Have you improved your diet but still struggle with cravings, tiredness after meals or difficulty managing your weight? Perhaps your fasting glucose looks reasonable, yet you do not feel that your energy is stable.
Blood sugar regulation involves more than how much sugar you eat. Your liver, muscles, hormones, nutrient status, sleep and stress response all influence how your body handles fuel.
What is insulin resistance?
Insulin helps glucose move from the bloodstream into cells, where it can be used for energy or stored.
When cells become less responsive to its signal, the pancreas may produce more insulin to compensate. Blood glucose can therefore remain within the laboratory range while insulin is working harder.
This is why I consider glucose and insulin together, rather than relying on one result.
The liver’s role
Your liver helps maintain blood glucose between meals and overnight.
It stores glucose as glycogen and releases it when needed. It can also make new glucose through a process called gluconeogenesis.
Insulin normally signals the liver to reduce glucose production when enough is available. With insulin resistance, this signal can become less effective, allowing the liver to keep releasing glucose.
Fat accumulation in the liver can further disrupt these processes. Insulin resistance and fatty liver can reinforce one another, making liver health an important part of the assessment.
Glycogen and overnight glucose
Liver glycogen acts as a glucose reserve during the night.
The amount available depends on factors including food intake, activity and liver metabolism. If blood glucose falls sufficiently, the body responds by releasing hormones that help restore it.
Adrenaline, also called epinephrine, and cortisol are part of this protective response. They encourage glucose release or production.
This can sometimes accompany waking with a racing heart, sweating, shakiness or a feeling of being suddenly alert. However, these symptoms have other possible causes and do not prove that glucose has dropped.
Histamine is another possible connection considered in this picture. The suggestion that overnight glucose dips can spark histamine release remains an explanation to explore, rather than something that can be assumed from night waking alone.
A raised morning glucose result does not establish what happened overnight. Looking at the pattern can be more informative than guessing.
How chronic stress can contribute
Chronic stress can be a contributing factor that precedes or reinforces difficulties with glucose regulation.
Stress hormones make fuel available for action. When that response is activated repeatedly, alongside poor sleep or limited recovery, glucose regulation can become more difficult.
The body also experiences physical stress from illness, inadequate food intake and disrupted sleep.
This is why eating less and exercising harder are not automatically the right next steps. Your daily demands and capacity to recover matter.
PCOS and the insulin connection
Polycystic ovary syndrome, or PCOS, involves different combinations of ovulation difficulties, androgen excess and changes in ovarian appearance.
Insulin resistance is common in PCOS, although it is not present in everyone.
Higher insulin can encourage the ovaries to produce more androgens, including testosterone. It can also reduce the liver’s production of sex hormone binding globulin, or SHBG, leaving more testosterone available to act on tissues.
This can contribute to patterns such as irregular periods, acne and increased facial or body hair. Androgen excess and insulin resistance can then reinforce one another.
Understanding this connection helps explain why PCOS support may need to address metabolic health alongside menstrual symptoms.
Hormonal patterns through the month
Glucose responses, appetite and energy can change across the menstrual cycle.
Some women notice greater hunger, cravings or less stable glucose in the second half of their cycle. Others notice changes during perimenopause.
I consider these patterns when reviewing symptoms and planning support, rather than expecting the same response every day.
Where leptin fits
Leptin is a hormone produced mainly by fat tissue. It helps communicate information about energy stores to the brain and contributes to appetite and energy regulation.
When the response to leptin becomes less effective, fullness and energy regulation may be disrupted.
Leptin is part of the wider metabolic picture, but persistent hunger or difficulty losing weight cannot diagnose leptin resistance on their own.
Movement and cellular energy
Muscle is an important place for glucose to be taken up and used. Muscle contractions help glucose enter cells, which is one reason regular movement and appropriate resistance exercise can be useful.
Inside cells, mitochondria help turn fuel into usable energy. Nutrients including vitamins B1 and B2 support the enzymes involved.
The aim is to support both glucose uptake and the body’s ability to use that fuel.
Could glucose monitoring help?
Where appropriate, a continuous glucose monitor may help us explore patterns after meals, during activity and overnight.
It can also help us compare responses to meal composition, timing, sleep and menstrual changes.
A monitor provides additional information, but it does not measure insulin or diagnose insulin resistance by itself. Unexpected low readings, particularly during sleep, may be sensor artefacts and need checking before conclusions are drawn.
My approach
I consider your meals, symptoms, sleep, stress, movement, menstrual history and liver health.
Where appropriate, I may recommend fasting glucose, fasting insulin and HbA1c, alongside relevant liver markers and blood fats. Hormonal testing may also be useful when PCOS or menstrual changes are part of the picture.
Results are interpreted together. For example, iron deficiency can affect HbA1c, so it needs to be considered when assessing glucose patterns.
Support may involve balanced meals, suitable meal timing, muscle support, sleep and recovery, alongside individual nutritional support. Nutrients such as thiamine or inositol may be considered where appropriate.
The aim is to understand what is driving your pattern and support steadier energy, hormone function and metabolic health.
If you feel you need support in this area, please reach out and let’s take the next steps together towards improving your overall wellbeing.
Lisa Cahill
Qualified nurse and naturopathic nutritionist
Evolve Female Wellness
lisa@evolvefemalewellness.com
Any supplements mentioned are included for information only and are not recommendations to take them. They do not suit everybody. Individual assessment of your needs, medical history and medicines is essential before use.