Did you know that before menopause, women are less susceptible to developing diabetes?
According to research, only 12.1% of premenopausal women have diabetes. In contrast, this number is 19.4% in postmenopausal women and even higher in surgical menopause. Also, compared to men of the same age, women have better protection against diabetes.
However, this outlook “makes a U-turn” after menopause. Changes in hormones can affect your blood sugar so much that it causes the risk of diabetes to be significantly higher.
Low Estrogen Due to Menopause May Cause You to Be More Susceptible to Diabetes
What Are the Hormones That Affect Blood Sugar?
Insulin and Glucagon
Insulin and glucagon are the two primary hormones regulating blood sugar (glucose). They work continually following and succeeded by each other in an “on-off” mechanism. So when insulin works, glucagon doesn’t, and vice versa.
Several hours after you consume food (the postprandial period), blood sugar rises significantly due to carbohydrate metabolism into glucose. In some people, the blood sugar level after a heavy meal can even exceed diabetic levels. In other words, they may have temporary diabetes for a short time until insulin gets in the way.
Insulin is released from the pancreas to increase glucose uptake by muscles and other glucose-sensitive tissues in the body. It allows glucose to be absorbed by organs, reducing the remaining sugar in the blood. But what if blood sugar is too low?
Glucagon is also secreted from the pancreas but by a different cell. This hormone increases blood sugar by triggering your liver to convert glycogen into glucose. Moreover, glucagon prevents your liver from storing glucose so that more sugar remains in your blood.
Although insulin and glucagon are well-known for their role in regulating blood sugar, estrogen is another vital factor that plays a part.
As a sex hormone, estrogen decides a woman’s feminine characteristics, such as the ability to develop and maintain the reproductive system, the menstrual cycle, pregnancy, and fertility. Estrogen also affects the brain, bones, skin, and circulation.
In metabolic health, estrogen affects insulin sensitivity and glucose production, which is crucial in blood sugar levels. Also, research shows estrogen plays a central role in regulating glucose homeostasis. Also, insulin resistance and the dysregulation of homeostasis are linked to estrogen deficiency, contributing to the onset of diabetes in humans.
How Does Estrogen Affect Insulin and Blood Sugar?
Understanding Insulin Sensitivity
Insulin sensitivity refers to how the body uses insulin to decrease blood sugar. The more sensitive the tissues are to insulin, the more sugar is absorbed and used, and the less remains in the bloodstream. Insulin sensitivity also affects insulin release from the pancreas, with more sensitivity resulting in more insulin being released.
In some people, the pancreas cannot produce enough insulin to control blood sugar. Some others cannot use insulin properly, leaving too much glucose in the bloodstream. This phenomenon is known as poor insulin sensitivity or insulin resistance.
Estrogen Improves Insulin Sensitivity
According to research, administering exogenous estrogen can improve insulin sensitivity in animal models. In general, glucose production in the liver and glucose uptake in tissue work together to maintain glucose homeostasis. At the same time, estrogen lowers blood sugar levels, which is linked to improved muscle glucose uptake.
However, inhibiting estrogen signaling may increase glucose production and insulin resistance in the liver. Therefore, it is suggested that FoxO1, a transcription factor that supports glucose expression, controls how estrogen improves glucose homeostasis. In other words, FoxO1 is required for estrogen’s action in the modulation of glucose production.
Menopause, Estrogen Decline, and Increased Diabetes Risks
Multiple research has shown that women have less chance of developing diabetes before menopause compared to men of the same age.
However, when estrogen levels drop, protection in women is significantly reduced. In line with these findings, women after menopause and the respective age-matched men show increased insulin resistance compared to premenopausal women.
According to research, postmenopausal women are more likely to have diabetes (19.4%) than premenopausal women (12.1%). Also, regardless of age, low estrogen increases the risk of diabetes, meaning that women before the natural menopause age (45-55) still have a higher risk if their estrogen is lower than normal levels. This theory is supported by evidence that surgically induced menopause raises the risk of insulin resistance.
Studies also reveal that an increase in body weight (as measured by the body mass index) and impaired glucose tolerance (as shown by increased fasting glucose levels) are more prevalent in postmenopausal women than in premenopausal women.
Preventing Diabetes With Hormone Replacement Therapy
Hormone Replacement Therapy Shows Efficacy
There has been considerable research on hormone replacement therapy for diabetes prevention. According to the Tulane Diabetes Research Program at Tulane University, the incidence of diabetes was 20% lower in patients on hormone therapy.
In another study, researchers assessed the impact of hormone therapy on fasting glucose levels and the occurrence of diabetes. Participants received either conjugated estrogen or a placebo and were monitored for four years. The study found that patients receiving hormone therapy experienced a 35% decrease in the incidence of diabetes.
A meta-analysis in 2006 showed that hormone therapy reduced diabetes risk by 30% and the HOMA-IR score (a method used to quantify insulin resistance) by 13% in women without diabetes. These numbers in diabetic women are 36% and 11%, respectively.
Factors That Impact Hormone Replacement Therapy
However, there have been conflicting findings regarding the impact of hormone replacement therapy on insulin sensitivity and glucose homeostasis. Variations in the study population, the regimen, the route of hormone administration, and the process of measuring insulin sensitivity can all explain these inconsistent results.
Additionally, the timing is essential; treatment started in early menopausal women has positive effects in contrast to treatment initiated in postmenopausal women, in whom hormone therapy has no impact or may even harm insulin sensitivity.
So, overall, can hormones affect your blood sugar? The short answer is yes.
Not only can the hormones well-known for regulating blood sugar, like insulin and glucagon, determine your blood sugar levels, but also estrogen has a significant role. Estrogen can do so due to its impact on insulin sensitivity and glucose production in the presence of a transcription factor that supports glucose expression known as FoxO1.
For this reason, hormone replacement therapy that aims to increase estrogen levels can be a potential approach to preventing diabetes in women. However, this therapy has not been approved for diabetes prevention. Still, the therapy can be an adjunct treatment that manages menopausal symptoms, which is indirectly beneficial for controlling diabetes.
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