Metabolic Syndrome and PreDiabetes
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Metabolic syndrome is a cluster of abnormalities — high blood sugar, abdominal obesity, low HDL cholesterol, elevated triglycerides and high blood pressure — that raises your risk of type 2 diabetes, heart disease and stroke. It is estimated that about one fourth of the world's adult population has it.
What is metabolic syndrome?
The metabolic syndrome (MetS) is a cluster of common abnormalities including hyperglycemia (high glucose), abdominal obesity, reduced high-density lipoprotein cholesterol (HDL-C) levels, and elevated triglycerides (TG) and blood pressure (BP). MetS was originally described in 1988 as “syndrome X” or “insulin resistance syndrome.”
The components of MetS are associated with endothelial dysfunction and atherosclerosis, and increase the risk for type 2 diabetes mellitus, heart disease and stroke. It is estimated that about one fourth of the world's adult population has MetS.
How metabolic syndrome is diagnosed
The most widely accepted diagnostic criteria are based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. According to this definition, metabolic syndrome is diagnosed when three or more of the following parameters are present:
Waist circumference
Greater than 40 inches in men and greater than 35 inches in women.
Triglycerides
TG of at least 150 mg/dl.
HDL cholesterol
HDL-C less than 40 mg/dl in men and less than 50 mg/dl in women.
Blood pressure
BP of at least 130/85 mm Hg.
Fasting glucose
Fasting glucose of at least 110 mg/dl.
Understanding the A1C test
Hemoglobin A1C is a common blood test used to diagnose type 1 and type 2 diabetes and to later gauge how well you are managing your diabetes. The A1C test also goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c.
Unlike usual measures of blood sugar levels, the A1C test reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control — and the higher your A1C level, the higher your risk of diabetes complications.
In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that the A1C test be the primary test used to diagnose prediabetes, type 1 and type 2 diabetes. After a diabetes diagnosis, the A1C test is used to monitor your diabetes treatment plan: unlike daily blood sugar monitoring, which only measures your blood sugar level at a point in time, the A1C test indicates how well your diabetes treatment plan is working overall.
What your A1C result means
For someone who doesn't have diabetes, a normal A1C level is about 5 percent, although it can range from 4.5 to 6 percent. Someone who has had uncontrolled diabetes for a long time might have an A1C level as high as 25 percent.
When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 6 and 6.5 percent means you have prediabetes, which indicates a high risk of developing diabetes.
Insulin resistance: the common thread
Metabolic syndrome and prediabetes are linked to your body's metabolism and to a condition called insulin resistance. Insulin is a hormone made by your pancreas that helps control the amount of sugar in your bloodstream. Normally, your digestive system breaks down the foods you eat into sugar (glucose). Your blood carries the glucose to your body's tissues, where the cells use it as fuel — and glucose enters your cells with the help of insulin.
In people with insulin resistance, cells don't respond normally to insulin, and glucose can't enter the cells as easily. Your body reacts by churning out more and more insulin to help glucose get into your cells, and the result is higher than normal levels of insulin in your blood. This can eventually lead to diabetes, when your body is unable to make enough insulin to control the blood glucose to the normal range.
Increased insulin raises your triglyceride level and other blood fat levels. It also interferes with how your kidneys work, leading to higher blood pressure. These combined effects of insulin resistance put you at risk of heart disease, stroke, diabetes and other conditions.
Treating the whole picture
Tackling any one of the risk factors of metabolic syndrome is tough; taking on all of them might seem overwhelming. But aggressive lifestyle changes, weight loss, exercise, hormone balance and the use of certain supplements will improve all of your metabolic syndrome components. Our program addresses each of the components of metabolic syndrome, and includes a treatment plan specific to your individual needs.
About the author
Allen Smolenski, M.D.
Emergency Medicine physician and founder of Coastal Medical Clinic in Surfside Beach (2009). After losing nearly 60 pounds himself — and placing third in his class at the 2008 NPC Natural Northern USA Bodybuilding Contest — he completed a fellowship in Anti-Aging and Regenerative Medicine through the A4M, and now helps patients across the Grand Strand optimize their hormones, metabolism, and long-term health.
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