120. Blood Sugar After 40: Please Stop Fearing Carbs
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Blood sugar and carbohydrates can feel incredibly confusing—especially in midlife, when changes in estrogen, muscle mass, sleep, stress, and body composition can affect metabolic health.
In this episode, we’re breaking down what your glucose, HbA and fasting insulin actually tell you, why you don’t need to fear carbohydrates, and why constantly chasing a perfectly flat glucose curve may be doing more harm than good.
- What “blood sugar balance” means—and why glucose spikes aren’t always bad
- Why carbs aren’t the enemy and how to build meals with all macronutrients
- How stress, under-eating, exercise, poor sleep, and midlife hormone changes can affect glucose regulation
- Why building muscle, moving regularly, eating enough, and looking at lab trends over time matter more than obsessing over one number or wearing a glucose monitor
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If you’ve been told you need to “balance your blood sugar,” avoid carbs, stop eating fruit, wear a glucose monitor, or make sure your blood sugar never spikes after a meal, this episode is for you.
This question actually came from someone in my email community, and I loved it, because blood sugar has become one of those topics where there’s a little bit of good information buried underneath a whole lot of fear.
And I don’t want you to be afraid of glucose – I want you to understand it. Glucose is not the enemy. Neither is insulin or carbohydrate.
And your goal shouldn’t be a perfectly flat blood sugar chart all day — your goal should be: a healthy body that can appropriately respond to food, movement and stress.
Especially in our 40s and beyond. There’s a lot we can do to support that, so let’s get into it.
Blood sugar is supposed to go up
Women have often told me this: “My blood sugar is high, so I need to stop eating carbs.” That’s not usually the best course of action, and honestly, eating little to no carbs can often make your overall health picture more complicated, not better.
When people talk about “balancing blood sugar,” they usually mean keeping glucose from getting too high or too low and helping your body regulate it appropriately.
Glucose regulation does matter. But the wellness world has taken something that is physiologically normal and turned it into something women are scared of.
Your blood sugar is supposed to go up after you eat — you eat carbs, your digestive system breaks them down, glucose enters your bloodstream, your pancreas releases insulin, and insulin helps your cells take up and use or store that glucose. That’s normal physiology.
If you eat a bowl of oatmeal and your glucose rises, that’s what your body is supposed to do.
The real question is whether your body can appropriately handle that glucose and bring things back toward baseline. That’s a very different conversation, and it’s a big part of why I don’t love the current obsession with keeping glucose perfectly flat.
What the labs actually tell you
There are a few markers worth knowing, and they don’t all tell you the same thing.
Fasting glucose is your blood glucose at one point in time — it’s useful, but it’s a snapshot. Hemoglobin A1c, or HbA1c gives you a broader picture because it reflects your average blood glucose over the previous 2-3 months.
Fasting insulin which is the hormone that helps move glucose out of your bloodstream and into your cells.
When your cells become less responsive to insulin, your pancreas may compensate by producing more of it to keep your blood glucose in range.
If one fasting glucose comes back higher than you expected, don’t jump straight to diagnosing yourself with a metabolic problem — look at the pattern, look at your other labs and symptoms, and retest when appropriate.
To give some context: I recently had my own fasting insulin come back at 18, and my first thought was, okay, that’s something I want to pay attention to. I’m not going to sit here and tell you that means I have insulin resistance for a number of reasons: my glucose and Hba1c were fine. And that blood draw wasn’t exactly clean.
I’d intentionally been eating in a surplus while focusing on building muscle, so I’d gained some weight. The night before, I was at a fair and completely forgot I had labs the next morning, so I had typical fair food: sausage, french fries, and a lemonade.
And I probably didn’t fast as long as I should have either. Could all of that have influenced the result? Sure. I’m not ignoring the 18, but I’m also not panicking over it —because in prior labs, my insulin was never that high.
I’m looking at the context, paying more attention to fiber-rich carbohydrates and how often I’m reaching for things like sourdough, bagels, or rice. And I’ll retest in a couple of months under better conditions.
That’s what I mean by looking at trends, instead of obsessing over a single data point. And if you have real concerns about your labs, that’s a conversation for your healthcare provider, or consider working with my team – I wouldn’t try to self-diagnose from some Instagram post because someone gave a level that you should always remain at.
Carbs are not the villain
This is where I think we’ve gotten a little ridiculous. Some women have become so afraid of carbohydrates that they treat a sweet potato like it’s basically a Snickers bar. It isn’t.
Carbohydrates are one of the three macronutrients your body needs, and carbohydrate-derived glucose is an efficient fuel source, especially for your brain and for higher-intensity activity.
If you’re active — strength training, walking a lot, doing cardio, or trying to build or maintain muscle — your carb needs are going to look different than someone who’s sedentary.
There’s no universal “right” amount of carbohydrate for every woman; it depends on your activity level, goals, total intake, metabolic health and your individual response.
So instead of asking “are carbs bad,” ask what type of carbohydrate you’re eating, how much, and what the rest of the meal looks like. Rice, potatoes and fruit are not necessarily the problem. Beans and lentils definitely are not the problem. The overall pattern is what matters.
One of the easiest strategies I teach is to stop eating “naked carbs” — meaning don’t build a meal or snack around carbohydrates alone with nothing else. If you’re having oatmeal, add protein and some fiber and fat, like eggs on the side, berries, ground flax or chia.
If you’re having rice, pair it with chicken or fish, vegetables and a healthy fat. If you’re having fruit, add Greek yogurt or cottage cheese. Not because carbs are dangerous, but because pairing carbohydrates with protein, fiber and fat slows digestion and changes the glucose response.
I’d also lean toward higher-fiber, minimally processed carb sources more often — beans, lentils, legumes, berries, vegetables, sweet potatoes, whole grains, seeds — and yes, a reasonable serving of rice can absolutely fit into a healthy diet.
My own plate is pretty simple: a lot of vegetables, a good protein source, a carbohydrate that makes sense for what I’m doing, some healthy fat, and fruit. That’s it.
One thing that might surprise you: protein also stimulates insulin secretion and amino acids can influence glucose metabolism. But don’t hear that and panic that protein is bad too —your body needs all three macronutrients doing their jobs together.
The goal isn’t finding the one magic macro that doesn’t affect anything; it’s eating an appropriate amount of all of them for your body, level of activity, and your goals.
Now about those glucose monitors…
Continuous glucose monitors can be genuinely useful for people who need to track glucose for medical reasons. But if you’re a generally healthy person without diabetes, I don’t think most women need to be wearing a CGM and watching every spike.
Here’s what concerns me about them: you eat a banana, your glucose goes up, you panic. You eat it again with almond butter, it goes up less, and now bananas are “bad” and almond butter is “good.” Then you work out, your glucose goes up, and now you’re afraid of exercise too. That’s how a piece of technology ends up dictating what you eat, when you eat, and how you feel about perfectly normal physiological responses.
I talked about my thoughts on tracing certain health metrics in episode 118 – go back and listen to that if you haven’t already.
Stress itself affects glucose — when you’re stressed, your body releases hormones that make energy available, and that’s your body doing its job. The same thing happens with exercise.
During higher-intensity activity, your body may temporarily increase glucose production to fuel your working muscles, so yes, you can sometimes see glucose rise during or right after a hard workout. That doesn’t mean the workout was bad for your metabolic health — regular exercise generally improves insulin sensitivity and glucose handling over time.
And we can’t ignore muscle
Muscle is one of the major places glucose goes after you eat.
This is why I keep saying strength training isn’t just about looking toned — muscle is metabolic tissue, and as we get older, maintaining and building it becomes increasingly important.
It’s also why I don’t want you spending all your energy avoiding carbohydrates while doing very little physical activity. Use the carbs to help you build muscle and recover. Walk more. Move after meals. Give your body a reason to use the fuel that you’re feeding it.
That brings me to under-eating
I’ve talked about this in previous episodes. I’ve seen many women in my coaching practice who simply do not eat enough or they’re eating very little during the week, then binging on weekends or not eating most of the day, then binging at night.
What do you think that does to your blood sugar? It’s not great. So you end up exhausted, hungry, sleeping poorly, and in many instances, always thinking about food or snacks.
Chronic under-fueling is its own stressor, and stress hormones influence glucose regulation. So if your blood sugar isn’t where you want it, the first question isn’t necessarily “what do I need to eliminate” — it might be “am I eating enough, am I getting enough protein and fiber, am I eating enough carbohydrates for my activity level, am I strength training, am I sleeping well?” Your metabolism is not a single lab value.
What changes in midlife
This is where I want to bring it back to women in their 40s and 50s specifically. As we move through perimenopause and menopause, estrogen changes, and alongside that, many women see shifts in body composition, muscle mass, activity, sleep, appetite and where they tend to store fat. All of that can influence metabolic health.
So if your body doesn’t seem to handle food quite the way it did at 30, you’re not imagining it — something has changed. But that doesn’t automatically mean you need to go low-carb.
It means we look at the whole picture: hormones, muscle, movement, nutrition, sleep, stress, body composition, and your actual labs.
If your labs come back out of range
Don’t panic, and don’t start taking six supplements. Look at the pattern; has it changed over time? If your fasting glucose, insulin, or A1c is elevated, talk to your provider about what needs to be repeated or evaluated, and take an honest look at your nutrition, activity, sleep and body composition (meaning your muscle to fat ratio) – before deciding whether cutting carbs, adding supplements or medication make sense.
There’s absolutely a place for supplements or medication for some people, but I don’t want you reaching for berberine, chromium, inositol or whatever the supplement of the month is just because someone on Instagram said your glucose needs “optimizing.”
Work with someone who can guide you on all this.
The takeaway
Your goal doesn’t have to be perfect blood sugar. It’s metabolic flexibility — a body that can eat a meal, appropriately release insulin, use glucose for fuel, store what it needs to store, and bring things back to normal.
The goal is to build muscle that can use glucose. A body that moves often, gets enough food, plenty of fiber-rich whole foods, protein, healthy fats, carbohydrates that support your activity and goals, and enough sleep.
So the next time someone tells you to keep your blood sugar perfectly flat, avoid all carbs, or wear a glucose monitor to micromanage every bite, take a step back and ask better questions:
- What do my actual labs show?
- What’s the trend?
- What are my symptoms?
- Am I moving enough?
- Are my workouts effectively building muscle?
- Am I eating enough?
- How much sleep am I getting?
That’s how we get out of fear-based health strategies and informed health strategies.
Not another food to fear, not another number to obsess over — just better information, better context, and the confidence to make decisions based on your body.
And if you have a question, you’d love me to dig into on the show, send it our way at support@claudiapetrilli.com. Until next time…
Claudia Petrilli is the host of Perimenopause Simplified podcast and an Integrative Nutrition Health Coach helping high-achieving women 40+ navigate perimenopause with clarity and confidence. After being dismissed by doctors in her 20s over debilitating periods and unexplained health issues, she took her health into her own hands and never looked back. When perimenopause brought a new wave of symptoms in her late 30s, she used that same evidence-based approach to feel like herself again.
She’s the creator of The Perimenopause Method, her signature coaching program, where she helps women rebuild the foundations — nutrition, movement, sleep, and stress — that actually support their hormones through this transition, while also teaching them to self-advocate and make informed choices about their care. Because you don’t have to just get through midlife, you can thrive in it.
