Signs of Insulin Resistance in Perimenopause We See Most
Insulin resistance in perimenopause means your cells stop responding well to insulin, so your body pumps out more of it to get the same job done. The early signs are behavioral before they are clinical. An afternoon crash, hunger an hour after eating, and a waistband that changes while the scale sits still.
She does not announce herself. Insulin resistance, we mean.
Nothing hurts and nothing breaks, and for most of our ladies the first clue is something small and annoying, like needing a handful of chocolate chips at 3pm when that was never a thing before, or the jeans buttoning but pinching while the number on the scale has not moved an inch.
More than 2 in 5 American adults have prediabetes, and 8 in 10 of them do not know it, according to the CDC. Most of them feel fine. Some of them feel a little off and chalk it up to being busy, or being 47.
We are coaches, not doctors, and nobody can diagnose you from a blog post. What we can give you is the pattern we hear on calls every week from women 42 to 58, and what tends to help.
What insulin resistance is, minus the jargon
Insulin is the key that lets glucose out of your bloodstream and into your cells. Insulin resistance is your cells getting slow to answer the door, so your pancreas sends more keys. Blood sugar can look fine on paper for years while insulin quietly runs high in the background.
Muscle is where most of that glucose is supposed to go. Somewhere between half and two thirds of the glucose from a mixed meal gets taken up by skeletal muscle, which makes your muscle the storage tank for everything you eat. So when muscle mass drops, and it does in midlife unless you are training, you lose the room to put the food. (AHA Journals)
More coming in, less space to store it, more insulin working overtime. That is the whole mechanism.
Why perimenopause changes the math
Estrogen does metabolic work, not just reproductive work, and when it starts swinging and dropping, fat stops going to the hips and thighs and starts parking around the middle.
The Study of Women's Health Across the Nation followed midlife women through this and found that the menopause transition comes with increasing visceral fat, and the size of the weight gain across the transition determined the risk of developing insulin resistance. (Wiley Online Library)
Then there is the piece nobody warns you about. In a four year study of women moving through the transition, activity energy expenditure dropped significantly during the perimenopausal years. Not workouts you skipped. Movement your body stopped doing on its own, in the kitchen, up the stairs, across the parking lot. (PubMed Central)
And the trend line is bigger than any one woman. Among nondiabetic US adults, insulin resistance rose from 24.8% in 1999 to 38.4% by 2018. (PubMed Central)
The scale is the last thing to change and the first thing we look at. Flip that order and perimenopause makes a lot more sense.
The signs we hear most
None of these are diagnostic on their own. They are worth paying attention to as a group, not one at a time.
The 3pm crash that feels chemical. Lunch was a sandwich and chips, and by mid afternoon you are foggy and irritable and looking for something sweet. A big glucose rise followed by a hard drop feels exactly like that from the inside.
Hunger an hour after a real meal. You ate. You were full. Sixty minutes later you are standing in the pantry. When insulin runs high it pulls glucose down fast, and hunger follows it down.
The waistband change with no scale change. This is the one our ladies name first, and it is the most specific signal in the whole list. Same weight, different shape, and the jeans that fit in April do not fit in October.
Cravings that feel louder than they used to. Pam G., one of our VIP ladies, named "more energy, less sugar cravings" as her biggest 21 day win, and the cravings going quiet is usually the first thing women notice once meals get built differently. Nothing about that required her to white-knuckle anything.
The skin stuff. Skin tags along the neck or under the arms, or dark velvety patches in the folds of your skin, are recognized physical signs of high circulating insulin. Point them out at your next appointment.
What to ask your doctor to check
We cannot order labs and we would never tell you what to do with your results. What we can tell you is what to ask for, because "your blood work looks fine" usually means somebody glanced at fasting glucose by itself.
Fasting insulin, not just fasting glucose. Insulin can climb for years before glucose ever moves.
A1C, which gives your doctor a three month average instead of one morning.
Triglycerides and HDL together, since that ratio tends to travel alongside insulin resistance.
A fasting glucose of 99 is normal. It is also one point below the range the CDC uses for prediabetes, and the awareness gap in that range is enormous. Ask for the fuller picture, and ask again if you get brushed off.
What we do about it with our ladies
Nothing here involves giving up the food you love. We have watched too many women try that version and quit by week three, and then blame themselves for it.
Protein at every meal, starting with breakfast. Protein blunts the glucose rise, keeps you full past the two hour mark, and gives your body the raw material for the muscle doing the storing. Most of our ladies are eating about half of what they think they are. Coffee and a banana is not a breakfast that holds you until noon.
Lift heavy three times a week. Your muscle is the tank, and exercise is a strong stimulus for improving how muscle takes up and stores glucose, whatever the scale does in the meantime. Three sessions you will actually do beats five you will not. (AHA Journals)
Walk after your biggest meal. Ten or fifteen minutes is enough, because contracting muscle pulls in glucose through a route that does not require insulin at all. Gina walked 20,000 steps a day in her teaching years, stepping in place at the front of a classroom, and that ordinary movement is the part that quietly does the work. (AHA Journals)
Protect sleep before you add anything else. Short nights and high stress both nudge blood sugar in the wrong direction, and there is no meal plan that outruns four hours of sleep.
And the wine stays. A 6 oz glass of Sauvignon Blanc is about 150 calories, and you put it toward your carbs or your fats and go enjoy your night. Friday pizza stays too. That is the 80/20 lifestyle, and it is the only version of this we have seen women hold onto for years instead of weeks.
Where to start this week
Add 30 grams of protein to breakfast and change nothing else for seven days.
Walk 10 minutes after dinner, phone in your pocket.
Book the lab work and ask for fasting insulin by name.
Don't get on that scale while you do it. Watch the 3pm slump instead, and whether the jeans button differently by the end of the month. Those move first, and they tell you more.
Ready to stop guessing at your own body?
VIP is macros built for you and this season of you, workouts you can do in your basement, and two coaches who notice when you go quiet for a week. Progress over perfection, with somebody watching.
We are your gals.
