When glucose is thus locked out of resistant cells, it has nowhere to go and starts building up in the bloodstream. The pancreas releases yet more insulin to try to compensate, and for a while, that works to force glucose through the cell doors.

An insulin resistant person can maintain normal blood glucose levels, although doing so may require insulin levels as much as 40 percent above normal. And as Stanford's Dr. Reaven has publicized, excess insulin alone can cause significant cardiovascular damage.

What's more, in at least a portion of the estimated 60 million to 80 million Americans who are currently insulin resistant, the pancreas will eventually lose its battle and glucose levels will begin creeping upward.

Untreated, 10 percent of those who started out as simply insulin resistant are likely to progress to full-blown diabetes, according to Dr. Reaven. But only then will most people realize they have a problem. Insulin resistance has been called a "silent killer," because it is symptomless, or so it was thought.

Telltale Sign and Treatment
A study published in 1999 by researchers at Washington University in St. Louis reaffirms what Dr. Mogul had been observing in her female patients: that a tendency to accumulate fat at the midriff, creating a so-called apple-shaped body, is a strong marker for insulin resistance.

That aspect of Syndrome W, together with the other symptoms Dr. Mogul has identified in women, appears to offer a valuable set of early warning signs of insulin resistance. Dr. Mogul is currently working with a colleague to identify the symptoms of Syndrome W in men.

Meanwhile, Dr. Mogul feels a diagnosis of "W" is good news. "The positive side of Syndrome W is that it is so easy to recognize and treat, and proper treatment can delay the onset of heart disease and diabetes, or prevent it altogether," she explains. Her Syndrome W patients are put on an unrestricted-calorie,but low-glycemic diet to avoid spikes in their blood glucose levels. Most also take Metformin, an insulin-sensitizing medication, to counteract their insulin resistance.

The results can be dramatic. "Once I started going to Dr. Mogul and being on this diet, then she gave me medication, I had spunk!" Ilene Cohen attests. "I had energy, I felt like a person. I could be like everybody else, working, going out, cleaning, having fun." She's lost nearly 40 pounds, changed careers, and regained her confidence. "I feel much better about myself, I feel like I conquered a lot."

Dr. Mogul reports similar transformations and relief in many of her patients, particularly those who have sought help for years and been told there was nothing wrong with them. "I think that the reason that this wasn't previously diagnosed is that traditionally, thin male physicians who never had to struggle with their weight said, 'oh you're just eating too much and not exercising enough,' and for these women that just wasn't true.

I think if you happen to be lucky enough to see an endocrinologist, they are very aware of problems related to insulin, but they still have their own biases. If blood sugar's normal, then everything's okay," Dr. Mogul explains. When her patients "find out that there really is something that's going wrong, particularly something that can be fixed, it's really very exciting for them," she adds.

Avoiding "W" Altogether
Dr. Mogul is still working to understand why the insulin resistance that underlies Syndrome W begins at mid-life in her patients. "There seems to be a switch that goes off at 40," she observes, "The genes do change and there are some major metabolic changes at 40." Certain groups of women also seem particularly vulnerable, Dr. Mogul adds, including, "A very high percentage of Asian, Middle Eastern and Hispanic women... also, women who have had polycystic ovary syndrome, and Ashkenazi women. It's not typically a syndrome of African American women."

Dr. Mogul says that for all women, the best way to avoid developing Syndrome W in the first place is to keep overall weight down. "Watch the calories and watch the carbohydrates," she recommends, "And don't make the mistake that low-fat means low-calorie. Also, oral estrogen is associated with weight-gain, so work with your doctor to get the prescription right if you're taking hormones. And exercise!