 minutes of your day.


References: 1. PMID: 29697773 2. PMID: 15192443 3. https://doi.org/10.1186/s12905-023-02671-y 4. PMID: 32940941 5. PMID: 34856088  
6. https://doi.org/10.1038/s41467-023-40562-w 7. Sims, PhD, S. (2016). ROAR. New York: Rodale. 8. PubMed: 27926890

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