Some families do have a strong genetic familial form of insulin resistance, which can contribute to each condition you mention, including Type 2 diabetes.

The first thing I would do is to REALLY make sure he is at a healthy weight and eats healthy. For instance, crackers often contain trans fat, which is unhealthy and has been linked to Type 2 diabetes. Also, some people are 30 pounds overweight, and think they are "normal" due to the current obesity epidemic. I am not saying this is the case with your husband, just pointing that out.

He is doing well with his exercise program, kudos to that!

Second is to look at any medications he currently takes. Some, such as steroids to treat asthma, can contribute to insulin resistace.

If he really is at a healthy BMI, follows a healthy diet, and exercises regularily, then unfortunately this may be a case of genetic insulin resistance. While a healthy lifestyle can prevent or delay Type 2 diabetes in *most* cases, it certainly will not help in all. On the bright side, perhaps he has delayed his conditions into middle age. Type 2 diabetes and the metabolic syndrome (what he has) will affect the body much more in the long run if developed at age 20 as opposed to age 47.

Metformin and other diabetes medications will help with the insulin resistance, and make sure he keeps up his healthy lifestyle. If he does this, he should be fine and healthy well into old age.

I would make sure he eats NO processed foods, plenty of lean meats and fish, as well as lots of fibre, good fats (i.e. olive oil), and non startchy vegetables.

Supplements such as cinnamon, bitter melon, and Omega 3 fatty acids may help.