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December 12, 2001

Diagnosis and Symptoms

Question from Wilmington, North Carolina, USA:

My 11 year old daughter is overweight, and has dark patches of skin under her arms and the back of her neck. There is a history of diabetes in my family, (nephew and sister). Someone just told me that this is a sign that the body is producing too much sugar and that she is at risk of developing diabetes. Are dark areas of the skin a sign of too much sugar?

Answer:

Your friend was close — but not quite correct.

What you are describing in your heavyset daughter is likely Acanthosis Nigricans, a dark, thickening of the skin typically seen in the areas you noted, but can also be seen to a lesser degree under the breasts, upper inner thighs, and elsewhere. It is more of a reflection of high insulin levels, rather than high glucose levels. However, the high insulin levels are often produced because the individual is insulin resistant which necessitates more insulin production to get the same effect. (If this is confusing, maybe it helps to recall that in your home in the wintertime, if you kept your windows and doors open, your house might still be warm, but at the cost of your furnace working hard all the time. Extra heat has to be produced to keep your house warm compared to if you just closed your windows.)

This insulin resistance is a major component of type�2 diabetes. So while your daughter may or may not have diabetes now, she is at high risk! Other associations can be high cholesterol levels, high blood pressure, and menstrual irregularities even with excess male hormone production in adolescent and older women. Please have her assessed by her doctor. They may even consider a formal glucose tolerance test. The key to turning this around is attention to weight control!

DS

[Editor’s comment: Please see What You Need to Know about Type 2 Diabetes in Children.

SS]