Hi Kate! I know pre HRT my blood sugar would spike to over 650 requiring Metformin and frequent E.R. visit's for insulin. Since beginning transition and HRT it stays at a steady level of 120ish without Metformin. My Endo thinks I had blood sugar issue's because of all the stress my body was under physically, emotionally and mentally. I took 12 daily meds for everything from blood pressure to depression, chronic pain (job caused), etc. I have been off ALL 12 for 16 months now and I really have not changed my diet too much. I don't know if this helps in any way as it is just my personal experience and showed the stress Dysphoria, depression, anxiety, etc, put my body under. 🙂