How to Control Blood Sugar in Menopause for Better Sleep, Fewer Hot Flashes, and More Energy
We’re coming out of the menopause dark ages. Our needs are being heard (a little more), some research is being done (on us, for us), and hormones are back on the table.
If you follow the menopause world as closely as I do, you might start to think everyone should be on hormones. That’s for you and your doc to decide. But I’ll tell you this… even hormones won’t help you if you aren’t doing the unsexy foundational work to improve your health.
One big part of that foundational work is maintaining healthy blood sugar levels. And I get it—this isn’t just theory for me. Since hitting menopause, my own blood sugar has crept into the prediabetic range, which, as I’ve learned, is incredibly common. It was frustrating to realize that the same habits I had for years weren’t working anymore. But once I started focusing on stabilizing my blood sugar, everything changed—my energy, my sleep, and even those stubborn menopause symptoms.
That’s because blood sugar impacts so much more than just energy levels—it plays a major role in how we feel every single day. When it’s out of balance, the effects ripple through everything from our sleep to weight health.
Erratic blood sugar can make hot flashes worse and make sleep even more elusive. It can also make that belly fat all the more resistant to your weight loss efforts.
Poor blood sugar control has far-reaching effects on fat storage, sleep, stress, and inflammation. So let’s explore that a little.
Benefits of Good Blood Sugar Control During Menopause
Reduced Hot Flashes
Improved Sleep Quality
Easier Weight Management
Better Energy and Mood
How does blood sugar affect menopause?
It helps to understand the connection between your blood sugar and your stress hormones. I’ve written previously about the way blood sugar affects stress and sleep in great detail.
When you get low blood sugar, it causes adrenaline surges. You know that “hangry” feeling? You’re probably experiencing a bit of an adrenaline surge associated with a blood sugar drop. That hangry feeling might be common, but it’s not normal. It’s a sign that your blood sugar is off balance.
Adrenaline is a first-line stress hormone that kicks off your fight-or-flight response. It can also kick off a hot flash🔥. Low or rapidly dropping blood sugar is typically caused by eating foods/beverages that spike your blood sugar too high, and your body rebounds with low blood sugar. Your body reads this as stress. You might have noticed that many hot flashes come up during periods of stress. Well, your body can’t tell the difference between erratic blood sugar and a tiger walking down the road. So when you start your day with a high-carb meal like cereal or a bagel, you can be sure that it will lead to a crash in an hour or 2.
Feel the cravings
Let me be clear, this doesn’t have to be clinically low blood sugar (which is typically below 70mg/dl). We can get mild symptoms when our blood sugar is dropping faster than it should, even when it stays in normal ranges.
It’s natural for that crash to make you crave more sugar. By “natural” I mean low blood sugar is so dangerous to your body that you have multiple redundant mechanisms to help you get it back up. It’s a survival thing.
When your blood sugar drops, you are hard-wired to fix it in any way you can. I’m thinking… double mocha and a scone? Maybe a plate of fries? Just the thing to cause an other wild blood sugar ride. Up and down again. 🔥🔥 Once you get to that spot of feeling hangry, your biology takes over and it’s hard to fight it. The trick is to avoid that drop in the first place.
During our group programs where everyone uses a continuous glucose monitor for 4 weeks, people consistently find they can reduce their cravings by stabilizing blood sugar. People who always needed to snack the day away now find they don’t think about food as much.
Insulin resistance during menopause
Insulin is the hormone that helps us control blood sugar. It rises after a carbohydrate-rich meal to help store excess glucose in fat and muscle cells and bring blood glucose down to healthy levels.
But insulin is oh-so-much-more. It acts as a switch that tells your body to store fat. When insulin is up, you body is in storage mode and is decidely NOT able to burn fat for energy. We do want insulin to go up after meals, but then we want it to come down between meals and overnight so we can toggle into BURNING fat for energy.
Does weightlifting help with menopause?
During the menopause transition, you are likely to be losing muscle if you’re not actively trying to put it on. As we age, we get what we call anabolic resistance, which means it’s harder to put on muscle. Pair that with being less physically active and not eating enough protein, and you are likely to be a less buff version of your 30 year old self.
Muscles are important here because muscles are how you dispose of glucose. They have glucose receptors that respond to insulin. But if you’ve been losing muscle, you’ve also lost some insulin sensitivity along with it. Another way of saying this is you become more insulin resistant.
What happens now is your pancreas has to make more insulin to manage your glucose, and this causes… you guessed it… more fat storage. And insulin just loves to store fat in your visceral region. We call this fat visceral adipose tissue (VAT). I’ve written extensively about VAT in this article. In a nutshell, it’s the deep fat in your belly and it loves to produce inflammatory cytokines. This increased inflammation leads to more pain, brain fog, increased autoimmune symptoms, and increased risk of heart disease.
Balancing your blood sugar and increasing muscle mass will be your best tools to reduce this VAT fat and lower your risk of other related diseases. That muscle will also be your insurance policy against diabetes and frailty as you age. While you may have anabolic resistance, you can still put on muscle. The tricks are to lift heavy and fuel properly with adequate protein after exercise. It’s generally thought that 30g of high-quality protein within 30-45 minutes of finishing your strength workout will help overcome anabolic resistance so you can build muscle.
Balanced blood sugar can help you sleep😴
The blood sugar rollercoaster adds to your stress bucket. As our estrogen and progesterone wane, we become more sensitive to stress. We don’t adapt to stress and recover the way we could in our 30’s. So cortisol comes to the rescue. Cortisol is a second-line stress hormone that kicks on after repeated stressors. Cortisol is naturally high in the morning to get us out of bed and feeling functional. But as the day goes on, cortisol naturally wanes, reaching its lowest point around bedtime. This allows melatonin to rise and send you off into blissful sleep.
Not so fast if you’ve been fueling your day with sugar or processed carbohydrates. After that super stressful day with all those blood sugar spikes, your evening cortisol will be higher than normal, making you feel wired and tired. Do you know what I’m talking about? Have you experienced nights where you’re overtired and are in desperate need of a good night of sleep but sleep won’t come? It’s so frustrating. But that’s your elevated cortisol keeping your hypervigilant and helping you stay awake.
Is cortisol belly a thing?
Cortisol does more than keep you awake. It causes insulin resistance. My patients all use continuous glucose monitors and are always amazed at how much their blood sugar goes up in response to stress and/or poor sleep. The long-term effects of chronic stress and elevated cortisol can lead to insulin resistance and chronically high insulin. As we discussed earlier, that causes more of the VAT stored in the belly.
The high cortisol also makes it harder to recover from workouts and build muscle.
Improve your energy with steady blood sugar
Brain fog and low energy are two things I hear from my patients regularly during their menopause years. I’m still surprised how quickly that turns around once we deal with the blood sugar.
All this yo-yo blood sugar takes its toll, leaving most people feeling drained in the afternoon. This naturally necessitates an afternoon coffee which makes sleep even harder.
The adoption of a high(er) protein breakfast, a solid moderate-carb lunch and an afternoon snack with good hydration throughout the day can do wonders for a woman’s afternoon energy levels.
This pattern of eating, rather than the toast, pasta, sandwich pattern, stabilizes blood sugar. By keeping peaks lower and nutrition up, women can fuel their busy day without the extra sprinkling of stress hormones. In our group programs using continuous glucose monitors to watch our blood sugar, it’s very common for people to tell me they dropped their afternoon coffee within a few days because they weren’t falling asleep after lunch anymore. I’m not against coffee, but afternoon coffee can trigger both hot flashes and poor sleep.
If you stay consistent with eating regular meals with enough protein and good hydration in the first half of her day, you’ll likely start improving your sleep too. (And imagine what you can accomplish with a good night of Z’s!💪💪)
Practical Tips to Balance Blood Sugar in Menopause
So, how can you start balancing your blood sugar and feeling better? It doesn't have to be complicated—small, consistent changes can make a big difference. Here are some of the most effective strategies I use with my patients:
🍗🥦Focus on Protein and Fiber: How these stabilize blood sugar and keep you full.
When I’m working with a patient on their blood sugar, these 2 are our first focus. I usually recommend around 25g of fiber per day and will recommend an appropriate protein goal.
Back when I wrote this article on protein needs, I was recommending about 0.5g protein per pound lean body weight. (For perpesctive, a 5’4” woman has a lean weight of around 130lbs and would need 65 grams of protein per day.) Since then, I’ve seen people get much better results with 0.7-1g protein per pound lean body weight, especially women over 40. For a 5’4” woman, that equals 90-130g of protein per day.
🥤Hydration matters
Staying well-hydrated helps your metabolism and your blood sugar. This means water and for many, it includes adding some salts or electrolytes to help the body absorb and retain it. I recommend drinking 12 ounces of water first thing in the morning and again before meals as a way to remember.
💤Prioritize Sleep: Poor sleep worsens blood sugar regulation and menopause symptoms.
You probably don’t need me to tell you this. But look into the things that are sabotaging your sleep. This includes alcohol, late eating, Netflix, pets, and a snoring bed partner. Also, consider getting a home sleep study done to see if you have sleep apnea. It’s very common in menopause, even if you aren’t overweight.
🍭Reduce Sugar: The sugar in your coffee, in your soda, your juice, your breakfast, that little sweet after every meal and in your salad dressings. Begin to take stock of where you’re taking sugar in during the day
💪Stay Active: Walking after meals helps blood sugar and digestion. But menopause is the time to start building your muscles too.
📱Use a Continuous Glucose Monitor (CGM): CGMs give real-time feedback on how foods impact your blood sugar. It’s not only an effective way to learn, it’s kind of fun.
Does HRT help with blood sugar?
Balancing blood sugar naturally is one of the most powerful ways to feel better in menopause. But what about HRT? Could it help? It might. Estrogen affects insulin production. Many women get more sensitive to carbs after menopause for this reason. They may produce less insulin. So there is a chance that HRT could help.
Equally, balanced blood sugar will help HRT work better. If you do your homework and improve other areas of your health, then coming in with some hormones will be the icing on the cake that helps you sleep better and have more energy for your life.
Next Steps: How to Get Started with Blood Sugar Management
Continuous glucose monitors (CGMs) are widely available now. In 2024, 2 models were made available without a prescription: the Dexcom Stelo and the Abbot Lingo. We cover them both in this video.
You can also ask your doctor to write you a prescription for a FreeStyle Libre 3+. You don’t need to have diabetes to get this prescription and you don’t need insurance coverage. With that prescription, each sensor will cost you around $40 and last for 2 weeks.
These are fun to use and I help set people up on them every day. You might find you’d like some pro advice on how to interpret your data and how to take action on the data. That’s what I’m here for. You can download a free guide to getting your first CGM here.
Work with me👭
If you want to get this blood sugar thing knocked on its head, why don’t you set up a call with me?
Some people work with me for a month and we make blood sugar our b*%#h. You become an expert at using that CGM, we figure out what works for you, and send you on your way with a solid plan.
Others sign up for a bit more. Especially if you want more ongoing support for weight loss and those annoying digestion issues that often come our way. We bite off 3 months and meet regularly, look at your labs, sort out that cupboard of supplements, and help you plan meals to get you on the right track.
It’s easy to book a free discovery call to let me know what you’re looking for and you can decide if I’m a good fit. No pressure.
References
Dormire SL. The Potential Role of Glucose Transport Changes in Hot Flash Physiology: A Hypothesis. Biol Res Nurs. 2008 Nov 17;10(3):241–247. doi: 10.1177/1099800408324558
Verberne AJM, et al. Adrenaline: insights into its metabolic roles in hypoglycaemia and diabetes. Br J Pharmacol. 2016 Mar 8;173(9):1425–1437. doi: 10.1111/bph.13458
Genazzani AD, et al. Metabolic syndrome, insulin resistance and menopause: the changes in body structure and the therapeutic approach. Gynecological and Reproductive Endocrinology and Metabolism 2023; 4(2-3):86-91 DOI: doi.org/10.53260/grem.234026
