Updated 17 February 2017

Metabolic syndrome tied to diabetes

More than 1.5 million South Africans have type 2 diabetes, which is particularly common among people older than 30 and which often forms part of the metabolic syndrome.


More than 1.5 million South Africans have type 2 diabetes, which is particularly common among people older than 30.

This common type of diabetes often forms part of the metabolic syndrome (or X syndrome), which also includes high blood pressure and other risk factors for heart disease. The problem is that a patient's glucose levels might be managed dilingently, but if his blood pressure and blood cholesterol levels aren't under control, he could still be at risk of a heart attack or stroke.

Type 2 diabetes has a genetic origin, explains Dr Magda Conradie of the Metabolic Unit at the Tygerberg Hospital. The initial problem is often not an insulin deficiency; quite the opposite, in fact. Initially, the pancreas produces enough insulin, but the action of the insulin is insufficient. To compensate, the pancreas produces more and more insulin, but as soon as the pancreas tires, a relative insulin shortage develops.

The problem doesn’t stop here...

More than a decade ago, researchers discovered that most people with type 2 diabetes also have high blood pressure and high cholesterol levels, and that these people are consequently more prone to die from heart disease or stroke. About 80% of people with type 2 diabetes die because of heart problems, and not because of glucose-related complications.

This implies that a lot of type 2 diabetics are suffering from metabolic syndrome, but their high blood pressure and high blood cholesterol levels are either not diagnosed or not treated effectively enough. Blood pressure is only controlled well if it is maintained at or below 144/82mmHg. It is absolutely essential for doctors to treat the glucose part of metabolic syndrome as well as properly controlling high blood pressure and the other risk factors for heart disease.

It has also become clear that metabolic syndrome can cause damage for many years prior to it being diagnosed. By the time diabetes is diagnosed, the patient already has a degree of pancreas failure. The first signs can be detected early by means of a glucose-intolerance test.

With healthy eating habits, regular exercise, and the effective control of glucose levels, high blood pressure and high blood cholesterol, the progression of type 2 diabetes can be slowed down.

Who is at risk?

You are at risk for type 2 diabetes or metabolic syndrome, if you answer "yes" to one or more of these questions:

  • Does you brother, sister, mother or father suffer from diabetes?
  • Are you overweight, especially around the waist?
  • Is your body apple shaped, making you look like you don’t have a waist, even though you aren’t overweight?
  • Is your stomach measurement more than 100cm?
  • Are you older than 45?
  • Do you have high blood pressure?
  • Are you blood cholesterol levels high? 

Watch out for the following symptoms of diabetes:

  • A continual thirst
  • Excessive urination
  • Extreme hunger
  • Recurring fungal infections in men and women

- (Health24, updated February 2010)


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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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