Insulin Resistance: A Clinical Guide for Midlife, Menopause and Beyond

Afternoon energy crashes, brain fog, sugar cravings, and a body that seems to be storing fat regardless of what you eat. These are not just random symptoms of getting older. They can be an indication of

insulin resistance.

Insulin resistance has become one of those terms that follows you around. You hear it at the gym, see it on social media, read it in the news, and chances are someone in your circle has brought it up recently. GPs mention it in appointments, it gets tested for in blood tests, and it gets loosely linked to weight gain and diabetes risk. But for all the conversation around it, most people have never had it properly explained.

What is insulin resistance? Why does it matter? And what can you do about it?

What is insulin?

Insulin is a hormone produced by the pancreas in response to rising blood glucose levels. Its job is to signal your cells, primarily in the muscle, liver, and fat tissue, to take up glucose from the bloodstream and use it for energy or store it for later.

This is what we are referring to when we talk about blood sugar regulation. Insulin is the hormone that controls how much glucose remains circulating in the blood at any given time. When that system is working well, levels stay stable. When it is not, glucose and insulin levels fluctuate, and those fluctuations have a direct impact on energy, weight, and metabolic function overall.

The effects of insulin extend far beyond blood sugar regulation. It also drives fat storage (particularly around the abdomen), influences appetite, promotes inflammation, and makes it significantly harder for the body to access stored fat for fuel.

What is insulin resistance?

The primary driver of insulin resistance is chronic overexposure to glucose. A diet consistently high in refined carbohydrates, sugar, and ultra-processed foods causes blood glucose to rise repeatedly, triggering insulin release again and again. Over time, the cells become desensitised to insulin, much like tuning out a noise that never stops, and that desensitisation is insulin resistance.

Once resistant, the cells stop responding efficiently to insulin's signal. Because the cells are not responding properly, the pancreas compensates by producing more and more insulin, essentially working harder and harder to do a job that is becoming increasingly difficult. The result is chronically elevated insulin levels, a problem that can go undetected for years because standard blood tests measure glucose, not insulin.

What does insulin resistance do to the body?

Insulin resistance is a systemic problem, not simply a blood sugar problem.

Because insulin is the body's primary fat storage hormone, chronically elevated levels shift the body into a persistent storage state. The body begins storing fat around the abdomen and organs, known as visceral fat. This fat is metabolically active, meaning it releases hormones, inflammatory compounds, and free fatty acids that perpetuate insulin resistance and increase the risk of cardiovascular disease."

Insulin resistance also affects appetite regulation, as insulin interacts with leptin, the hormone that signals fullness, and ghrelin, the hormone that drives hunger. When insulin levels are chronically elevated, leptin's ability to signal fullness is impaired, while ghrelin levels rise, amplifying hunger. The result is a system that is constantly telling the body it needs to eat.

Energy becomes unstable as the body struggles to maintain consistent fuel supply to the brain and muscles, producing the familiar pattern of energy spikes and crashes, brain fog, and fatigue.

Over time, the pancreas loses its ability to compensate and blood glucose continues to rise, first into the prediabetes range and, if left unmanaged, into type 2 diabetes. Chronically elevated insulin also promotes systemic inflammation and increases the risk of fatty liver disease. This is why insulin resistance carries consequences well beyond body weight.

The menopause connection

Oestrogen plays a significant protective role in metabolic function, influencing how the body stores fat, regulates blood sugar, and maintains insulin sensitivity. As oestrogen declines through perimenopause and beyond, the body becomes measurably less responsive to insulin.

This is well-established in the research. A 2024 meta-analysis of 17 randomised controlled trials involving over 29,000 women confirmed that oestrogen decline directly increases insulin resistance risk, and that hormone therapy significantly reduced insulin resistance in healthy postmenopausal women.

Other common experiences of the menopause transition, including muscle loss, disrupted sleep, chronic stress, and reduced physical activity, all contribute to worsening insulin sensitivity.

How does insulin resistance present clinically?

Symptoms develop gradually and are easy to dismiss as a normal part of ageing. Common signs include:

• Abdominal weight gain, even when eating habits have not changed

• Mid-afternoon energy crash and tiredness after eating

• Strong carbohydrate & sugar cravings, and hunger that is hard to satisfy

• Fatigue that sleep does not fix

• Nocturia (waking at night to urinate)

• Brain fog

• Elevated fasting glucose, fasting insulin, HbA1c, or triglycerides on blood tests

  
  

A history of dieting and repeated cycles of calorie restriction can impair insulin sensitivity over time, leaving the metabolism in a compromised state. The goal is not to eat less. The goal is to improve insulin sensitivity, to help your cells respond to insulin properly again while protecting and building metabolic flexibility.

(Read more: I Am Eating Less and Exercising More, Why Aren't I Losing Weight?)

Improving insulin sensitivity: the four pillars framework

Insulin resistance is highly responsive to lifestyle change.

In clinical practice, I approach this through four pillars:

Pillar 1: Nutrition

Prioritise five serves of different coloured vegetables daily, including leafy greens, plus no more than two serves of fruit. Build meals around lean protein, plant foods, and fibre. Choose complex carbohydrates and whole grains. Reduce ultra-processed foods, refined carbohydrates, and added sugars.

Protein deserves particular attention. It supports muscle repair and preservation, stabilises blood sugar, and helps regulate appetite. Most women in midlife are eating significantly less protein than they need. Current evidence supports a target of 1.2 to 1.6g of protein per kilogram of body weight per day, with requirements sitting at the higher end for those who are active or looking to build muscle. In practical terms, this translates to approximately 30 to 40g of protein per meal across three meals per day.

Pillar 2: Movement and exercise

Resistance training has the single greatest impact on insulin sensitivity. Skeletal muscle is the largest glucose-absorbing tissue in the body, and every strength session improves insulin sensitivity independently of insulin itself. Research in postmenopausal women consistently supports this.

Daily movement beyond structured exercise matters equally. Aim for at least 20 minutes of walking after meals where possible, and a daily step target of 8,000 to 10,000 steps. Yoga, stretching, and other low-intensity movement throughout the day all contribute. The goal is to avoid long periods of sitting and keep the body moving.

Pillar 3: Sleep and stress

Poor sleep is one of the most underestimated drivers of insulin resistance. Insomnia is common in perimenopause and deserves proper clinical attention. Aim for 7 to 9 hours per night. A consistent bedtime routine, regular sleep and wake times, limiting screen exposure before bed, and a cool, dark sleep environment all support better sleep quality and, by extension, better metabolic health.

Stress management is clinical, not optional. Chronic stress raises cortisol, drives glucose up, and keeps the whole system dysregulated. Scheduling regular downtime is not a luxury, it is part of the treatment. This might look like dedicated time to read, knit, draw, or engage in any activity that genuinely allows the nervous system to settle. Breathing practices are particularly effective for regulating the nervous system and lowering cortisol. If stress or anxiety is significant, working with a counsellor or psychologist is worth considering as part of a broader approach to metabolic health.

Pillar 4: Habit change

Sustainable improvement in insulin sensitivity is built on consistency. This means three regular meals per day, no snacking, consistent meal timing, and planning both meals and exercise in advance. These structural habits support more stable insulin levels throughout the day and reduce the appetite dysregulation that drives poor food choices. Developing the mindset and routine that supports long-term behaviour change is where clinical support can make a significant difference. Read more: Harnessing Willpower and Habits: Transforming Your Diet for Long-term Health

For some women, hormone therapy or GLP-1 medications may also be appropriate as part of a broader plan, but neither replaces these four pillars. They work better alongside them.

The bigger picture

Insulin resistance is not exclusive to those who are overweight. It is a metabolic condition that can affect women of any body size, and its consequences extend well beyond body composition. Poor metabolic health is closely linked to cardiovascular disease, fatty liver disease, cognitive decline, osteopenia, and accelerated ageing. Addressing insulin resistance in midlife is an investment in long-term health, preserving energy, strength, bone density, and cognitive function.

Midlife is a demanding season. Many women are managing careers, families, ageing parents, and the physical and emotional changes of menopause simultaneously. The instinct is to push harder, restrict more, and do everything with less. But this is precisely the stage of life where that approach becomes counterproductive. The body in midlife needs more, not less. More nourishment, more muscle, more recovery, and more support.

Want to understand what is going on with your metabolic health and what a targeted approach looks like for you? Book a consultation here

In good health,

Melissa x