Perimenopause and Type 2 Diabetes

What perimenopause has to do with type 2 diabetes and why it matters

We all know that as we get older, the risk of developing type 2 diabetes increases, but we rarely stop to think about why. Did you know that the hormonal changes beginning during the perimenopause stage of life affect many biological systems and have a direct connection to blood sugar balance and metabolic health?

And here is something most women do not realise — these hormonal shifts can begin as early as your 30s. You may not notice any obvious symptoms at first, but changes are quietly happening in the background.

The effects of these hormonal changes on body weight, metabolism, and cardiovascular health are gradual and progressive, meaning they continue to evolve over time. Let’s take a closer look at how each of these systems is affected and how that relates to the risk of developing type 2 diabetes.

Body weight

During perimenopause, declining oestrogen levels begin to slow the metabolism and alter the way fat is stored. Many women notice a gradual increase in body fat, particularly around the abdomen. This is not just about appearance. Abdominal fat is more active hormonally and can influence how the body handles sugar and insulin.

As oestrogen drops, the balance between female and male hormones shifts, and the body becomes slightly more androgen dominant. This change encourages fat to settle around the middle and makes it easier to develop insulin resistance, a key factor in type 2 diabetes.

These hormonal changes also affect appetite and how efficiently the body burns energy, making it easier for fat to build up and harder to maintain metabolic balance.

Metabolic changes

Hormonal fluctuations also impact how the body uses and stores energy. As oestrogen levels fall, insulin sensitivity decreases, meaning your body has to produce more insulin to keep blood sugar levels stable. Over time, this can lead to insulin resistance, higher blood sugar levels, and increased fat storage, which are the early steps toward metabolic imbalance.

Cardiovascular changes

Lower oestrogen levels influence cholesterol balance and blood vessel health too. LDL (‘bad’) cholesterol may rise while HDL (‘good’) cholesterol declines, and arteries can become less flexible. These cardiovascular changes often occur alongside the metabolic shifts described above, affecting overall circulation and heart health.

How these changes connect to type 2 diabetes

When you put all these changes together, it is easy to see how menopause and metabolic health are linked. The combination of slower metabolism, increased abdominal fat, reduced insulin sensitivity, and altered cholesterol levels creates the perfect environment for insulin resistance to develop.

Insulin resistance means the body’s cells stop responding efficiently to insulin, forcing the pancreas to produce more of it. Over time, this can exhaust the system, leading to chronically elevated blood sugar and predisposing women to type 2 diabetes.

The good news is that this does not happen overnight. It is a gradual, progressive process influenced by hormones, lifestyle, and genetics, but it is also modifiable. Through balanced nutrition, regular physical activity (especially strength training), good sleep, and stress management, you can help support hormone balance, maintain metabolic health, and significantly lower your risk of developing type 2 diabetes.

Healthy eating tips to reduce type 2 diabetes risk during perimenopause

It is important to remember that the risk of developing type 2 diabetes is multifactorial. It is influenced by a combination of age, genetics, family history, lifestyle habits, body weight, and other health conditions. While some of these factors are beyond our control, the choices we make around food are one of the most powerful tools we have to protect our health. Thinking about what you eat does not mean following a restrictive diet or denying yourself enjoyment. It is about nourishing your body in a way that supports hormone balance, stabilises blood sugar, and maintains a healthy weight. Small and consistent changes can make a meaningful difference over time. By approaching food as fuel and medicine, you can take proactive steps during perimenopause to reduce your risk of diabetes and support long-term wellbeing.

➳ Choose drinks with no added sugar

We often do not realise how much sugar hides in our favourite fizzy drinks, energy drinks, or even fruit smoothies, but these can have a big impact on blood sugar balance and weight, especially during perimenopause. Research shows a clear link between regularly consuming sugary drinks and a higher risk of developing type 2 diabetes.

Cutting back on these beverages is one of the simplest ways to support your metabolism and reduce your diabetes risk. If you find it hard to give them up completely, start by choosing diet or low-calorie versions, and always check the label for added sugars.

Try not to replace sugary drinks with fruit juices or smoothies, as these can still contain a large amount of free sugars. Instead, opt for plain water, sparkling water with a slice of lemon, unsweetened tea, or black coffee. Evidence even suggests that regularly drinking unsweetened tea and coffee may help lower your risk of developing type 2 diabetes. A small, easy change that makes a meaningful difference.

➳ Choose wholegrains and high-fibre carbs

Refined carbs like white bread, white rice, and sugary cereals can raise blood sugar and increase the risk of type 2 diabetes. Choosing wholegrains, such as brown rice, wholewheat pasta, oats, and wholegrain bread, helps keep blood sugar steady and supports long-term health.

When shopping, check labels and pick foods higher in fibre. Other good carbohydrate sources include fruit, vegetables, pulses (like beans, lentils, and chickpeas), and unsweetened dairy.

A higher-fibre diet is also linked to a lower risk of obesity, heart disease, and some cancers. This is another great reason to make wholegrains part of your everyday meals.

➳ Cut down on red and processed meat

Eating a lot of red and processed meats, like bacon, ham, sausages, beef, pork, and lamb, is linked to a higher risk of type 2 diabetes, as well as heart disease and certain cancers.

Try getting more of your protein from healthier sources, such as pulses (e.g., beans and lentils), eggs, fish, chicken or turkey, and unsalted nuts.

Fish, especially oily fish like salmon, sardines, and mackerel, is a great choice because it is rich in omega-3 fats that help protect your heart. Aim for at least one portion of oily fish and one portion of white fish each week for balanced nutrition.

➳ Eat plenty of food and veg

Eating more fruit and vegetables is linked to a lower risk of type 2 diabetes and some types are especially beneficial. Studies show that apples, grapes, berries, and green leafy vegetables like spinach, kale, and rocket offer the greatest protection.

Fresh or frozen, try adding them to your meals or enjoying them as snacks throughout the day.

Do not worry about the natural sugar in whole fruits. It is not the same as added sugar. Just be mindful with fruit juices and smoothies, as these contain free sugars that can spike blood sugar levels. Whenever possible, eat the whole fruit or vegetable for all the fibre and nutrients.

➳ Choose natural yogurt and cheese

Fermented dairy foods like yogurt and cheese are linked with a lower risk of type 2 diabetes. The fat content (full-fat or low-fat) matters less than choosing unsweetened options such as plain natural or Greek yogurt, and plain milk. However, i would recommend to stay away from low-fat or lighter versions.

Aim for about three portions of dairy a day to support bone health and calcium intake (e.g., 200 ml milk, 30 g cheese, 125 g yogurt).

➳ Cut down on alcohol

Drinking too much alcohol can raise your risk of type 2 diabetes and make weight management harder. Cut down on alcohol and avoid binge drinking, as it increases the risk of diabetes, heart disease, and certain cancers.

➳ Cut down on salt

Too much salt raises blood pressure, increasing the risk of heart disease, stroke, and type 2 diabetes. Aim for no more than one teaspoon (6 g) per day.

Check food labels and cook from scratch when possible so that you are in control of what you are adding to your food. Instead of adding salt, flavour meals with herbs, spices, lemon, or garlic for a tasty, heart-friendly alternative.

Prioritise sleep

Getting enough good-quality sleep is essential for overall health and blood sugar balance, especially during perimenopause. Poor sleep can leave you feeling foggy, irritable, and low on energy, and over time, it can contribute to weight gain, insulin resistance, and an increased risk of type 2 diabetes.

Most adults need at least seven hours of sleep per night, though sleep quality that is uninterruptedand refreshing rest is just as important as quantity. Too much sleep, nine hours or more, has also been linked to negative health outcomes, so balance is key.

Stay active

Exercise is one of the most effective ways to reduce the risk of type 2 diabetes and support hormone balance during perimenopause. Regular movement helps your body use insulin more efficiently, keeps blood sugar levels stable, and prevents fat from accumulating around the abdomen.

You do not need to spend hours at the gym. Even brisk walking, swimming, cycling, dancing, or yoga can make a real difference. Aim for at least 150 minutes of moderate activity a week, and include some strength training to maintain muscle mass and boost metabolism. Most importantly, find activities you enjoy so movement becomes a natural and enjoyable part of your daily routine.

These are just a few simple ways to support your health and reduce the risk of type 2 diabetes during perimenopause. Small, consistent changes to your eating habits can make a big difference in maintaining healthy blood sugar levels, hormone balance, and long-term wellbeing.

If you have any medical concerns or existing health conditions, be sure to talk to your doctor for personalised guidance.

And I would love to hear from you if you have your own healthy eating tips or stories about managing energy, hormones, or blood sugar during perimenopause. Share them in the comments below so we can learn and inspire each other to feel our best at every stage of life.

Disclaimer: No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.