RT Journal Article SR Electronic T1 The metabolic syndrome: A tug-of-war with no winner JF Cleveland Clinic Journal of Medicine JO Cleve Clin J Med FD Cleveland Clinic SP 990 OP 994 VO 69 IS 12 A1 Brotman, Daniel J. A1 Girod, John P. YR 2002 UL http://www.ccjm.org/content/69/12/990.abstract AB The metabolic syndrome may be viewed as a state of insulin-counterregulatory overdrive: counterregulatory hormones and fatty acids chronically duel with insulin, causing a cascade of biochemical interactions resulting in insulin resistance, hypertension, and dyslipidemia. Even before beta cells fail and type 2 diabetes ensues, the deadly quartet is quietly rehearsing.