Could menopause be causing uncontrolled diabetes in women?

Question

Hello doctor,

My 56-year-old daughter has had type 2 diabetes for the past seven years. Since entering menopause, her blood sugar levels have become very difficult to control despite a strict diet and regular exercise.

Her HbA1c increased from 7.2 % to 9.8 % over the last six months. She is currently taking Metformin 1000 mg twice daily, Glipizide, and Jardiance, yet her sugars remain high. Her fasting glucose is consistently above 200 mg/dL (245 mg/dL today), and post-meal levels sometimes reach 300 to 350 mg/dL.

She has developed diabetic neuropathy in both feet, with burning pain and numbness that disturb her sleep. Gabapentin was tried but caused dizziness and weight gain, so it was stopped.

Her kidney function is worsening, with a creatinine of 1.8 mg/dL and eGFR reduced to 42 mL/min. She also has recurrent vaginal yeast infections, which her doctor attributed to poor glycemic control.

Additionally, she is experiencing blurred vision, and her ophthalmologist has identified early diabetic retinopathy changes.

Her endocrinologist has advised starting insulin therapy, but she is extremely anxious about injections and fears hypoglycemia, especially because she drives for work and is concerned about low blood sugar episodes while driving.

She wants to know:

Is it possible to regain diabetes control without starting insulin?
Are there safer alternatives given her kidney function and complications?
How can she prevent further kidney damage and vision loss?

We are very worried about her overall health and the risk of progression to kidney failure.

Kindly advise on the best next steps.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I am truly sorry that your daughter is going through this. What you have described is understandably frightening for both of you, especially when she is making sincere efforts with her diet and lifestyle, yet seeing her diabetes (a chronic condition in which the body cannot properly regulate blood sugar (glucose) levels) worsen. That can feel deeply discouraging.

Menopause can significantly disrupt blood sugar control. Hormonal changes during this phase increase insulin resistance, and it is not uncommon to see a sudden rise in HbA1c (hemoglobin A1c) at this stage of life. This is not a personal failure on her part.

With fasting sugars persistently above 200 mg/dL, post-meal readings reaching 300 to 350 mg/dL, and the development of complications involving the eyes, nerves, kidneys, and recurrent infections, her body is clearly signaling that oral medications alone are no longer sufficient.

In this situation, insulin is not a punishment or a last resort. Rather, it is often the most effective way to quickly bring glucose levels under control and protect vital organs, particularly the kidneys. Starting insulin earlier can:

Slow the progression of kidney damage.
Improve neuropathy symptoms over time.
Reduce recurrent infections.
Lower the risk of further vision loss.

Sometimes allow reduction or discontinuation of other diabetes medications later

Her fear of injections and hypoglycemia (low blood sugar) is completely understandable, especially since she drives for work. However, modern insulin regimens are far safer than many people expect. Starting with a low-dose, long-acting insulin at night carries a very low risk of severe hypoglycemia when carefully monitored and mainly targets high fasting sugars that are driving her HbA1c (hemoglobin A1c, also called glycated hemoglobin).

Many patients are surprised to learn that insulin needles are extremely small and nearly painless. With proper diabetes education, she can learn how to recognize early symptoms of low blood sugar, prevent episodes, and follow safe driving strategies.

Given her declining kidney function, some oral diabetes medications become less effective or carry added risk, which is another reason insulin is being recommended now. Regarding her neuropathy (damage to the nerves), there are alternative medications to Gabapentin that may be better tolerated, and improving glucose control itself is one of the most important ways to slow nerve damage progression.

The most important message for both of you is this: starting insulin does not mean she has failed, and it does not mean kidney failure is inevitable. In many cases, this step is what prevents dialysis (a medical treatment that does the work of the kidneys when they can no longer function properly) and further vision loss when taken early and managed properly.

With close follow-up, careful dose adjustments, diabetes education, and emotional support, many people regain better control and confidence. What your daughter needs right now is reassurance, not blame, that there is still a clear and meaningful path forward to protecting her health and quality of life.

I hope this helps.

Please revert in case of further queries.

Thank you.