Both my husband and I have a strong family history of type 2 diabetes, and our five year old daughter was recently diagnosed with hyperinsulinemia. She is overweight for her age and also has elevated DHEA and cortisol levels. Her doctor made the diagnosis of hyperinsulinemia after noticing some discoloration under her neck, axillae and in between her thighs. Does all this link together? Is this a form of diabetes? Could you please give me some information on this?

The skin condition that you describe is almost certainly Acanthosis Nigricans which, with the hyperinsulinemia, the obesity, and the hormonal changes is entirely compatible with type�2 diabetes in a child, especially in view of the family history. A much rarer possibility is that she might have been one of the many forms of Maturity Onset Diabetes of the Young, but the skin changes make this very unlikely.

Type 2 diabetes that has been increasingly recognised in the last few years in many parts of the world. It is often ascribed to a sedentary lifestyle and a fondness for high carbohydrate foods, but the truth is that it is little understood in molecular terms.

DOB
Additional comments from Dr. John Schulga:

The signs and hormone levels you describe all fit together. Your daughter has hyperinsulinism, hyperandrogenism all related to her weight. It is a well recognised condition, and it can theoretically lead to type 2 diabetes if it is not controlled.

How do you control it? The reason for the hormone changes are all secondary to the obesity, so the way to correct the hormonal problems are to lose weight or at least not gain any more weight. This is easier said than done, but is extremely important. It all boils down to eating less and exercising more, and admitting that some people find it much easier to gain weight than others, and adapting to deal with this fact. You should get advice from your paediatrician and dietitian for help on how to deal with this increasingly common problem, especially in the US.

JS
Additional comments from Dr. Stuart Brink:

You should talk to the physicians who made the diagnosis. This sounds like what is called insulin resistance and is directly related to obesity. Other parts of the syndrome are exactly what you are describing, elevated androgens, often menstrual irregularities and cystic ovaries, sometimes hirsutism (hairiness) and frequently hypertension, high blood lipids and elevated insulin levels.

If one does not reverse the obesity with better food and snack choices coupled with more vigorous, daily activity and weight loss, then the future risk for developing type 2 diabetes, heart disease, hypertension, strokes etc is very high.

SB