"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.” "In general, we believe the metabolic syndrome can be thought of as a state of insulincounterregulatory overdrive, in which insulin chronically duels with counter-regulatory hormones, such as glucocorticoids, glucagon, and catecholamines, along with free fatty acids. These two physiologic processes become “revved up” while working against each other. In a biochemical tug-of-war, insulin is trying to store fuel, while counterregulatory hormones and fatty acids are trying to prevent fuel storage. We believe this ongoing battle causes the complex abnormalities of the metabolic syndrome.” "But even in a well-fed state, adipocytes release some free fatty acids constitutively (basal lipolysis). Basal lipolysis is under hormonal control: it is upregulated by counterregulatory hormones and the renin-angiotensin-aldosterone system,16 and inhibited by insulin. (Stimulation of lipolysis is one important mechanism by which the counterregulatory hormones exacerbate carbohydrate insulin resistance.)"