If you are a woman over 40 and your body suddenly seems to be responding differently to food, exercise, and weight loss, you are not imagining the change. You may be eating much the same way you always have. You may still be active. You may have even responded to stubborn weight gain by cutting calories, exercising harder, fasting, eating fewer carbohydrates, or going back to strategies that worked perfectly well ten years ago. Yet your waistline continues to change, the scale barely moves, or the weight you lose seems to come right back.
That is usually when women start asking, “What am I doing wrong?”
I think there is a better question.
What is my body trying to tell me?
Weight gain is information. So are stronger cravings, afternoon energy crashes, changes in appetite, increasing abdominal fat, feeling shaky or irritable between meals, or suddenly feeling as though you need something sweet even though you ate only a few hours ago. None of these symptoms proves you have insulin resistance, but they are worth paying attention to because symptoms leave clues.
For women over 40, insulin resistance is one of those clues worth understanding. It is not the explanation for every case of perimenopause weight gain, and I do not want women diagnosing themselves based on a list of symptoms. But metabolic changes can begin long before someone receives a diagnosis of pre-diabetes or type 2 diabetes, which is why looking at the bigger pattern matters.
The CDC estimates that 115.2 million American adults, more than two out of every five, have pre-diabetes, and roughly eight in ten do not know they have it. Pre-diabetes and insulin resistance are not identical, but insulin resistance often develops earlier, while the pancreas is still producing enough insulin to maintain blood glucose within an acceptable range. Research using U.S. population data has also found insulin resistance to be common among women without diabetes, although prevalence estimates vary depending on how insulin resistance is defined and measured. (cdc.gov) (pmc.ncbi.nlm.nih.gov)
This becomes especially relevant during perimenopause and menopause because several metabolic changes may be happening at the same time. Estrogen is changing. Muscle mass becomes easier to lose if we are not intentionally protecting it. Sleep may become less predictable. Stress may increase. Fat distribution often begins shifting toward the abdominal area. Researchers have also documented increasing cardiometabolic risk across the menopause transition, although menopause itself is only one part of a much larger picture that also includes aging, activity, muscle mass, sleep, stress, genetics, and nutrition. (pmc.ncbi.nlm.nih.gov)
This is why I think telling a woman with stubborn weight gain after 40 to simply “eat less and move more” misses too much of the context. Energy balance still matters. Calories did not suddenly stop existing when you turned 40. But appetite matters too. Muscle matters. Sleep matters. Stress matters. Hormones matter. Insulin sensitivity matters. The environment in which your body is trying to regulate energy has changed, and sometimes pushing harder against that system creates another layer of problems rather than solving the first one.
Understanding Insulin Resistance in Women Over 40
Insulin is a hormone made by your pancreas. When you eat carbohydrates, your body breaks them down into glucose, which enters your bloodstream. Your pancreas releases insulin to help move that glucose into your cells, where it is used for energy or stored for later.
Insulin is not bad. Glucose is not bad. A rise in blood sugar after eating is part of normal physiology.
The problem begins when your cells become less responsive to insulin. Your pancreas then has to produce more insulin to accomplish the same job. Early in this process, your fasting glucose may still look completely normal because your pancreas is working harder behind the scenes to keep it there.
That is one reason insulin resistance can go unnoticed for years.
This was part of my own experience. When I began looking more closely at my metabolic health, my fasting glucose was 89 mg/dL. Nothing about that number would raise much concern on its own. My hemoglobin A1C was 5.6%. The conventional threshold for pre-diabetes begins at 5.7%.
Technically, I was still below the cutoff.
But I was also gaining weight, watching my body composition change, and moving through menopause. I had gained about 15 pounds in one year despite remaining active and without making some dramatic change in how I ate. I was not interested in waiting until one of my numbers crossed a diagnostic threshold before asking more questions.
That experience changed how I think about laboratory testing. Conventional diagnostic ranges answer important questions. Has someone reached the threshold for pre-diabetes? Has someone reached the threshold for diabetes? Those are useful questions.
But I was asking something different.
Where is my metabolic health headed?
That is why I prefer looking at trends and patterns rather than one isolated number. In the video accompanying this article, I talk about fasting glucose, A1C, fasting insulin, HOMA-IR, triglycerides, HDL, waist circumference, and glucose tolerance testing. No single marker tells the entire story. Put several pieces together, though, and you begin to see a direction.
Your Blood Sugar May Look Normal While Insulin Is Rising
One of the more important things to understand about insulin resistance is that glucose and insulin do not tell us exactly the same thing. Imagine two women who both have a fasting glucose of 90 mg/dL. One woman’s body maintains that glucose level with a relatively small amount of insulin. The other woman’s pancreas has to release much more insulin to hold her glucose at the same level.
Those women do not necessarily have the same metabolic picture.
This is why fasting insulin sometimes adds useful context. Fasting glucose gives us a snapshot of blood sugar at one point in time. A1C gives us an estimate of average glucose over the previous two to three months. Fasting insulin gives information about how much insulin the body is producing in a fasting state. HOMA-IR uses fasting glucose and fasting insulin together to estimate insulin resistance.
None of these should be interpreted in isolation, and there is no single HOMA-IR cutoff accepted for every population. More testing is not automatically better. The goal is to gather the information that answers the question you are trying to ask.
That philosophy became an important part of how I built The Vital Woman Journey. We begin with Reveal because I would rather gather information than guess. We look at symptoms, history, laboratory trends, body composition, lifestyle, and patterns before deciding where attention belongs.
Your Everyday Symptoms Are Data Too
Laboratory values are useful, but your body gives you information every day.
Think about what happens after meals. Do you eat a carbohydrate-heavy lunch and feel as though you need a nap two hours later? Do you eat breakfast and find yourself hunting for something sweet by 10:30? Do you become shaky, irritable, weak, anxious, or intensely hungry between meals? Has more of your weight started collecting around your abdomen even though your overall habits have not changed much?
Your history matters too. Gestational diabetes, PCOS, and a strong family history of type 2 diabetes are all pieces worth bringing into the conversation.
Again, none of those things by itself tells you that you have insulin resistance. The value comes from connecting them.
When I wanted to understand my own glucose patterns more closely, I wore a continuous glucose monitor for a short period. My goal was not to chase perfectly flat blood sugar. I wanted information. I looked at how different meals affected me, what happened when I paired carbohydrates with protein, what happened after a walk, and what happened after poor sleep.
I treated the whole experience like a science experiment.
No failure. Only feedback.
The most surprising piece of information came when my highest glucose spike occurred without any food involved. It happened during an intensely stressful situation. That moment made the connection between stress, glucose regulation, and metabolic health impossible for me to ignore. Stress hormones such as cortisol and adrenaline help make glucose available when your brain perceives a threat. Your body is preparing to give you energy for whatever it thinks you need to deal with.
The problem is that most modern stress does not end with us physically using that energy. We sit at the computer. We answer the email. We worry about money. We deal with a family situation. We lie awake thinking about tomorrow.
The physiology still responds.
That is also why insulin resistance in women over 40 should not be reduced to a conversation about carbohydrates. Sleep affects insulin sensitivity. Stress affects glucose regulation. Skeletal muscle helps dispose of glucose. Estrogen influences body composition and insulin sensitivity. These systems overlap.
And that brings us back to why treating every symptom as a separate problem often leaves women exhausted and frustrated.
Stop Playing Whack-a-Mole With Your Symptoms
Weight gain appears, so you diet harder. Fatigue appears, so you drink more coffee. Sleep falls apart, so you take something to sleep. Cravings increase, so you cut carbohydrates. Brain fog shows up, so you order another supplement.
Soon you have five or six symptoms being treated as though they came from five or six unrelated problems.
But what if several of those symptoms are connected?
This is where I want women to stop asking, “What else should I try?” and start asking, “Which system deserves my attention first?”
Sometimes insulin sensitivity is an important lever. For another woman, sleep is the place to start. Chronic stress might be interfering with several things at once. Thyroid dysfunction may deserve investigation. Declining estrogen may be influencing body composition, sleep, glucose regulation, and other symptoms at the same time.
Finding a useful starting point changes the conversation. When blood sugar becomes more stable, cravings may become easier to manage. When energy improves, movement feels more accessible. More movement supports insulin sensitivity. Better fueling improves workouts. Resistance training helps preserve and build muscle. More muscle provides a larger place for the body to use glucose.
One useful change starts supporting the next.
This does not mean there is one magical lever hiding somewhere that fixes everything. Human physiology is more complicated than that. It means you stop throwing random solutions at your body and start making decisions based on the information your body is giving you.
Muscle Is Part of the Insulin Resistance Conversation
I also want women over 40 to understand why muscle belongs in any serious conversation about metabolic health and healthy aging.
Skeletal muscle is one of the major tissues responsible for glucose disposal. When your muscles contract, they use glucose. Building and preserving muscle therefore supports glucose regulation while also supporting bone health, strength, mobility, and independence as you age.
During my own transformation, I lost approximately 45 pounds while gaining more than 12 pounds of muscle and improving my skeletal muscle mass. The second half of that sentence matters more to me now than the first.
I did not want to become a smaller, weaker version of myself.
I wanted a body capable of carrying me through the next several decades.
I have cared for older women who experienced a fall, fractured a hip, lost their independence, and never fully recovered. Those experiences changed what “success” means to me. I want to be riding my horses well into my eighties. I would like to be the 80-year-old woman still throwing her own saddle on.
That is a different goal than simply weighing less.
It is also why the scale eventually stopped being the most important part of my own story.
Start Looking at the Pattern
If your body has changed after 40, I do not want you automatically assuming you lack discipline. I also do not want you assuming insulin resistance explains every symptom.
I want you to get curious.
Pull out your old lab work and look at the trends. What has happened to your fasting glucose over several years? What about your A1C? Your triglycerides? Your HDL? What has happened to your waist circumference and body composition during the same period?
Then look beyond the laboratory report. What changed around the time your weight started changing? What happened to your sleep? Your stress level? Your muscle mass? Your activity? Your menstrual cycle? Your appetite? Your energy?
Gather the clues before deciding what they mean.
That is the foundation of the work I teach. Reveal what is happening. Restore the systems asking for support. Then Reclaim something bigger than weight loss.
Because I understand why the extra 10 or 20 pounds bother you. I understand wanting your clothes to fit again. I understand looking in the mirror and wondering when your body changed.
I have been there.
But metabolic health reaches much further than the number on your scale. Insulin resistance is associated with the development of type 2 diabetes and is part of a broader cardiometabolic picture that often includes abdominal fat, higher triglycerides, blood pressure changes, fatty liver disease, and cardiovascular risk. (cdc.gov)
I want you thinking about the woman you are becoming too.
What do you want your health to look like at 60? At 70? At 80?
Do you have muscle? Are you strong? Are you independent? Are you able to travel, hike, ride horses, garden, play with grandchildren, or keep doing whatever makes your life feel like yours?
That is why stubborn weight gain after 40 deserves a bigger conversation than another diet.
Watch the First Video in My Four-Part Series
This article is part of a four-part series exploring why weight loss often becomes harder during perimenopause and menopause.
In the first video, I take you further into insulin resistance in women over 40 and explain fasting glucose, A1C, fasting insulin, HOMA-IR, triglycerides, HDL, waist circumference, continuous glucose monitors, meal composition, movement, and muscle. I also share more of my own experience and the information that finally helped me stop trying harder and start asking better questions.
The next video connects another major piece of this metabolic puzzle: chronic stress, poor sleep, cortisol, blood sugar, and stubborn weight gain.
Subscribe so you do not miss the rest of the series.
And in the meantime, remember this: symptoms leave clues. There is no failure here, only feedback. Get curious over critical.
Disclaimer:
The information shared in this publication is for educational and informational purposes only. It is not medical advice and is not intended to replace guidance from your physician or another qualified healthcare professional.
Do not use this information to diagnose, treat, cure, or prevent any health condition, or to make decisions about medications, supplements, or other forms of treatment. Always speak with your healthcare provider before starting, stopping, or changing any medication, supplement, nutrition plan, or treatment.
If you have a medical concern, or believe you may have a medical condition, contact a qualified healthcare professional promptly. Do not disregard professional medical advice or delay seeking care because of something you read, hear, or view in this publication.
Your use of this Substack, podcast, or any related products or services does not create a nurse-patient, client or coaching relationship with Tina Hergert.
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