If you’re a woman in your 40s or 50s, you may have noticed that your body doesn’t always behave quite as it used to.

Perhaps you’re eating reasonably well, but your weight is creeping up. You’re exercising, but it doesn’t seem to have the same effect. You’re more aware of changes around your waistline, your energy dips in the afternoon, or you find yourself reaching for something sweet more often. You might simply feel that you don’t have quite the same energy or resilience you once did.

And then there’s perimenopause, menopause, work, family, stress and often not enough sleep thrown into the mix.

I’ve been having more conversations with women about these changes recently, and one area I think is worth understanding is blood sugar and metabolic health. This is where HbA1c comes in.

It isn’t a magic number that explains everything about your weight or energy, but it can provide useful information about how your body is managing glucose and help inform the bigger picture of your long-term health.

HbA1c is a blood test that measures the amount of glucose attached to haemoglobin, the protein in your red blood cells that carries oxygen around your body.

When glucose circulates in your bloodstream, some of it attaches to haemoglobin. Measuring this gives us an indication of your average blood glucose levels over approximately the previous two to three months.

Unlike a single blood glucose reading, which tells us what your blood sugar is doing at one particular moment, HbA1c provides a longer-term picture.

It is commonly used to identify and monitor type 2 diabetes and assess the risk of developing it. It can also be a useful part of a wider conversation about metabolic health, particularly if you have other risk factors.

In the UK, HbA1c is measured in mmol/mol. For adults who are not pregnant, the usual thresholds are:

• Below 42 mmol/mol: Below the threshold for non-diabetic hyperglycaemia, often called prediabetes.
• 42–47 mmol/mol: Higher risk of developing type 2 diabetes. This is commonly described as non-diabetic hyperglycaemia or prediabetes.
• 48 mmol/mol or above: In the diabetes range. A healthcare professional will assess your result and may recommend a repeat test to confirm the diagnosis, depending on your circumstances.

A result below 42 does not automatically mean that every aspect of your blood sugar regulation is optimal, and HbA1c alone cannot tell us everything about your metabolic health.

It is also worth knowing that certain conditions, including iron deficiency anaemia and other conditions affecting red blood cells, can influence HbA1c results.

The important thing is to understand what your result means in the context of your overall health, rather than focusing on chasing a particular number.

Glucose is one of the body’s main sources of energy. When we eat carbohydrate-containing foods, such as oats, bread, potatoes, fruit and rice, some of that carbohydrate is broken down into glucose, which enters the bloodstream.

Insulin helps move glucose from the bloodstream into our cells, where it can be used for energy or stored for later use.

When this process becomes less effective, the body may need to produce more insulin to help manage blood glucose. This is known as insulin resistance and can develop for a variety of reasons.

Insulin resistance is associated with an increased risk of type 2 diabetes and can occur alongside other metabolic changes, including changes in body fat distribution.

So, where does weight come into this?

If you’re finding it harder to manage your weight, particularly around your middle, it can be helpful to look beyond food intake alone. Blood glucose regulation, appetite, sleep, stress, activity levels, muscle mass and your overall eating pattern may all be relevant.

However, HbA1c does not measure insulin resistance directly, and a higher HbA1c does not automatically explain weight gain. Weight management is influenced by many interacting factors, including genetics, hormones, medications, energy intake, activity and sleep.

Equally, you can have a healthy HbA1c and still struggle with weight, cravings or low energy.  HbA1c is one potential piece of the puzzle, not the whole picture.

Midlife can bring a combination of changes that make it harder to maintain the routines and body composition you were previously comfortable with.

During perimenopause and menopause, oestrogen levels fluctuate and eventually decline. These hormonal changes can coincide with changes in body composition, including a tendency to accumulate more abdominal fat.

You may also experience disrupted sleep, hot flushes, night sweats, changes in mood and fluctuating energy levels. All of these can influence how much you move, what you feel like eating and how easy it is to maintain your usual habits.

Muscle mass can also decline with age if we aren’t actively working to maintain it. This matters because muscle plays an important role in glucose regulation, helping to take up glucose from the bloodstream.

Put all of this together and it is understandable that some women find their weight and metabolic health harder to manage during midlife.

This does not mean that menopause inevitably causes insulin resistance or type 2 diabetes. Many women maintain healthy blood glucose regulation throughout midlife.  Rather than blaming everything on hormones, I prefer to look at what may be changing and what we can realistically do to support the body.

The good news is that supporting your metabolic health doesn’t have to mean following a strict diet, cutting out carbohydrates or completely overhauling your lifestyle.

Small, consistent changes can help build a more sustainable foundation.

1. Include protein at your meals

Protein helps maintain muscle mass, supports recovery and can help you feel satisfied after eating.

Try to include a source of protein at your main meals. This could be:

• Eggs or Greek yoghurt
• Fish or chicken
• Tofu or tempeh
• Beans or lentils
• Cottage cheese or other suitable dairy products

As we move through midlife, combining adequate protein with resistance training becomes particularly important for maintaining muscle, strength and healthy ageing.

If you regularly skip breakfast or find yourself hungry and reaching for snacks later in the day, it may be worth reviewing whether your earlier meals are providing enough protein and overall nourishment.

2. Eat more fibre-rich foods

Fibre supports digestive health, feeds beneficial gut bacteria and can help moderate the rate at which glucose enters the bloodstream, depending on the type of fibre and the food it comes from.

Good sources include vegetables, fruit, beans, lentils, oats, nuts, seeds and wholegrains.

You don’t need to change everything overnight. Try adding beans to a soup, including berries with breakfast or choosing wholegrain bread more often.

Variety matters, too. Eating a wider range of plant foods helps you benefit from different types of fibre and the nutrients they provide.

3. Build balanced meals rather than cutting out carbohydrates

One thing I really don’t want this conversation to become is another reason to fear carbohydrates.

You don’t need to eliminate bread, potatoes, oats or fruit to support healthy blood glucose regulation. These foods can all form part of a balanced diet.

Instead, consider what you eat alongside them. Combining carbohydrate-rich foods with protein, fibre and some healthy fats can help make meals more satisfying and support a steadier post-meal glucose response.

For example:

• Porridge with Greek yoghurt, nuts and berries
• Wholegrain toast with eggs and tomatoes
• An apple with peanut butter or a handful of nuts
• Lentil and vegetable soup with wholegrain bread
• Salmon, potatoes and a generous portion of vegetables

The aim isn’t perfection. It’s finding combinations that nourish you, keep you satisfied and fit comfortably into everyday life.

4. Rethink your snacks

If you experience afternoon energy dips or frequent cravings, look at the balance of your meals and snacks rather than assuming you need more willpower.

A snack combining protein and fibre can be a useful option when you’re hungry between meals.

Some ideas include:

Protein and fruit

• Greek yoghurt or Skyr with berries and a few nuts
• Apple or pear with peanut or almond butter
• Cottage cheese with berries
• Banana with a small handful of walnuts

Savoury options

• Boiled eggs with cherry tomatoes
• Hummus with cucumber, peppers and carrots
• Wholegrain crackers with cottage cheese
• Oatcakes with hummus
• Edamame beans with a little sea salt

Something a little sweeter

• Greek yoghurt with berries and one or two squares of dark chocolate
• Chia pudding made with milk or yoghurt and berries
• Apple slices with peanut butter and cinnamon
• Overnight oats with Greek yoghurt, chia seeds and berries

You don’t need to ban biscuits, chocolate or your favourite foods. An occasional sweet treat isn’t going to determine your HbA1c. Your overall eating pattern over time matters much more.

Rather than focusing only on what you should remove, think about what you could add to make your meals and snacks more nourishing and satisfying.

5. Move after meals and make strength training a priority

Physical activity helps your muscles use glucose, and even a short walk after a meal can help reduce the rise in blood glucose that often follows eating.

One of the simplest habits you can introduce is to move for 10 minutes after a meal.

It doesn’t need to be a brisk power walk or a trip to the gym. A gentle walk around the block, walking the dog, doing a few laps of the garden or simply getting outside after dinner all count.

If 10 minutes feels too much on a busy day, start with five. Consistency matters more than perfection.

Alongside walking and other cardiovascular activities, don’t forget strength training.

Resistance exercise helps maintain and build muscle, supporting glucose regulation, strength and bone health as we age. If you’re new to it, start at a level that feels manageable and build gradually.

Reducing long periods of sitting and finding opportunities to move throughout the day can also make a difference.

6. Don’t underestimate sleep and stress

Poor sleep can affect appetite, food choices and the body’s response to insulin. Chronic stress can also influence sleep, eating patterns and our ability to maintain healthy routines.

Of course, telling a woman experiencing night sweats, anxiety or menopausal sleep disruption to simply sleep better isn’t particularly helpful!

Instead, start with what is within your control.

A regular bedtime routine, getting daylight in the morning, taking breaks during the day and finding ways to unwind may all help support better sleep and wellbeing.

If menopausal symptoms are significantly affecting your sleep or quality of life, speak to your GP or menopause specialist about the options available.

The goal is not to add another long list of things you feel you should be doing. It is to identify a few realistic changes that support you, rather than create more pressure.

This is an important point.

A normal HbA1c doesn’t mean your concerns about weight, energy, appetite or changes in body composition aren’t real. It simply means your average blood glucose is below the diagnostic threshold for diabetes or non-diabetic hyperglycaemia.

Depending on your symptoms and medical history, it may be worth discussing other factors with your healthcare professional, such as thyroid function, iron status, medications, sleep quality and menopausal symptoms.

In my nutrition practice, I also want to understand what your everyday eating pattern looks like, whether you’re getting enough protein and fibre, how much you’re moving, whether you’re maintaining muscle and how manageable your current routine feels.

Sometimes there are straightforward changes that can make a meaningful difference. Sometimes we need to investigate further.

The answer isn’t automatically to eat less, count every calorie or follow another restrictive diet.

If you’ve recently had an HbA1c test and aren’t sure what it means, start by discussing your result with your GP. If your result is in the diabetes range, you’ll need appropriate medical assessment and follow-up. Nutrition and lifestyle changes can be valuable alongside medical care to help build sustainable habits.

If your blood tests are within the normal range but you’re still struggling with weight, energy, cravings, sleep or feeling that your body has changed, there may be more to explore.

This is where I like to look at the whole picture rather than one number.

If you’re navigating perimenopause or menopause and finding that your body is changing in ways you don’t fully understand, you’re certainly not alone.

Blood sugar regulation and metabolic health are worth paying attention to, and HbA1c can provide useful information. But it isn’t a complete explanation for weight gain, cravings or low energy, and it shouldn’t be a reason to panic or start another restrictive diet.

Start with the foundations: balanced meals, enough protein and fibre, regular movement, strength training, and support for sleep and stress where possible.

You don’t have to do everything at once. A more balanced breakfast, a short walk after dinner or a little more variety in your weekly meals can be a useful place to begin.

And if you’re still struggling, don’t assume you’re doing something wrong. Sometimes you need a better understanding of what’s going on, rather than another diet.

Would you like support understanding your nutrition and metabolic health?

If this sounds familiar, you’re welcome to get in touch. In my nutritional therapy practice, I work with women to explore their individual symptoms, nutrition, lifestyle and existing blood results, helping identify practical, personalised steps towards better health and wellbeing.

You don’t necessarily need another diet. Sometimes you need a clearer picture of what your body needs.

This article is for general educational purposes and is not a substitute for individual medical advice, diagnosis or treatment. Please discuss blood test results and any concerns about diabetes or your metabolic health with your GP or another appropriate healthcare professional.