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By Alan Feldman, MD, FACE –
You probably have heard that there is an epidemic of diabetes throughout the world, including the USA. This is related to the increased prevalence of obesity, as weight is a major risk factor for the development of diabetes.
Type 2 diabetes, however, develops gradually over years. The initial problem is that of “insulin resistance”, a problem where the pancreas is making insulin (the hormone that controls blood sugars) but the body does not respond correctly to normal insulin levels. The pancreas compensates for this by making more insulin. As long as your pancreas can make enough insulin, the blood sugar remains normal. However, all of this insulin being produced causes other problems like; weight gain, high blood pressure, high triglycerides, and low levels of HDL (good) cholesterol. Eventually, as the demand for more insulin increases, the pancreas starts to fail in its ability to make insulin, causing blood sugars to rise. This pre-diabetic condition is called “metabolic syndrome” (also known as dysmetabolic syndrome, insulin resistance syndrome, syndrome X).
There are 5 criteria for the diagnosis of metabolic syndrome:
1. Waist circumference (measured at the level just above the belly button) greater than 35 inches in Caucasian females, greater than 40 inches in Caucasian males.
2. Blood pressure above 130/85
3. Fasting triglycerides above 150 mg/deciliter
4. HDL cholesterol less than 50 mg/dl in females, less than 40 mg/dl in males
5. A fasting glucose above 100 mg/dl
If you have 3 out of 5 of these criteria, by definition, you have metabolic syndrome. It is estimated that 35-40% of the US population meets the criteria for metabolic syndrome. Having metabolic syndrome not only increases the risk for developing diabetes (3.5 to 5 times increased risk), but also increases the risk for developing cardiovascular disease (1.5 to 2 times increased risk).
Prevention/treatment:
The most important goal to treat or prevent metabolic syndrome is weight reduction. This is best accomplished through a combination of decreasing calorie intake and increasing calorie burning (exercise). Following a low carbohydrate/starch diet tends to be the most successful way to reduce calorie intake, though a Mediterranean diet (high in fruits, vegetables, whole grains, nuts, olive oil) can also be effective. Aerobic exercise, such as brisk walking, at least 150 minutes per week is also essential.
There are currently no FDA approved medications for the treatment of metabolic syndrome. However metformin (a medication, commonly used to treat type 2 diabetes) can be effective in preventing the development of diabetes in patients with metabolic syndrome.
For more information please contact Dr. Feldman at 561-626-9041.
