My three year old son weighs 72 pounds and is tall for his age. His extreme weight gain started when he was 18 months old and we have been fighting doctors for referrals and appointments all this time. He will have an appointment with a specialist next month.

The doctor he has been seeing said he is insulin resistant, so we changed his diet like we were told to and he still gained 11 pounds in three months. He does not eat much at all, and he is a very active three year old. His first fasting blood sugar was 95 mg/dl [5.3 mmol/L] which they said was mildly elevated. We checked the pediatric ranges, and those numbers appeared to be normal. The doctor suggested we give him Glucophage [metformin] even though he told us before that the youngest person he has on it is 11. The doctor said this medicine would help control his appetite and in turn make him lose weight. I explained to him many times that my son hardly has an appetite if we suppressed it he would never be hungry. They act like my child eats all day long, and I am feeding him boxes of Twinkies, and that is definitely not the case.

Please help me with any suggestions or information you have on this medicine in three year olds since I have not been able to find it. I have not started him on the medicine, and I will not without knowing what harm it could do him.

Clearly, your three year old son is greatly overweight, and the first fasting blood sugar of 9.5 mmol [171 mg/dl] was not normal although a single estimation in a stressed three year old should be verified. This puts him in the category of Type 2 Diabetes in Children, an increasingly frequent problem which is accompanied by insulin resistance.

I imagine that the doctors who have been looking after him have excluded other rarer possibilities like the Prader-Willi syndrome and Cushing’s disease. So, the question of using Glucophage [metformin] is quite pertinent. For some time this drug has been used with insulin to help control type�1 diabetes in children where it seems to be effective in some difficult to control cases, and I know of one three year old who is receiving it without any ill effects. The drug not only reduces the production of glucose from the liver and thus fasting blood sugar, it is also an appetite suppressant so that it would be rational to try it in your son’s case. Even if fasting blood sugars are now normal with dieting, the values two hours after a meal may be abnormal, and it would be important to know if the hemoglobin A1c is within normal limits and also whether fasting serum insulin levels are raised.

DOB

[Editor’s comment: Apparently this family has succeeded in scheduling a referral to a pediatric endocrinology/diabetes program, in which case I’d strongly advise holding off on starting new therapy until the specialists have had a chance to review the workup thus far.

WWQ]