Managing Diabetes Through Menopause – 6 Essential Steps for Better Health Part 2

1. Check your glucose levels (GLs) more often

During perimenopause, hormone changes can make your GLs go up and down unpredictably. To keep track, check your GL more often. Symptoms like sweating, hot flushes or a fast heartbeat can be caused by low glucose levels or perimenopause. Regular checking helps you figure out what is going on. If you use insulin or certain diabetes tablets like Diamicron (Gliclazide) or Amaryl (Glimepiride), be extra careful as these medications put you at risk of hypoglycaemia (glucose levels under 4mmol/L).

It is also important to check whether your GLs are higher than usual. Check GLs in the morning, but also at different times across the day. The standard targets for GLs are:

- Before meals: 4–7 mmol/L.
- 2 hours after meals: 5–10mmol/L

If your levels are often outside these ranges, talk to your healthcare team.

2. Review your medications

The physical changes during perimenopause can make your body more resistant to insulin. Insulin resistance means it is more difficult for your body to move glucose from the blood into the cells. This means you might need to adjust your diabetes medications. This is especially important for those using insulin, because you might need higher or lower doses as your hormones change. It is a good idea to have regular check-ups with your diabetes care team during perimenopause and afterwards to keep on track.

3. Talk to your doctor about hormone replacement therapy

Hormone Replacement Therapy (HRT) replaces the hormones that decline during perimenopause. It has been shown to:

- Improve symptoms of perimenopause
- Prevent osteoporosis
- Maintain muscle mass
- Reduce risk of heart disease
- Stabilise glucose levels
- Reduce insulin resistance

However, it also comes with risks, such as a higher chance of breast cancer or blood clots. The benefits of HRT often outweigh the risks, especially if there is a plan to stop it once symptoms improve.

Discuss with your doctor whether HRT is right for you based on your health history and symptoms. For more information on HRT, check The Australian Menopause Society website.

4. Get Enough Calcium and Vitamin D

Bones become weaker after menopause because more calcium is passed into the urine. After menopause, aim for 4 servings of calcium-rich foods each day.

1 serving of this calcium is equal to:

o 1 cup milk (250ml)
o ¾ cup yoghurt (200g)
o 2 slices cheese (40g)
o 100g almonds
o 100g firm tofu
o 1 cup soy, rice or other non-dairy milk, fortified with at least 100mg of added calcium per 100mL
o ½ cup canned pink salmon with bones or 60g canned sardines

Vitamin D increases the absorption of calcium from food and plays a key role in bone health. Levels can be boosted by just a few minutes of sunshine each day during summer. Try to spend some time outdoors in summer and consider a vitamin D supplement in winter. Ask your doctor to check your vitamin D levels to see if you need a supplement.

5. Eat Enough Protein

Many women do not eat enough daily protein to meet their needs, which can make muscle loss worse. Aim to eat good sources of protein with at least 2 meals per day. This includes lean red meats, chicken, fish, eggs, tofu, legumes or nuts. You can view what a standard serving of protein is at eatforhealth.gov.au.

6. Do Strength-Based Exercise

Staying active is crucial during the perimenopause and post-menopausal years to help prevent muscle loss, reduced metabolism, and weaker bones. Strength-based exercises like weightlifting, pilates, resistance band workouts, and circuit training are especially helpful. Try to do strength training at least two days a week to help maintain muscle mass, manage weight and prevent falls. Diabetes Victoria is running an 8-week strength training program starting in October, read more about it on our website.

In Summary

Managing diabetes during perimenopause and beyond takes some extra effort, but these steps can help. By checking your glucose levels regularly, adjusting your medications, eating the right foods, and strength training, you can reduce the impact menopause has on your health. If you need more help, our diabetes health professionals at the Diabetes Victoria Clinic are here to support you.

For more support and information, consider making an appointment with our diabetes health professionals.