Metabolic Syndrome

(Insulin Resistance Syndrome)




Metabolic Syndrome is also known as Insulin Resistance Syndrome or Syndrome X.


For a long time, physicians have known that obesity, high blood pressure, diabetes and cholesterol disorder tend to cluster in a person who subsequently has a heart attack or a stroke. What we didn’t know was the link between these medical conditions.


In the last 20 years, there has been astronomical research in this field. Now we know the missing link is insulin resistance, hence the name Insulin Resistance Syndrome.




What is Metabolic syndrome or Insulin Resistance Syndrome?



The major components of Insulin Resistance Syndrome/ Metabolic Syndrome are:  



1. Overweight, especially around the waistline. Also called abdominal obesity (waistline more than 35 inches in females and more than 40 inches in males).  


 2.  Low HDL cholesterol: Less than 55 mg/dl in females and less than 45 mg/dl in males.  


 3.  High triglycerides: More than 150 mg/dl.  


 4.  High blood pressure: More than 130/80, even in a physician’s office.  


 5.  Impaired glucose tolerance: Blood glucose between 140 mg/dl and 200 mg/dl at 2 hours after 75 grams of a glucose drink in an Oral Glucose Tolerance Test.  


 6.  Impaired fasting glucose: Fasting blood glucose between 100 mg/dl and 125 mg/dl. Many people with impaired fasting glucose or impaired glucose tolerance eventually develop diabetes. Therefore, these conditions are also known as “pre-diabetes.”  


 7.  Diabetes: A fasting blood glucose more than 125 mg/dl or a 2 hour blood glucose more than 200 mg/dl in an Oral Glucose Tolerance Test.  


 8.  Increased risk for clot formation: which can cause an acute heart attack or stroke.  


 9.  High insulin level in the blood.  


 10. Increased uric acid level in blood can cause gout.  


 11. Women with Polycystic Ovary syndrome (PCO syndrome Manifests as irregular menses, excessive facial hair growth or facial acne.   



You don’t have to have all of these conditions to fit the diagnosis of Insulin Resistance Syndrome/Metabolic Syndrome.


Most individuals with Insulin Resistance Syndrome/Metabolic Syndrome have abdominal obesity, low HDL cholesterol and high triglycerides.


In more advanced stages of insulin resistance, patients also develop high blood pressure and pre-diabetes or diabetes.


What combination of these metabolic disorders will be present in a given person depends upon the severity and duration of the insulin resistance on one hand and that person’s capacity to produce insulin on the other hand.


Insulin is a hormone produced by our pancreas. Some people have a limited capacity to produce insulin. These patients usually develop diabetes at a younger age; in their thirties and forties or even in their teens if they are also obese.


On the other hand, some people have an extraordinary reserve to produce insulin. These patients do not develop diabetes until late in life. They may die of a heart attack or stroke before they develop diabetes.


These metabolic disorders also cluster in family members. For example, a mother may have high blood pressure while her son may have diabetes and a heart attack. An aunt may have diabetes and her niece may have high blood pressure and low HDL cholesterol.


Initially, people with Insulin Resistance Syndrome/Metabolic Syndrome don’t have any symptoms and therefore are under the impression that there’s nothing wrong with them. Then one day, they show up in the emergency room of a hospital with an acute heart attack. Family and friends wonder how it could have happened to such a (seemingly) healthy person.




This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.


Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.





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