Diabetes is a condition causing excessively high blood glucose (sugar) levels, usually controlled by a complex hormonal mix, particularly insulin. Normally, glucose from digested food passes into your bloodstream, where insulin from your pancreas moves it into cells for energy. In diabetes, this process is faulty due to low or absent insulin or a resistance to its effects. The cause is poorly understood.
This article was included in issue 105 (Summer 2025) of The Menopause Exchange newsletter. The Menopause Exchange also looks at other general health information at this time of life!
Prediabetes
Eighteen million UK adults have ‘pre-diabetes’. This is when blood sugar levels are slightly above normal. Type 2 diabetes eventually develops in 10% of people with pre-diabetes, but this may be slowed or even reversed by being physically active, maintaining a healthy weight and eating a balanced diet, low in salt, sugar and fat and high in vegetables (see the NHS online ‘Eatwell Guide’). Activity helps your muscles manage blood sugars, so aim for 150 minutes weekly, such as walking or cycling.
Types of diabetes
There are two main types of diabetes. Type 1 diabetes (8% of diabetes cases) mostly presents very suddenly in children but can start in adult life. It affects about 400,000 people in the UK. The body’s immune system mistakenly destroys pancreatic insulin-producing cells, possibly after a viral infection, requiring lifelong carbohydrate intake calculations and insulin injections. It’s usually managed by hospital specialist diabetes teams.
Type 2 diabetes affects 4.7 million people in the UK (over 90% of people with diabetes), often with a family history of the condition. People with type 2 diabetes either produce insufficient insulin or fail to react normally to insulin (‘insulin resistance’). The condition progresses with age. It’s generally managed by GP teams, with healthy eating, regular exercise and weight management, but medication is eventually needed.
Other diabetes types include ‘gestational diabetes’ and rarer forms including monogenic diabetes. Some type 2 diabetes is genetically linked, and certain ethnicities are more prone, including South Asians, Afro Caribbeans and Native Americans.
Diagnosis
It’s important that diabetes is diagnosed as early as possible. Untreated, it affects blood vessels of vital organs, including the heart, eyes, nerves and kidneys. See your GP if you have possible symptoms, e.g. extreme thirst, peeing frequently, tiredness, unexplained weight/muscle loss, persistent thrush, poor wound healing and/or blurred vision. However, pre-diabetes and early diabetes may be symptomless.
If you have a family history of diabetes or have had a stroke or heart attack, polycystic ovary disease, high blood pressure or abnormal cholesterol levels, talk to your practice nurse. They’ll check your urine for sugar and may suggest blood tests, including HbA1c (which assesses your overall sugar levels over the previous three months), glucose tolerance testing (serial blood tests after a sugary drink) and baseline fasting plasma glucose (FPG).
The World Health Organization has no definite criteria for pre-diabetes, but an HbA1C of over 5.5% (42mmol/ mol) or FPG of over 5.5mmol/L, are indicators. Diabetes itself is diagnosed with HbA1c of over 6.5% (48mmol/ mol) or FPG of over 7.0 mmol/L.
Medical management
The diabetes nurse annually checks your weight, blood pressure, peripheral pulses, sensation and urine sampling, and blood testing (HbA1c, kidney and liver function and blood cholesterols). You’ll also have eye screening for diabetic retinopathy, which leads to sight loss if untreated.
Metformin is the usual initial medication. This is free on a PF57 prescription fee exemption certificate. Metformin also helps to manage insulin resistance. Over time, you may need oral medication combinations, plus cholesterol controlling medicines, and eventually you may be offered insulin for the best control. New injection therapies (such as GLP1 & GIP) help to reduce insulin needs and reduce excess weight.
Menopause and diabetes
The perimenopause and menopause don’t cause diabetes, but falling female hormone levels in the perimenopause can affect blood sugar levels. Your body becomes less responsive to insulin, although the full impact isn’t well understood. It’s probably related to a tendency to carry more weight around your middle. This causes insulin resistance, leading to higher blood sugar levels whether you’re overweight or not.
Keeping active, stopping smoking and eating healthily are the simplest ways for your body to more effectively manage and stabilise blood sugar levels. This will reduce your diabetes and heart disease risk and boost bone strength. Rapid changes from high to low blood sugar for no apparent reason make it harder for some menopausal diabetic women to manage sugar levels. More frequent blood sugar testing, or treatment adjustments including HRT, may be necessary.
Some menopause symptoms resemble diabetes complications. For example, hot sweats and palpitations are easily confused with a hypo (when your blood sugar drops too low). Continuous glucose monitors make it easier to monitor your blood sugar levels and are available from your diabetes nurse if you’re on certain medications, including insulin. Discuss the possibility of HRT with your diabetes team, who’ll talk you through the risks and benefits, taking account of all aspects of your medical history. Both diabetes and falling oestrogen levels increase your risk of heart disease and fractures. So, it’s important to ensure your diet contains sufficient vitamin D and calcium. Being physically active helps to keep your bones strong too.
About the author
Dr Gill Jenkins is a GP in Bristol with an interest in diabetes and women’s health.
Created Summer 2025
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