For years, the diagnosis of diabetes in the primary care setting has been such a scary topic. People hear about it on the news and scary images of folks who are giving them selves insulin injections, taking large numbers of expensive drugs, and coping with other health problems come to mind. Usually in the exam room, folks know they have struggled with weight gain, diet, and lack of exercise for a long time. Often they come knowing that they have elevated blood sugars as well, so I would explain the overall concept of too much sugar in the blood stream and what this can mean for cells in the body. What they don’t understand is the full set of ramifications that come along with the actual diagnosis, and the set of risks that are associated with the overarching term: metabolic syndrome.

To further define: Metabolic syndrome is a grouping of traits that when combined (having any 3 of the listed ones below), increase your risk of major health issues: specifically cardiovascular disease, stroke and organ damage.

• Excess abdominal weight: A waist circumference of more than 40 inches in males and 35 inches in females
• Hypertriglyceridemia: Triglyceride levels that are 150 milligrams per deciliter of blood (mg/dL) or greater.
• Low levels of HDL cholesterol: HDL cholesterol of less than 40 mg/dL in males or less than 50 mg/dL in females.
• Elevated blood sugar levels: Fasting blood sugar level of 100 mg/dL or greater. If it’s 100 to 125 mg/dL, you have prediabetes. If it’s over 125 mg/dL, you likely have Type 2 diabetes.
• High blood pressure: Blood pressure values of systolic 130 mmHg or higher (the top number) and/or diastolic 85 mmHg or higher (the bottom number). *https://my.clevelandclinic.org/health/diseases/10783-metabolic-syndrome

My favorite analogy to explain metabolism is to talk about cars. Combustion engines run on gasoline, a very flammable liquid that burns hot and efficiently. When fuel is pumped into the fuel chamber in the engine and is then ignited by the spark plug, it burns, expanding in volume, giving off energy and heat. That pushes the cylinder down and that cylinder drives the system of energy transference from heat to mechanical push that causes the gears to turn and the engine to roar. The byproduct of the burn is carbon dioxide gas, water and some other chemicals that create the exhaust. Now, imagine that each cell in your body has a little engine in it, that is actually a cell component called a mitochondria, which burns a similar product called glucose. The chemical formula (C₆H₁₂O₆) is actually pretty similar to the gasoline fuel (C8H18) you put in your car and the byproducts are similar: water and carbon dioxide. The beauty is that your body is so much more efficient. We don’t heat up nearly as much and our breath has a much cleaner makeup compared to engine exhaust.

We take our car to the gas station to put fuel into it… We sit down for a meal to put fuel into our bodies. Think about fuel: gasoline is actually pretty scary stuff. Why are there all those warning signs at the pump? If you light a match, gasoline can burn like crazy, and even explode, so no smoking. Why are there protection devices on the pump to keep you from overfilling the tank and dumping gas on the ground? It’s really dangerous and a spark could ignite a fire and cause massive destruction. We need to consider the same signs for our meal times: be careful with fuel and don’t overfill.

The chemical glucose is then like gasoline: it’s great stuff for running our engines, but too little is not a good thing, and too much is basically toxic to our bodies. Literally toxic. High blood glucose levels in the bloodstream are toxic to cells and some cells are more susceptible to this effect than others. Nerve cells are very sensitive, so then diabetes is the number one cause of blindness and painful neuropathy. Kidney cells are sensitive: diabetes is the number one cause of chronic kidney disease and kidney failure. Heart cells are sensitive: folks with high sugar levels over time have very high rates of heart disease resulting in heart attacks, strokes, and heart failure.

In the exam room, we make a shared decision to do lab work and chart what our lifestyle looks like at home. What do you eat? What is your activity level like? What is your movement like throughout the day? Does the family have sugar problems: mom, dad, brothers and sisters?

I bring up the car analogy again and again. So, do you take your brand new sporty BMW, fuel it up, and then leave it in the garage? Of course not! You drive that thing and enjoy… it is engineered to move and move fast. In fact, our vehicles last longer and do better in terms of performance and longevity when they run on the freeway, as opposed to short little trips around town and long stays in the garage. Our bodies are no different.

In the United States, we have the bad habit of treating our cars way better than our bodies. We want to milk every last mile out of our vehicle to get value. On the other hand, we turn our bodies into a source of endless trips to the mechanic (our primary care providers and specialists) because something goes horribly wrong, basically because we over-fuel and under drive. This is a bit of an oversimplification but I think it relays the main point well: our bodies are engineered to move and fuel as we go. When we binge watch TV, eat too much over-processed food, sit at a computer all day for work, and eat out for convenience, we create an environment in our blood and cells that is toxic and literally eats away at our years, and vital organs.

That is basically metabolic syndrome, and that is why your primary care doc hits these topics over and over again: they are trying to save you from some serious suffering down the road.

To me this is a positive story: our bodies are amazing and engineered perfectly to run hard and long. We are not particularly fast as a species. Our advantage is that we can run marathons – train for the long game, and use our cognitive abilities to change our behaviors and live a better life.

Take an inventory of your maintenance practices: be as diligent with your body as you are with your precious car. Fuel well, but don’t overfill. Run your engine hard and don’t just settle for a sedentary lifestyle.