People often discuss our blood sugar levels in relation to our health. But how does blood sugar actually impact our well-being, and why is it especially important during menopause? In this blog post, we explore the importance of balancing blood sugar levels and provide tips on managing them through nutrition and lifestyle.

What are blood sugar levels?

Sugar is a type of carbohydrate and one of the simplest forms of sugar is known as glucose. Many of the food and drinks that we consume contain carbohydrates. Our body’s digestive system breaks down these carbohydrates into glucose. This glucose then enters our bloodstream and this level can be measured. But why does the amount of sugar/glucose in our blood matter?

Carbohydrates are a crucial source of energy for the body. Typically, when glucose enters the bloodstream, a hormone known as insulin is released. This glucose enters all the cells in our body and gives us energy. It is important that the majority of the carbohydrate sources we choose result in a slow rise of blood sugar levels to give us energy over a longer period of time. On the flip side, consuming too many carbohydrate sources that cause blood sugars to rise and fall very quickly can result in low energy levels and hunger. Over time, this can lead to some health problems – this will be discussed more later. 

How does menopause affect the balance of your blood sugar levels?

Hormonal changes

Research shows that the hormone oestrogen supports the delivery of insulin to cells., reducing the amount of glucose in your blood, and helping to regulate your blood sugar levels overall [1]. However, the onset of menopause, and the significant decrease in oestrogen levels that come along with it, can make it more challenging for your body to control your blood sugar levels. This drop in oestrogen can weaken your body’s ability to respond to the insulin that it makes. This is known as ‘insulin resistance’ and can therefore result in overall higher blood sugar levels. In addition, changes in oestrogen levels alter how the body stores fat, often leading to accumulation in the abdominal area. This ‘central adiposity’ can further stimulate insulin resistance [2].

Common symptoms of blood sugar imbalance

You may not notice any signs that your blood sugars are imbalanced, but some symptoms include:

• Fatigue
• Cravings – particularly for sugary foods
• Headaches
• Weight gain – particularly around the abdomen
• Feeling thirsty often
• Mood swings
• Brain fog

Many peri- and postmenopausal women experience these symptoms, so an imbalance in your sugar levels may exacerbate them. For more information on symptoms of menopause, check out this blog.

Health risks associated with blood sugar imbalance

In the long-term, a lack of regulation of your blood sugar levels and insulin resistance can have negative consequences for your health. The risk of developing metabolic syndrome increases [2]. Metabolic syndrome is characterised by having a number of conditions that collectively increase your risk of type 2 diabetes, heart disease and stroke. These include central adiposity, high blood pressure, high blood sugar levels, high levels of blood triglycerides and low levels of HDL (‘good’) cholesterol. It is difficult to avoid these risks in menopause due to the inevitable hormone changes. However, the health problems can be avoided through diet and lifestyle.

Key strategies for balancing blood sugar levels

Balanced Meals

Ensuring each meal and snack are balanced with sources of protein, healthy fats and fibre can help stabilise blood sugar levels. When consuming these other nutrients with carbohydrates, the release of glucose is slowed down, helping to prevent sugar spikes in the blood. In turn, this will promote a more gradual and stable energy supply throughout the day. 

Portion control and meal timing

Being in control of your food and drink portions is a simple way of controlling your blood sugars. It is generally recommended that 1/2 of your plate should be made up of non-starchy vegetables, 1/4 should be a protein source and the remaining 1/4 should be a carbohydrate source. Sticking to the right portion sizes helps to prevent consuming excess carbohydrates and calories. This is more difficult when eating out which is why homecooked meals the majority of the time is the best way to manage blood sugar levels. Other ways to control portion sizes include:

• Using smaller plates and bowls
• Check food labels for recommended portion size
• Eat slowly to help you realise when you are full
• Freeze leftovers to use another day

There is some research to suggest that the timing of meals during the day can affect your blood glucose levels. In particular, a late dinner or eating during the night has been associated with hyperglycaemia (high blood glucose levels) and a risk of developing diabetes [3]. Different time windows in which to eat have been suggested in different studies and it is highly unlikely that one method would suit everyone. However, ensuring to eat breakfast in the morning, waiting around 4 hours between each meal, and avoiding late-night eating are strategies that will likely benefit your blood sugar regulation.

Mindful carbohydrate choices

We all need carbohydrates because as mentioned before, they are a vital source of energy for our bodies and particularly our brains. Carbohydrates should therefore not be excluded from our diets, however we can make better choices when it comes to the type of carbohydrates we consume. Choose complex carbohydrates with a low glycaemic index (GI) that are higher in fibre and will release glucose more steadily (e.g. wholegrains, legumes, vegetables), rather than refined carbohydrates that will cause rapid spikes in blood sugars (e.g. white bread, white rice/pasta, fizzy drinks, sweets, crips). 

Staying hydrated

Dehydration reduces the amount of water in your bloodstream and therefore the concentration of sugar in your blood rises. Staying hydrated throughout the day is important for regulating blood sugars and for maintaining metabolic health overall.  As well as still and sparkling water, you can get your fluids in through beverages like teas, coffee and milk. You can also flavour water by infusing it with different fruits. 

Nutrients for balancing blood sugar levels

Let’s have a closer look at why certain nutrients help regulate your blood sugars.

• Fibre – high-fibre carbohydrate sources release glucose at a slower rate and help to promote fullness, thereby reducing hunger and further cravings. Some examples of high-fibre foods include oats, beans, peas, lentils, vegetables (e.g. carrots, broccoli, cauliflower), wholegrains (e.g. brown rice, quinoa, bulgar wheat)
• Healthy fats – certain sources of fat can also help to reduce spikes in your blood sugar and release energy gradually. Choose foods such as avocados, nuts, seeds and vegetable oils for rich sources of mono- and poly-unsaturated fats, rather than choosing foods high in saturated fats such as butter, cakes and processed meat.
• Protein – when protein is part of a meal or snack that contains carbohydrates, it helps to slow the absorption of glucose into the bloodstream. It is best to choose lean protein sources, such as white fish, poultry, beans and tofu as these are lower in saturated fat and can aid in weight management. Protein is especially important for menopause to maintain muscle mass which normally starts to decline around this time.
• Micronutrients – there are certain vitamins and minerals that research has shown help in the management of blood glucose. For example, low levels of both magnesium and chromium have been associated with insulin resistance and type 2 diabetes. Foods rich in magnesium include green veg, nuts, seeds and dark chocolate, whereas chromium is found in foods like wholegrains and egg yolks. Vitamin E is especially important for improving the body’s response to insulin contributing to stable glucose levels in the blood. There is evidence for the beneficial effects of vitamin D, including supplementation, on blood sugars. It may help to promote the secretion of insulin and a deficiency in the vitamin has been linked with poor insulin sensitivity [4]. To learn more about supplements in menopause, you can read this blog.

Lifestyle strategies for balancing blood sugar levels

Physical activity

Whether or not you have insulin resistance, exercise is an important strategy for managing blood sugar levels as it makes our bodies more sensitive to insulin, allowing it to move more glucose from the bloodstream to our cells. The recommended level of exercise for adults in the UK is 150 minutes moderate activity or 75 minutes vigorous activity per week. To maintain strong bones and muscles, this should also include strength exercises on 2 days of the week. This level of physical activity can reduce your risk of type 2 diabetes by 40% [5]. 

Stress management

Stress is a prevalent aspect of life these days and a difficult one to manage. However, getting our stress levels under control will significantly benefit how our bodies manage blood sugars. When feeling stressed, hormones known as cortisol and adrenaline are released but this actually impairs the secretion of insulin and so blood sugars may rise as a result. As well as eating a healthy diet and taking time to exercise, you can manage stress using techniques such as yoga, mindfulness, and deep breathing. Self-care is important and talking to friends or family members can also help ease your mind and body.

Sleep quality

Among symptoms of menopause, disruption to your sleeping pattern is a common one. Studies report that 33-51% of women experience poorer sleep quality during peri- and post-menopause years. [6]. It is unclear why, but links have been reported between insufficient sleep and poorer blood glucose control, which can in turn increase the risk of type 2 diabetes [7]. Here are some ways to help improve your sleep quality and get 7-9 hours of sleep every night:

• Eat a healthy diet rich in wholegrains, fruit and veg
• Engage in any form of physical activity
• Avoid drinking alcohol at least 3 hours before you go to bed
• Avoid looking at screens at least 1 hour before you go to bed
• Try to stick to a consistent sleeping schedule
• Swap caffeinated tea for decaf tea before bed 
• Swap biscuits and sweets as an evening snack for nuts and dark chocolate – their magnesium content can help promote sleep

Do you need to monitor your blood sugar levels?

There are multiple ways to measure blood sugars, from finger prick tests to continuous glucose monitoring (CGM). Your GP can test your blood sugars for you but nowadays companies exist that supply glucose monitors to you at home, even to those without diabetes. They involve wearing a small monitor on your arm that can read your blood glucose level any time of day or night, which you can find out on a mobile device. In general, normal blood sugar levels before a meal are 4-7mmol/l and 8.5-9mmol/l or less after a meal. You may sometimes have your HbA1c level tested which is your average level of blood sugars over the last few months and a normal value for this is 48mmol/mol. CGM for those without diabetes can be a useful tool for finding out about how your body responds to glucose, and may help highlight insulin insensitivity, especially given that around 30% of people in England living with type 2 diabetes are undiagnosed [8]. One recent study has reported improved menopause symptoms in women who were given personalised dietary advice through an app and blood glucose was one aspect that was monitored to provide this advice [9]. 

However, these personal CGMs can be very expensive and may cause unnecessary fixation on normal variations in daily blood sugar levels. It is a good idea to test every once in a while with your GP and any concerns can be discussed with them, but otherwise your body is likely doing its job and sticking to a healthy diet and lifestyle habits will support this.

Foods which help balancing blood sugars levels

• Porridge made with milk with toppings like berries, nuts and seeds
• Toasted wholegrain bread with sliced avocado and poached eggs, topped with spinach and seeds
• Greek yoghurt with homemade granola and fruit
• Chicken or tofu stir fry made with brown rice, steamed kale and broccoli
• Chicken/turkey/tofu salad made with feta cheese, spinach and grains e.g. quinoa, bulgar wheat
• Brown pasta with homemade green or red pesto, spinach chicken and chickpeas
• Wholemeal bagel with smoked salmon and cream cheese
• Hummus on wholemeal crackers topped with cucumber and turkey slices
• Peanut butter on wholemeal crackers with sliced banana
• Haddock with asparagus and brown rice

Summary

Hormonal changes in menopause mean that it can be more difficult for your body to control your blood sugar/glucose levels. It may lead to insulin resistance which can present itself with symptoms such as fatigue, sugar cravings and abdominal weight gain. Persistent lack of control over blood sugar levels and insulin resistance can lead to health problems like type 2 diabetes and heart disease.

There are a number of diet and lifestyle strategies to help balancing blood sugar levels:

• Eating balanced meals with protein, healthy fats and fibre
• Controlling portion sizes of meals
• Choosing complex carbohydrates with a low glycaemic index such as wholegrains, legumes, vegetables
• Staying hydrated with fluids throughout the day
• Engaging in physical activity every day
• Managing stress levels
• Getting sufficient sleep every night

Our bodies are excellent at producing insulin to help reduce our blood sugars after a meal and maintaining stable levels. Continuous glucose monitoring is likely not needed for most people, however your GP may check blood sugar levels every few years for older adults. In the meantime, eating a healthy and balanced diet with an active lifestyle is the best way to balancing blood sugar levels.