12: Managing Prediabetes in Menopause
EP. 12
Previously, we explored insulin resistance, a condition where your body struggles to use insulin effectively, often worsened by hormonal shifts during perimenopause. Now, we turn our attention to prediabetes—a stage where blood sugar levels are elevated but not yet high enough for a type 2 diabetes diagnosis. While prediabetes increases the risk of developing type 2 diabetes and cardiovascular disease, it doesn’t have to be inevitable. Early intervention is key.
Today, we’ll discuss how simple lifestyle changes—like adjusting your diet and exercise—can reverse prediabetes, regulate blood sugar, and lower health risks. We'll also cover medical treatments, including anti-obesity medications and hormone replacement therapy, to further support metabolic health.
Listen to the full episode:
What is Prediabetes?
Prediabetes occurs when your body is no longer able to keep blood sugar levels within the normal range. This is often due to stress on the beta cells in the pancreas, which produce insulin. As insulin resistance increases, these cells work overtime to maintain blood sugar control. Eventually, they reach a tipping point where they can’t keep up, and blood sugar levels begin to rise.
In the early stages, blood sugar may still be within a normal range, but once it reaches the "prediabetes" threshold, it signals that your beta cells are starting to struggle. According to the American Diabetes Association, prediabetes is characterized by a fasting blood sugar of 100 to 125 mg/dL, while the World Health Organization defines it as 110 to 125 mg/dL. Ethnic background can also influence which range is more appropriate.
Another key marker of prediabetes is your hemoglobin A1C level, which reflects your average blood sugar over the past three months. A hemoglobin A1C between 5.7% and 6.4% indicates prediabetes. This test measures the percentage of red blood cells that have glucose attached to them—an indication that your body is struggling to regulate blood sugar effectively.
In essence, prediabetes is the warning sign that your pancreas and beta cells are under strain, and without intervention, it could progress to type 2 diabetes. Recognizing this early can help prevent further complications by taking action to regulate blood sugar and reduce stress on your beta cells.
How Lifestyle Choices Impact Your Pancreas
Think of your pancreas as an assembly line responsible for producing insulin, which helps your body use or store the carbohydrates you consume. Under normal conditions—when you're at a healthy weight and eating a balanced amount of carbs—this process runs smoothly. However, various factors can disrupt the balance and put excessive strain on this "assembly line." Here are some of the key stressors:
Overconsumption of Carbohydrates: Carbs are everywhere, and they're easy to overeat, especially since they light up the same reward pathways in the brain as highly addictive substances like crack cocaine. Processed foods and sugary snacks are widely available, making it all too simple to consume more than you realize.
Refined Sugars in Packaged Meals: In our fast-paced lives, we often opt for convenience foods, many of which are packed with refined sugars and starches. These added sugars cause blood sugar spikes, forcing the pancreas to produce even more insulin, overworking the beta cells.
Sedentary Lifestyle: We're more sedentary than ever due to desk jobs, technology, and busy schedules. Lack of physical activity reduces muscle mass, which in turn affects how efficiently our body uses insulin. Without enough movement, weight gain—especially around the midsection—becomes more common, further straining the pancreas.
Body Composition Changes: Aging, hormonal shifts (such as those during perimenopause), and environmental factors can cause a shift in body composition, leading to increased fat around the middle. These changes make it harder for insulin to do its job, pushing the pancreas to work overtime.
Chronic Stress and Sleep Deprivation: Stress and poor sleep are often overlooked but can greatly impact blood sugar levels. Both stress hormones and lack of sleep can interfere with how the body processes insulin, making it harder for the pancreas to maintain healthy blood sugar levels.
Together, these factors stress the pancreas, forcing it to produce more insulin. Over time, this can lead to prediabetes as the body can no longer regulate blood sugar effectively, pushing the assembly line to its limits
Slowing Down the Assembly Line: Lifestyle Tweaks to Improve Blood Sugar Control
To help your pancreas keep up with insulin production and prevent prediabetes from progressing, making mindful lifestyle changes can lead to better blood sugar management and overall health. Here are some practical ways you can slow down that overworked assembly line:
Watch Your Carb Choices: Focus on cutting back on refined sugars and starches, like white bread and sugary snacks. Instead, choose complex carbohydrates that come from whole foods such as fruits, vegetables, and whole grains. These are digested more slowly, keeping your blood sugar levels more stable.
Portion Control: Many of us have lost touch with what a true serving size looks like. It’s easy to overeat, especially in places like the U.S., where portions are often oversized. Take time to learn what a balanced serving looks like to avoid unnecessary stress on your pancreas.
Increase Fiber: Fiber is your friend. It helps slow down the absorption of sugar, giving your pancreas a break. Foods like beans, whole grains, and leafy greens are great ways to up your fiber intake without spiking blood sugar.
Exercise Regularly: Movement is crucial for reversing prediabetes. Studies show that as little as 11 minutes of exercise per day can make a significant impact on blood sugar control. For even better results, aim for 150 minutes of exercise per week, including both cardio and strength training.
Build Muscle: Strength training doesn’t just help with fitness—it plays a major role in keeping your metabolism up by preserving muscle mass, which burns more calories at rest. Aim for at least 30 minutes of strength training a few times a week to protect muscle and support your metabolic health.
Boost Your Protein Intake: Along with cutting down on refined carbs, it’s important to ensure you’re eating enough protein to maintain muscle mass. More muscle means a healthier metabolism and better blood sugar regulation.
These steps, combined with consistency, can help take some of the burden off your pancreas and restore balance to your insulin production.
Addressing Pre-Diabetes with HRT and Anti-Obesity Medications
As we navigate prediabetes, especially for women over 40, we must consider how hormonal changes and body composition affect our health. The decline in estrogen during perimenopause can exacerbate body composition changes, making it essential to take proactive measures.
For women in this demographic, I emphasize cutting back on refined carbs, prioritizing protein, and incorporating strength training and regular cardiovascular activity.
Additionally, discussing options with your healthcare provider is crucial. If your BMI is over 30, you may qualify for anti-obesity medications, which can aid in weight management and metabolic health. Some insurance companies also recognize those with a BMI of 27 or higher, especially if they exhibit signs of cardiometabolic disease.
Hormone replacement therapy (HRT) can also significantly impact prediabetes management. Research shows that HRT may reduce the progression of prediabetes to diabetes by up to 30%, making it a valuable consideration for women experiencing hormonal changes. While HRT can provide significant benefits, it's essential to understand that it is not the only solution. Lifestyle changes and weight management remain critical components of a comprehensive approach to preventing the progression of prediabetes.