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October 24, 2001

Diagnosis and Symptoms

Question from Newcastle, New South Wales, Australia:

I have a child with hyperinsulinism who is expected to develop diabetes at puberty or before, but no genetic abnormality has been found. Many researchers feel that insulin resistance can be hereditary and acquired from birth in the young. Would my following a low to zero carbohydrate diet reduce or reverse any insulin resistance I may have that I might pass on to a second child, if I conceived while in an insulin resistant state? I have read much about low to zero carbohydrate diets, and one, by a cardiologist, advocates remaining in a state of ketosis which he states is all right in the long term, as there is no high sugar to accompany it. Can insulin resistance be tested for? Is it reversible by diet?

Answer:

There are many forms of insulin resistance in the young, and essentially all of them derive from a spontaneous or inherited chromosomal change which affects one of the many components of the insulin receptor site or the post site events. Specifying them can be very complex which is probably why they have not been investigated in your child’s case. In any case, a specific diagnosis does not much affect care. Looking for insulin receptor antibodies which is Type B Insulin resistance for example is expensive and not usually carried out.

In the sense that the underlying factor is almost certainly already fixed in your’s or your husband’s or your child’s DNA, it is not going to be affected by diet. Since insulin resistance can be overcome by more insulin and in some cases by the thiazolidinediones, I would not recommend reducing carbohydrate intake to the point of inducing ketosis. In any case. the condition is not reversible by diet The simplest test for insulin resistance is to show that serum insulin levels are inappropriately high for the blood glucose levels, but there are more elaborate tests like looking at the ratio of the Area Under the Curve for Insulin (AUCI) to the Area Under the Curve for Glucose (AUCG) in a glucose tolerance test.

DOB