11: Understanding Insulin Resistance During Perimenopause

Oct 21

EP. 11

Struggling with stubborn pounds around your midsection, despite sticking to a healthy diet and regular exercise, is a frustrating reality for many women as they enter perimenopause and menopause. Hormonal shifts—particularly a decline in estrogen—can trigger insulin resistance, making it harder to lose weight, control blood sugar levels, and maintain muscle mass.

In this episode, the first of my Endocrine Series, we dive into what insulin resistance is, how decreasing estrogen during perimenopause worsens it, and the key steps you can take to monitor and manage it effectively. Tune in for practical tips to help you work with your healthcare providers and take charge of managing insulin resistance, weight changes, and overall metabolic health during perimenopause and beyond.

Listen to the full episode:

Today, we’re diving into what insulin resistance is, how decreasing estrogen during perimenopause worsens it, and the key steps you can take to monitor and manage it effectively. Read on for practical tips to help you work with your healthcare providers and take charge of managing insulin resistance, weight changes, and overall metabolic health during perimenopause and beyond.

What Is Insulin Resistance?

To fully grasp what insulin resistance means, it’s essential to understand the role of the pancreas. This vital organ is nestled in the middle of your abdomen, just below the ribs. It consists of various cells, but its primary players are the beta cells, responsible for producing insulin.

Insulin is crucial for our bodies because it helps store and process the carbohydrates we consume, ensuring we have a steady supply of energy. When the beta cells function correctly, they efficiently produce insulin to manage blood sugar levels. However, when these cells start to malfunction, problems arise, leading to insulin resistance, pre-diabetes, and potentially type 1 or type 2 diabetes, depending on the nature of the dysfunction.

Imagine your pancreas as a factory assembly line. The beta cells work tirelessly, producing insulin and packaging it for distribution. This insulin either helps store carbohydrates or allows the body to utilize them as energy. But what happens when this assembly line malfunctions?

Understanding Pancreatic Malfunctions

The pancreas plays a critical role in insulin production and overall metabolic health. However, it can malfunction in a couple of significant ways, leading to insulin resistance and various forms of diabetes. The two major categories of pancreatic malfunction are:

1. Autoimmune Attack

An autoimmune attack occurs when your immune system, which is meant to protect you from harmful pathogens, mistakenly targets your body's own tissues. In this case, the white blood cells that typically fight off bacteria and viruses begin to view the pancreas as an enemy. They target the beta cells—those responsible for producing insulin—and initiate an attack.

As a result of this autoimmune response, beta cells are gradually destroyed, leading to a reduced ability to produce insulin. This destruction is the primary cause of type 1 diabetes, where the body's own defense mechanisms ultimately impair its ability to regulate blood sugar levels.

2. Insulin Resistance from Body Composition Changes

The second way the pancreas can malfunction is through insulin resistance, often exacerbated by changes in body composition. Factors such as decreased physical activity, hormonal fluctuations (including those experienced during menopause), and dietary changes can all contribute to a shift in how your body processes fat and maintains muscle mass.

During perimenopause, many women experience an increase in fat accumulation around the abdomen, known as visceral fat. Unlike subcutaneous fat, which sits just under the skin, visceral fat is located deeper within the abdominal cavity and surrounds vital organs. This type of fat is particularly inflammatory and can impede the normal function of beta cells, making it harder for the pancreas to produce enough insulin to manage carbohydrate intake effectively.

Let’s think back to the pancreas as a factory assembly line. When your body is at a normal weight and functioning well, a cookie may require just a couple of units of insulin to process. However, as weight increases—especially due to the accumulation of visceral fat—the beta cells have to work much harder. For example, a person who has gained 20 to 30 pounds may now require four to eight units of insulin for the same cookie. This increased demand on the beta cells can lead to stress and burnout.

Just like an assembly line that becomes overloaded with tasks, when your body demands more insulin but the pancreas cannot keep pace, blood sugar levels begin to rise. This marks the initial stages of insulin resistance, where the body struggles to efficiently manage blood sugar levels due to the pancreas's diminished capacity to produce insulin effectively.

How Does Insulin Resistance Worsen in Perimenopause?

As women enter perimenopause, significant hormonal changes occur, particularly a decrease in estrogen levels. This hormonal shift has profound effects on body composition and metabolic health, leading to a worsening of insulin resistance.

With declining estrogen levels, many women experience an increase in weight around the abdominal area while simultaneously struggling to maintain muscle mass. This change in body composition exacerbates insulin resistance, making it increasingly challenging for the body to regulate blood sugar effectively.

Impact on Women with Diabetes

Interestingly, women diagnosed with either type 1 or type 2 diabetes often experience menopause earlier than their peers. They already face challenges with their beta cells, and the additional body composition changes during perimenopause further complicate their insulin resistance.

In my clinical practice, I frequently observe that women with diabetes see a significant increase in insulin resistance as they navigate menopause. This means that controlling blood sugar levels becomes even more difficult, leading to potential complications if not managed properly.

Gestational Diabetes Considerations

While research hasn’t definitively linked gestational diabetes to worsening insulin resistance in perimenopause, my clinical observations suggest otherwise. Although official studies may not support a strong connection, I’ve seen enough cases to feel that there is an interplay worth discussing. As women who have experienced gestational diabetes move into perimenopause, they may also find their insulin resistance becoming more pronounced.

Monitoring Your Insulin Resistance: Key Actions to Take

Here are some important steps to consider to help you monitor your insulin resistance during this transitional phase:

Pay Attention to Your Body: Be mindful of any changes in your body composition. Notice if you’re losing muscle mass in your arms or legs; this can be an early sign that your body composition is shifting. Additionally, if you start gaining weight around your midsection, this is often where insulin resistance begins to manifest.
Know Your Family History: If you have a family history of obesity, pre-diabetes, or diabetes, it’s essential to get screened for insulin resistance. This screening process is typically aligned with those for pre-diabetes or diabetes, so be sure to discuss this with your primary care provider.
Monitor Blood Sugar Levels: If you already have pre-diabetes or diabetes, keep a close eye on your blood sugar levels. You may be maintaining the same exercise routine and diet, but if your blood sugar readings are increasingly problematic, it could indicate that perimenopause is worsening your insulin resistance.
Consult with Healthcare Professionals: It's vital to communicate with your doctor about the possibility of hormone replacement therapy and any necessary adjustments to your medications. Addressing both hormonal changes and insulin resistance is crucial for effective management.
Advocate for Yourself: When visiting healthcare providers, ensure you advocate for appropriate tests to screen for insulin resistance. Your input about your symptoms is invaluable, as it helps guide your healthcare team in understanding your needs.

Navigating the changes brought on by perimenopause can be challenging, especially concerning insulin resistance and metabolic health. By staying vigilant and proactive—monitoring your body, understanding your family history, keeping track of your blood sugar levels, and advocating for your health—you can take significant steps toward maintaining your well-being. Remember, communication with your healthcare team is essential in managing these transitions effectively, allowing you to thrive during this important stage of life.

Komal Patil-Sisodia