Insulin Resistance in Midlife: What Every Woman Needs to Know
- Dr. Meghan Tierney, DABOM MSCP
- Aug 28
- 7 min read
Here's something that might surprise you: you can have normal blood sugar levels and still have insulin resistance. Insulin resistance can be sneaky, developing gradually and often hiding behind labs that technically fall within normal ranges.
But here's why this matters more than you might think: insulin resistance isn't just about blood sugar. It's about energy, mood, weight, hormones, and your long-term metabolic health. And for women in midlife, understanding insulin resistance is crucial because perimenopause changes everything.
What Is Insulin Resistance, Really?
Think of insulin as a key that unlocks your cells so glucose (sugar) can enter and be used for energy. When you're insulin sensitive, this process works smoothly. Your body produces just enough insulin, and your cells respond appropriately.
But with insulin resistance, your cells become less responsive to insulin's signal. It's like the lock has gotten rusty—the key still works, but you need to jiggle it harder and longer to get the door open.
So your pancreas starts producing more insulin to get the same job done. Your blood sugar might still look normal because that extra insulin is working overtime to keep things stable. But underneath, your body is working much harder than it should be.
The Midlife Connection: Why Now
During perimenopause, several factors converge to increase insulin resistance risk:
Declining estrogen: Estrogen helps maintain insulin sensitivity. As levels drop, our cells become more resistant to insulin's effects.
Changing sleep patterns: Poor sleep—common in perimenopause—directly impacts insulin sensitivity. Even one night of poor sleep can make you more insulin resistant the next day.
Increased stress: Chronic stress elevates cortisol, which promotes insulin resistance. And let's be honest—midlife comes with its share of stressors.
Muscle loss: We naturally lose muscle mass as we age, and muscle is one of our most important glucose-consuming tissues. Less muscle means less capacity to handle glucose effectively.
The Visceral Fat Factor
Here's where things get complicated—and where we need to talk honestly about body fat without falling into shame or oversimplification.
Not all body fat is created equal. Subcutaneous fat (the fat under your skin that you can pinch) behaves differently than visceral fat (the fat that surrounds your internal organs).
Visceral fat is metabolically active tissue. It releases inflammatory compounds and hormones that can interfere with insulin sensitivity. The more visceral fat someone carries, the more likely they are to develop insulin resistance.
But you cannot determine someone's visceral fat levels by looking at them. Two women of the same size might have completely different amounts of visceral fat. This is why weight-neutral approaches to metabolic health make sense: appearance doesn't tell us the whole story.
The Silent Nature of Insulin Resistance
Here's something important to understand: insulin resistance typically has no symptoms that you can feel, especially in its early stages. Unlike what you might read in popular health articles, insulin resistance doesn't reliably cause energy crashes, specific cravings, or sleep disruptions.
This is actually one of the biggest challenges with insulin resistance—it's largely silent until it progresses to more advanced metabolic dysfunction. You can be insulin resistant for years without knowing it, which is why routine screening and comprehensive metabolic testing matter so much.
The Earliest Signs: What Actually Shows Up First
The earliest indicators of insulin resistance are biochemical, not symptomatic:
Elevated fasting insulin levels: Often the first detectable change, even when blood glucose remains normal
Changes in lipid patterns: Particularly increased triglycerides and decreased HDL cholesterol
Inflammatory markers: Subtle increases in markers like C-reactive protein
Body composition changes: Particularly increased abdominal/visceral fat
These changes can occur years before any symptoms develop or blood sugar becomes elevated. This is why comprehensive metabolic testing that goes beyond basic glucose screening is so valuable—it can identify insulin resistance in its earliest, most treatable stages.
Beyond the Scale: What Lab Tests Really Matter
Standard glucose tests often miss early insulin resistance. Here are the tests that give us better information:
Fasting insulin: This should be under 10 mIU/L, ideally under 7. Many women have "normal" glucose but elevated insulin.
HOMA-IR: This calculation combines fasting glucose and insulin to assess insulin resistance. A score under 1.9 is ideal.
Hemoglobin A1c: This shows your average blood sugar over 3 months. You can potentially have a normal A1C (below 5.7%) and have other signs of early insulin resistance.
Triglycerides: High triglycerides often accompany insulin resistance.
HDL cholesterol: Low HDL (under 50 for women) combined with high triglycerides suggests insulin resistance.
The Good News: Insulin Resistance Is Reversible
Unlike some conditions that we manage, insulin resistance can often be significantly improved or even reversed. The interventions that work best focus on the root causes, not just the symptoms:
Strength training: Building muscle mass improves glucose disposal. This is why our muscle-building content matters so much. It's not just about strength, it's about metabolic health. More skeletal muscles means more cells that need glucose.
Strategic nutrition: This isn't about restriction or elimination diets. It's about understanding how different foods affect your insulin response and finding sustainable patterns that work for your body and your life.
Sleep optimization: Prioritizing 7+ hours of quality sleep dramatically improves insulin sensitivity.
Stress management: Whether through mindfulness, therapy, or lifestyle changes, managing chronic stress is crucial.
Sometimes, medication: Medications can be valuable tools, especially when lifestyle changes alone aren't enough.
Why This Matters for Your Future
Addressing insulin resistance isn't about achieving a certain weight or appearance. It's about:
Energy and vitality: Stable blood sugar means stable energy throughout the day
Cognitive function: Your brain runs on glucose—insulin resistance affects mental clarity
Hormonal balance: Insulin resistance can worsen perimenopausal symptoms
Long-term disease prevention: Early intervention can prevent progression to type 2 diabetes
Quality of life: Better mood, sleep, and overall well-being
Moving Forward Without Shame
If you recognize yourself in this description, please know that insulin resistance isn't a moral failing or a result of "not trying hard enough." It's a physiological condition influenced by genetics, hormones, stress, sleep, and yes, lifestyle factors.
The goal isn't perfection or dramatic transformation. It's about understanding your body's signals and working with your physiology, not against it.
When to Seek Support
Consider working with a healthcare provider who understands metabolic health if you:
Experience several of the symptoms I've described
Have a family history of diabetes or metabolic syndrome
Feel like your current approach isn't working
Want comprehensive testing beyond basic glucose screening
Need support creating sustainable lifestyle changes
At Sorrel, we help women understand their metabolic health through comprehensive testing, body composition analysis, and personalized care plans that honor where you are and where you want to go—without shame, judgment, or one-size-fits-all approaches.
The Bottom Line
Insulin resistance is common, under-diagnosed, and treatable. Understanding it empowers you to make informed decisions about your health and advocate for the care you deserve.
Ready to understand your metabolic health better? At Sorrel, we offer comprehensive metabolic assessments including insulin testing and body composition analysis as part of our holistic approach to midlife wellness.
Next time, we'll dive into practical nutrition strategies for supporting insulin sensitivity—without restrictive dieting or complicated meal plans. Stay tuned.
Frequently Asked Questions
Can you be insulin resistant and still have normal blood sugar?
Absolutely. This is one of the most important things to understand about insulin resistance. Your pancreas may be producing extra insulin to keep your blood sugar in the normal range, but that doesn't mean the system is working efficiently. This is why testing fasting insulin levels, not just glucose, gives us much better information about your metabolic health.
Is insulin resistance the same as pre-diabetes?
They're related but not identical. Insulin resistance often precedes pre-diabetes by years. You can be insulin resistant with completely normal glucose and A1C levels. Pre-diabetes is diagnosed when blood sugar levels are elevated but not yet in the diabetic range. Think of insulin resistance as the earlier warning sign.
Will losing weight cure my insulin resistance?
Weight loss can improve insulin resistance for some people, but it's not the complete picture. Some people in smaller bodies have insulin resistance, and some people in larger bodies have excellent insulin sensitivity. The key is addressing the root causes: building muscle, managing stress, improving sleep, and sometimes using medications. At Sorrel, we focus on metabolic health improvements that may or may not coincide with weight changes.
Do I need to avoid carbs if I have insulin resistance?
No. The relationship between carbs and insulin resistance is more nuanced than "avoid all carbs." It's more about the types of carbohydrates, timing, and what you eat them with. Many women do well including nutrient-dense carbohydrates as part of a balanced approach. We'll cover this in detail in next week's nutrition post.
Can stress really cause insulin resistance?
Yes. Chronic stress elevates cortisol, which directly interferes with insulin sensitivity. This is why stress management isn't just about feeling better—it's a crucial component of metabolic health. Many women find that addressing chronic stress significantly improves their symptoms.
Is insulin resistance genetic?
There is a genetic component, but genetics aren't destiny. Having a family history of diabetes or metabolic syndrome does increase your risk, but lifestyle factors play a huge role in whether those genes get "turned on." This is actually empowering because it means you have significant control over your metabolic health.
What's the difference between Type 1 and Type 2 diabetes and insulin resistance?Type 1 diabetes is an autoimmune condition where the pancreas doesn't produce insulin. Type 2 diabetes typically develops from long-standing insulin resistance—the pancreas eventually can't keep up with the demand. Insulin resistance is the earlier stage where your body is still producing insulin, often too much, but your cells aren't responding well to it.
Should I test my blood sugar at home?
Home glucose monitoring can provide some useful information, especially if you're curious about how different foods affect your blood sugar. However, for diagnosing insulin resistance, we need more comprehensive testing including fasting insulin levels. If you're experiencing symptoms, comprehensive lab work is more valuable than home testing alone.
Can insulin resistance affect my hormones?
Absolutely. Insulin resistance can worsen perimenopausal symptoms, contribute to irregular periods, and affect other hormones including testosterone and thyroid function. High insulin levels can also interfere with ovulation. This is another reason why addressing insulin resistance is so important for women's overall health, not just blood sugar control.
Ready to learn more about your metabolic health? Book a discovery call to discuss comprehensive testing and personalized care plans that fit your life and goals.