Diabetes risk in menopause

[chuchy]

Hi everyone, I registered about a week ago but forgot to say hello. I have not been diagnosed with diabetes, but for the past two years I've been watching my blood sugar levels - and in fact I have been eating as if I was diabetic to avoid it happening. I believe the menopause puts me (and most women) at high risk - not that anyone has ever warned us about it!

I had an A1C done in January, which was 36 - up from 33 back in September last year! It was probably influenced by the holiday period to some extent, but I was not that indulgent - I think the decline in oestrogen is responsible. 36 is actually regarded as a pre-diabetic state in the US, but not in the UK. However, if this trajectory continues (3 points increase every 6 months), I will be diabetic within a couple of years even by UK standards. I also had some alarming readings through the finger prick method: fasting levels at 7.1 at one point (although it did vary a lot and could be as low as 4.9) and had a post meal reading at 10.6 within an hour of eating (I wanted to see how high it would spike.

In the end I bought a CGM from Abbott to see what was going on. I've been watching my levels closely for the past 12 days - and managed to stay within the non-diabetic range (3.9-7.8) 99% of the time, but only by doing some form of exercise (usually walking or cycling) every time I eat something. It's exhausting, but also rewarding seeing no huge spikes even with carb heavy meals. I now eat just twice a day (around 11 am and around 5pm) - concentrating on mainly plant-based wholefoods, but I also eat some meat/fish, eggs and dairy, so I haven't cut out anything other than ultra-processed food.

I'm thinking I can be doing all the right things, but if oestrogen deficiency is causing my glucose dysregulation, it might be a losing battle. I'm 55 but I'm not yet fully menopausal - my BMI is on the lower end of the scale, around 20, because of all the exercise I do, I guess, but like I said it's exhausting and I'm getting stressed about my sugar levels.

Has anyone in this forum gone on HRT and found that their glucose management has improved?

PS: I've also been suffering with hypoglycemic episodes for the past couple of years - which is what prompted me to look into my blood sugar in the first place. With the CGM I could see that my levels sometimes crash, and although they don't actually go into the red, I have all the classic hypoglycemic reactions: fatigue, shakiness, sweatiness, confusion, anxiety - only for a short while until my levels correct themselves usually within a couple of minutes. It's like I run out of energy all of a sudden with my batteries exhausted. Something to do with cell function at mitochondrial level.

 

[Leadinglights]

Welcome to the forum
I have had no ovaries since the age of 32 and only became Type 2 diabetic when 66, so I can't blame that.
You are certainly well within the bounds of normal HbA1C. It sounds like your response to food is completely normal, everybody's blood glucose goes up and down all the time, It is whether it comes down after eating a carb heavy meal that is a problem if diabetic and remains high for extended period of time. The criteria that people use is to look at the blood glucose level 2 hours after eating rather than 1 hour or less.
The expected levels are somewhat tighter if not diagnosed as diabetic than if you are Type 2.
You could relax a bit if you are finding it all too exhausting otherwise it will not be sustainable and that can be where the risk is.

 

[chuchy]

Welcome to the forum
I have had no ovaries since the age of 32 and only became Type 2 diabetic when 66, so I can't blame that.
You are certainly well within the bounds of normal HbA1C. It sounds like your response to food is completely normal, everybody's blood glucose goes up and down all the time, It is whether it comes down after eating a carb heavy meal that is a problem if diabetic and remains high for extended period of time. The criteria that people use is to look at the blood glucose level 2 hours after eating rather than 1 hour or less.
The expected levels are somewhat tighter if not diagnosed as diabetic than if you are Type 2.
You could relax a bit if you are finding it all too exhausting otherwise it will not be sustainable and that can be where the risk is.

Thanks for your reply - I know it's not sustainable and it only adds to my menopausal anxiety! However, the hypoglycaemic episodes keep happening due to my dysregulated glucose metabolism. I have to be very careful about what I eat and when to avoid them. I just don't want to wake up one day with diabetes if there's something I can do now to avoid it. And I'm thinking HRT could be it, in addition to a sustainable diet and exercise regime? It's not something that's talked about much but I have found some research studies to support this theory. I was just wondering if anyone had any personal experience with HRT in relation to diabetes. I never had any problems before and now all of a sudden I do - despite a much better diet and lifestyle than I used to have. Of course, it could be down to just natural "ageing".

 

[Inka]

@chuchy The non-diabetic range isn’t really 3.9-7.8. People without diabetes can spike up to the 10s sometimes. Your HbA1C is normal. The idea that it will go up 3 points every 6 months is just fantasy. There’s no reason for it to do that at all, especially as you’re slim.

I don’t believe the menopause puts women at high risk of T2 diabetes. The menopause can increase insulin resistance sometimes but most women stay in the non-diabetic zone. Some women even find their insulin sensitivity improves.

I think you’re worrying unnecessarily. Carry on eating well and living well.

 

[chuchy]

@chuchy The non-diabetic range isn’t really 3.9-7.8. People without diabetes can spike up to the 10s sometimes. Your HbA1C is normal. The idea that it will go up 3 points every 6 months is just fantasy. There’s no reason for it to do that at all, especially as you’re slim.

I don’t believe the menopause puts women at high risk of T2 diabetes. The menopause can increase insulin resistance sometimes but most women stay in the non-diabetic zone. Some women even find their insulin sensitivity improves.

I think you’re worrying unnecessarily. Carry on eating well and living well.

Thank you for the reassurance - I do suffer from health anxieties, I must admit.

 

[silentsquirrel]

Association rather than correlation? What about all the men who develop diabetes at a similar age? Menopause (usually) related to age, age related to onset of T2?

 

[chuchy]

Association rather than correlation? What about all the men who develop diabetes at a similar age? Menopause (usually) related to age, age related to onset of T2?

Yes, of course it can be purely age related as well - but it can also be an independent risk factor - anxiety, lack of sleep, rise in cortisol levels, change in the gut microbiome, etc (all menopausal symptoms) which can raise insulin resistance and cause glucose dysregulation, which can then trigger the development of diabetes. It's also a risk factor for Alzheimer's due to the changes in the brain - 2 in 3 Alzheimer sufferers are women! There's ongoing research into this.

 

[Inka]

Thank you for the reassurance - I do suffer from health anxieties, I must admit.

Just forget it @chuchy Have regular (ie annually or every few years) HbA1Cs if it reassures you, but don’t worry about something you don’t have. I know there’s plenty to worry about as we get older but focus on positive things not things that might or might not happen 🙂

 

[trophywench]

I'm a great fan of HRT meself. Everything including skin hair and nails takes a dive along with both the female - and male! - hormones. But mine was surgical too due to fibroids and endometriosis.

 

[chuchy]

Just forget it @chuchy Have regular (ie annually or every few years) HbA1Cs if it reassures you, but don’t worry about something you don’t have. I know there’s plenty to worry about as we get older but focus on positive things not things that might or might not happen 🙂

Thank you 🙂

 

[everydayupsanddowns]

Welcome to the forum @chuchy

Sounds like you are doing well with an improved diet, and keeping active. But sorry to hear that you are getting some health anxiety despite your healthier lifestyle.

It can be difficult to avoid worrying when the pattern-spotting pat of your brain has some numbers to work on, but I hope you’ve been reassured by members’ comments. It’s quite natural for HbA1c to rise slightly in later life, and people without diabetes see glucose variation throughout the day.

This research showed that many spend some time above 10 each day, without developing diabetes.

https://forum.diabetes.org.uk/boards/threads/bg-profiles-in-healthy-non-diabetics.99521/

It’s unfortunate that there is a fairly pervasive myth about ‘normal’ being a completely flat line, and quite modest glucose variations being termed a ‘spike’.

Keep going with your healthy changes, and try to be reassured that your risk of developing diabetes is currently being held quite low 🙂

 

[chuchy]

Welcome to the forum @chuchy

Sounds like you are doing well with an improved diet, and keeping active. But sorry to hear that you are getting some health anxiety despite your healthier lifestyle.

It can be difficult to avoid worrying when the pattern-spotting pat of your brain has some numbers to work on, but I hope you’ve been reassured by members’ comments. It’s quite natural for HbA1c to rise slightly in later life, and people without diabetes see glucose variation throughout the day.

This research showed that many spend some time above 10 each day, without developing diabetes.

https://forum.diabetes.org.uk/boards/threads/bg-profiles-in-healthy-non-diabetics.99521/

It’s unfortunate that there is a fairly pervasive myth about ‘normal’ being a completely flat line, and quite modest glucose variations being termed a ‘spike’.

Keep going with your healthy changes, and try to be reassured that your risk of developing diabetes is currently being held quite low 🙂

Thank you for the reassurance. Can I take this opportunity to ask you a question? I've noticed that my "fasting" levels (when I haven't eaten anything for several hours) can go up and down quite erratically, for example at night. Let's say I ate my last meal at 5/6 pm, go for a walk during which there's a slight rise (hardly above 6 if I leave for my walk straight after eating), and then it goes back down to base level within 90/120 mins or so (base level being about 5.0/5.5). However, it then rises again (after I came back from my walk) several times, higher than I got from my meal, sometimes over 7.0 even at night - by which time I would have been fasting for several hours. It goes up and down between 7.0 and 5.0 and it doesn't settle until 1.00 or 2.00 am, at which point it finally settles at around 5.1/5.2 for the rest of the night. Then it may go back up in the morning as well as high as 6.9 even before I eat anything, only to fall back to 4.9/5.0 later in the morning until I eat something. Do you think that's normal in a non-diabetic?

 

[Inka]

What does it rise to @chuchy ? Blood glucose goes up and down through the day. Exercise can both reduce it and put it up, for example. If these rises are on the Libre, they might not be accurate, as the algorithm re-adjusts as it ‘catches up’.

 

[chuchy]

What does it rise to @chuchy ? Blood glucose goes up and down through the day. Exercise can both reduce it and put it up, for example. If these rises are on the Libre, they might not be accurate, as the algorithm re-adjusts as it ‘catches up’.

Sorry, I think my previous post was accidentally published before I finished writing my train of thought. see above!

I did notice that the Libre shows some values that never actually show up on the graph. I though that was because it only records data every 15 mins, while I can see the real life data every minute (or as often as I scan). So sometimes I might get an alert that my levels are going too low and show 3.8, but the graph never actually goes as low as that.

 

[Inka]

3.8 would be fine for someone not on insulin or similar @chuchy The Libre alerts are for people on insulin really. Yes, the Libre predicts values, then re-adjusts its graph as needed.

Ups and downs are completely normal and can be caused by many things - food, exercise, stress, heat, etc etc. Blood glucose is supposed to go up and down, just like our heartrate reduces and increases over the day.

 

[everydayupsanddowns]

I've noticed that my "fasting" levels (when I haven't eaten anything for several hours) can go up and down quite erratically

I think most people generally use ‘fasting’ to refer to their first reading of the day, so having not eaten for 8 hours or more. Partly this is because digestion of some meals (especially those with more fats and proteins) can take many hours. And the absorption of any carbohydrates in such meals can be significantly slowed down.

Another possibility might be that it is other factors affecting your glucose levels. Food is only one reason for your levels to rise. Releases of hormones such as cortisol (either from stress/anxiety/excitement or as part of the natural circadian rhythm overnight) can release stored glucose in muscles or the liver.

This can be slightly perplexing, especially if it results in a rise on levels between bedtime and waking when you know you haven’t eaten anything!

 

[rebrascora]

Sorry, I think my previous post was accidentally published before I finished writing my train of thought. see above!

I did notice that the Libre shows some values that never actually show up on the graph. I though that was because it only records data every 15 mins, while I can see the real life data every minute (or as often as I scan). So sometimes I might get an alert that my levels are going too low and show 3.8, but the graph never actually goes as low as that.

That is caused by the algorithm used to try to make up the lag between interstitial fluid and blood glucose. The algorithm takes the previous reading and extrapolates them to predict what your BG reading will be if levels continue to rise or fall at the current rate, but if the rate of change changes, the algorithm takes a while to spot that, and once it does, it adjusts the graph to show a more likely profile and hence a high or low reading can be left hanging above or below the line. So for instance if you are dropping into a hypo but the alarm goes off and you eat some fast acting carbs to prevent it, those fast acting carbs will start to hit your blood stream in 10-15 mins but the Libre is reading interstitial fluid which may well continue to fall until the increased glucose makes it's way into the tissue that the filament is sampling. This is why it is important to check hypo recovery with a finger prick rather than Libre because it will take Libre about 30 mins to show recovery and at 15 mins after treatment it will almost always show levels have dropped lower, thereby encouraging you to potentially over treat a hypo. It happens in the same way when levels are rising sharply but then tail off and start to drop.... the algorithm continues to predict them rising until it gets data that they have started to drop and then it redraws the graph below the extrapolated point, because they never actually reached that level.
Not sure if that makes sense. It is hard to describe in words. 🙄

 

[Lucyr]

Yes, the Libre predicts values, then re-adjusts its graph as needed.

Not exactly. The reading you see at the top of the screen is the current blood sugar estimate. The value you see on the graph is a 15 minute average. So short hypos of less than 15 minutes won’t always show as red on the graph.

 

[chuchy]

That is caused by the algorithm used to try to make up the lag between interstitial fluid and blood glucose. The algorithm takes the previous reading and extrapolates them to predict what your BG reading will be if levels continue to rise or fall at the current rate, but if the rate of change changes, the algorithm takes a while to spot that, and once it does, it adjusts the graph to show a more likely profile and hence a high or low reading can be left hanging above or below the line. So for instance if you are dropping into a hypo but the alarm goes off and you eat some fast acting carbs to prevent it, those fast acting carbs will start to hit your blood stream in 10-15 mins but the Libre is reading interstitial fluid which may well continue to fall until the increased glucose makes it's way into the tissue that the filament is sampling. This is why it is important to check hypo recovery with a finger prick rather than Libre because it will take Libre about 30 mins to show recovery and at 15 mins after treatment it will almost always show levels have dropped lower, thereby encouraging you to potentially over treat a hypo. It happens in the same way when levels are rising sharply but then tail off and start to drop.... the algorithm continues to predict them rising until it gets data that they have started to drop and then it redraws the graph below the extrapolated point, because they never actually reached that level.
Not sure if that makes sense. It is hard to describe in words. 🙄

Yes, it makes perfect sense - thanks for the explanation. I suspected it was something like that, but I've never seen it explained so clearly!

 

[chuchy]

Not exactly. The reading you see at the top of the screen is the current blood sugar estimate. The value you see on the graph is a 15 minute average. So short hypos of less than 15 minutes won’t always show as red on the graph.

I was wondering about that too. My levels can change dramatically within 15 mins - they can easily go up and down 2 whole points within that time and come back looking stable on the graph. When I check my fasting blood sugar with a finger prick test, it could be normal, pre-diabetic and even in the diabetic range - depending at which point in the morning I check them. I didn't understand why subsequent readings be so different from each other - even accounting for the 10% error of margin. Then I saw on the CGM that my fasting level was fluctuating between 6.9 and 4.9 - so I don't know!