Insulin Resistance and Perimenopause: A Guide to Diet, Exercise, and Blood Sugar

Why blood sugar becomes harder to manage in perimenopause

Insulin resistance is one of the most consequential and under-discussed metabolic changes of perimenopause. Understanding it helps explain some of the most frustrating experiences of this transition: weight that accumulates around the abdomen despite no obvious change in eating, energy crashes after meals, persistent carbohydrate cravings, and difficulty losing weight even with consistent effort.

Estrogen plays a direct role in insulin sensitivity. It supports the body's ability to use insulin effectively to move glucose from the bloodstream into cells, where it is used for energy. As estrogen declines, this regulatory effect weakens. Cells become less responsive to insulin, and the pancreas has to produce more of it to achieve the same result. Over time, this leads to higher baseline insulin levels and blood glucose that trends upward.

This shift is not inevitable or irreversible, but it does require a deliberate response. The dietary and lifestyle habits that worked well in your 30s may be genuinely less effective now, and understanding why is the first step to working with your changing biology rather than against it.

What insulin resistance feels like and how it shows up

Insulin resistance does not always come with obvious early symptoms, which is why it can progress unnoticed for years. But many women experience recognizable patterns before any formal diagnosis.

Abdominal weight gain is a hallmark. When insulin levels are chronically elevated, fat storage is promoted, particularly in the visceral fat compartment around the organs. This type of fat is more metabolically active and inflammatory than subcutaneous fat.

Energy crashes after carbohydrate-rich meals reflect blood sugar spiking and then dropping sharply as the body over-corrects with insulin. The afternoon energy dip that many women in perimenopause notice is often partly a blood sugar regulation issue.

Cravings for sweets and refined carbohydrates can intensify with insulin resistance, partly because the brain is not getting the steady glucose supply it works best with.

Difficulty losing weight despite caloric restriction is a common and deeply frustrating experience. When insulin is chronically high, fat breakdown (lipolysis) is suppressed regardless of what you are eating. Reducing insulin levels through diet and exercise is often more effective than simply reducing calories.

In the longer term, unmanaged insulin resistance increases the risk of type 2 diabetes and cardiovascular disease. Both risks already increase during perimenopause due to the loss of estrogen's protective effects.

Dietary approaches with the strongest evidence

There is no single diet that works for every person, but several dietary patterns have strong evidence for improving insulin sensitivity specifically.

Reducing refined carbohydrates and added sugar is the most consistently supported intervention across all research on insulin resistance. These foods cause the sharpest and fastest rises in blood glucose, driving the highest insulin responses. Replacing them with fiber-rich carbohydrates (vegetables, legumes, whole grains) slows glucose absorption and produces a more moderate insulin response.

Protein at each meal helps stabilize blood sugar and supports satiety. Adequate protein intake also preserves muscle mass, and muscle tissue is one of the primary sites of glucose uptake. Aiming for roughly 25 to 35 grams of protein at each main meal is a reasonable starting point for most women.

Healthy fats, including avocado, olive oil, nuts, seeds, and fatty fish, do not raise blood glucose and support satiety. Including fat in meals slows glucose absorption from carbohydrates eaten at the same time.

A lower-carbohydrate approach is effective for many women with insulin resistance. This does not have to mean very low carbohydrate or ketogenic eating. Simply shifting toward a carbohydrate intake centered on vegetables, legumes, and minimally processed whole grains, while reducing bread, pasta, rice, and sugary foods, produces meaningful improvements in insulin sensitivity for most people.

Time-restricted eating, eating within a window of 8 to 12 hours and fasting overnight, has accumulated evidence for improving insulin sensitivity. It is not appropriate for everyone, particularly those with a history of disordered eating, but for many women it is a practical and effective tool.

Why exercise is one of the most powerful insulin-sensitizing tools

Exercise is among the most effective interventions for insulin resistance available, sometimes comparable in effect to medication for people in the prediabetic range.

When muscles contract during exercise, they take up glucose from the bloodstream through an insulin-independent pathway. This means that physical activity lowers blood sugar and reduces insulin demand directly, without relying on improved insulin signaling. This effect lasts for hours after exercise ends.

Resistance training is particularly important because it builds lean muscle, and each additional pound of muscle increases the body's capacity to clear glucose from the blood. For women in perimenopause, where muscle mass is already under pressure from hormonal changes, strength training has a double benefit: it preserves metabolic tissue and directly improves glucose metabolism.

Even short walks after meals have a measurable effect on post-meal blood sugar. A 10 to 15 minute walk after eating is one of the simplest and most accessible interventions available, requiring no equipment and no dedicated workout block.

Aerobic exercise performed consistently over weeks and months improves insulin sensitivity at the cellular level, not just in the immediate post-exercise window. Combining aerobic activity and resistance training gives the broadest benefit.

Sleep, stress, and insulin resistance

Sleep deprivation is a powerful driver of insulin resistance. Even a few nights of shortened or disrupted sleep measurably reduces insulin sensitivity and raises fasting blood glucose. Since sleep disruption is one of the most common experiences of perimenopause, this creates a cycle where hormonal changes impair sleep, sleep impairment worsens metabolic function, and metabolic dysfunction makes hormonal symptoms more severe.

Addressing sleep disruption directly, whether through medical management of night sweats, better sleep hygiene, or behavioral interventions, is not just about how you feel. It is a metabolic intervention with measurable blood sugar benefits.

Chronic stress raises cortisol, which raises blood glucose. Cortisol is a counter-regulatory hormone that exists precisely to mobilize glucose in response to threat. When stress is ongoing, cortisol keeps glucose elevated, which keeps insulin elevated, which drives all the downstream effects of insulin resistance. Stress reduction is not optional for metabolic health in perimenopause. It is a direct intervention.

Testing and medical evaluation

Standard blood tests used to evaluate blood sugar and insulin status include fasting glucose, HbA1c (hemoglobin A1c, a measure of average blood sugar over three months), and fasting insulin. Many standard checkups only include fasting glucose and HbA1c. Fasting insulin is a more sensitive early marker of insulin resistance because it can be elevated for years before fasting glucose moves out of range.

If you are experiencing significant abdominal weight gain, energy crashes, or carbohydrate cravings that feel out of control, asking your provider for a fasting insulin level alongside the standard glucose and HbA1c tests is a reasonable step.

For women who already have prediabetes or type 2 diabetes, perimenopause may require adjustments to existing management plans. Insulin requirements can shift as hormone levels change, and medication doses may need revisiting.

In some cases, medications like metformin are used for insulin resistance during perimenopause, both for blood sugar management and for other potential benefits. This is a conversation to have directly with your provider based on your full clinical picture.

Small changes with a large cumulative effect

Managing insulin resistance in perimenopause does not require a dramatic overhaul of everything at once. Small, consistent changes accumulate into significant metabolic benefit over weeks and months.

Adding a 10-minute walk after your largest meal is a meaningful start. Shifting one meal per day to include more protein and fewer refined carbohydrates is another. Building two to three resistance training sessions into your week over a few months adds up to real improvements in glucose metabolism.

Logging your meals, energy levels, and workouts in PeriPlan gives you a way to notice the connection between what you eat, how you move, and how you feel. You might find that certain meals consistently cause afternoon crashes, or that your energy is noticeably better on days you moved in the morning. These patterns are valuable information.

The goal is not perfection. It is a consistent shift in the right direction. The payoff is better energy, easier weight management, lower long-term metabolic risk, and a body that works with you rather than against you.

This article is for informational purposes only and does not replace medical advice. Work with your healthcare provider to evaluate and manage blood sugar concerns.