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Menopause and Diabetes

Guest post by Dr Ornella Cappellari

It is widely known that premenopausal women have a lower incidence of diabetes compared to men of the same age.

However, this advantage disappears after menopause with disrupted glucose homeostasis, in part due to a reduction in circulating 17Ξ²-estradiol (Ean estrogen steroid hormone). We all know the hormonal changes that women undergo after menopause. Those changes have an impact on glucose metabolism. 

A very recent study (Nov 2018) published on diabetes, explains and demonstrates that premenopausal women are protected against type II diabetes. This condition relates to a dysfunction in the pancreas which is the organ that produces insulin.

Menopause seems to have an impact on many mechanisms of the female body including glucose metabolism

There are two types of diabetes: type I and type II. Type I occurs due to the inability of the pancreas to produce enough insulin due to the loss of beta cells also known as pancreas cells. Type II begins with insulin resistance, a condition in which cells fail to respond to insulin properly. Insulin is a hormone that regulates carbohydrate, fat and protein metabolism, but mostly, the absorption of glucose from the blood into the liver, fat and skeletal muscle cells. If glucose remains in the bloodstream, the consequences could be fatal. 

People with Type II diabetes make insulin, but as previously mentioned, their cells don’t use it as well as they should. Doctors call this insulin resistance. In Type II diabetes, the pancreas initially produces more insulin in an attempt to get glucose into the cells. But eventually it can’t keep this up, and the sugar builds up in the blood instead. Menopause seems to have an impact on many mechanisms of the female body including glucose metabolism therefore leading to an increased probability of developing Type II diabetes. In fact, when you have your period, your estrogen and progesterone hormones are fluctuating and this can affect how your body responds to insulin. 

…it is especially important to keep track of weight changes during perimenopause and menopause as too much weight gain puts women at a higher risk of developing Type II diabetes…

During perimenopause, many women experience periods that are heavier or lighter, longer or shorter than usual. This is caused by the imbalance between progesterone and estrogen. For women with diabetes, the higher levels of estrogen can improve insulin sensitivity. However, higher levels of progesterone can cause insulin resistance instead. So, there is a really difficult balance between hormones. If you suffer with diabetes and your menstrual cycle is less predictable, you can expect the condition to be less stable on some days than it is on others. Moreover, it is no surprise to most women that whenever their hormone balance changes, their body weight can change accordingly. Therefore, it is especially important to keep track of weight changes during perimenopause and menopause as too much weight gain puts women at a higher risk of developing Type II diabetes either from a physiological point of view (menopause increasing the probability), or from a hormonal one (hormonal unbalance influencing glucose metabolism). 

Researchers have found that estrogen levels in women who are overweight, regardless of whether they have diabetes or not, drop slower than in those who are underweight or normal weight. In fact, researcher affirm that, β€œIf you are overweight, your cells take anything made from cholesterol and convert it to estrogen, so people who are overweight have a lot of estrogen sitting around in their fat cells” with the consequences of a slower estrogen level drop. It is important to know, that menopause can mimics diabetes symptoms in women. Therefore, women who are already diabetics need to monitor their blood sugar level carefully. It is also important to remember that the hormonal imbalance that triggers menopausal health issues (for example weight gain, sleep problems, infections, hot flashes) can also raise or lower blood glucose level. 

The important message is then to maintain as healthy a lifestyle as possible by controlling weight gain and continously monitoring blood sugar levels as menopause approaches. 

REFERENCES

Diabetes.2018 Nov 28. pii: db180638. doi: 10.2337/db18-0638. [Epub ahead of print] Estrogen Improves Insulin Sensitivity and Suppresses Gluconeogenesis via the Transcription Factor Foxo1.

Eur J Endocrinol.2018 Oct 1. pii: EJE-18-0602.R1. doi: 10.1530/EJE-18-0602. [Epub ahead of print] Early menopause and premature ovarian insufficiency are associated with increased risk of type 2 diabetes: a systematic review and meta-analysis.

Maturitas.2018 Nov;117:6-10. doi: 10.1016/j.maturitas.2018.08.009. Epub 2018 Aug 23. Menopause and diabetes: EMAS clinical guide