March 29, 2001
Diagnosis and Symptoms
Question from St. Paul, Minnesota, USA:
My 12 year old daughter had early puberty and took monthly Lupron injections which stopped the puberty process for three years. At age 11.8 years, they stopped the injections and her period was supposed to start which did not happen. She gained weight more rapidly than before, but was very active and ate healthy food. The doctor watched the weight for six months and then did a insulin test (187 two hours after eating [normal: 7-13]). I was told that my daughter probably has PCOS and is insulin resistant, but they say she is too young to be treated. She is 5 feet 5 inches tall and weighs 15 pounds with an apple-shaped body (carries it around her middle). She continues to gain weight even though we have restricted her diet, and I give her herbs -- cinnamon, chromium, primrose oil, glutamine. I am worried about her future. I need advice on what to do next and what to expect. Do I need to ask the doctor to do more frequent insulin tests? What kind of therapy should I expect from doctors? Are they seeing kids now that have developed early puberty with insulin resistance?
Your daughter is certainly overweight with a Body Mass Index (BMI) of 26, and that in itself could be a cause of the high two-hour insulin level. Polycystic Ovary Syndrome (PCOS) is really a misnomer for a condition in which there is ovarian hyperandrogenism (too much male hormone) together with insulin resistance. There may or may not be cystic changes in the ovaries. To confirm the diagnosis, it is necessary to show an elevated serum Free Testosterone or an altered FSH/LH ratio. Inappropriate masculinity, if present can be treated with birth control pills.
The insulin resistance should not be regarded as a losing cause. You should talk to your doctor about starting metformin which has long been used in the management of type�2 diabetes and more recently has been used in difficult to control type�1 diabetes in conjunction with insulin. It has other properties however which include appetite suppression and an ability to reduce insulin resistance. Lowering insulin requirements at this stage could well postpone a later need for injected insulin as a result of protracted hyperinsulinism.
Additional comments from Betty Brackenridge, diabetes dietitian:
In addition to metformin or other medicines to address your daughter’s insulin resistance, I strongly urge you to help your daughter in whatever ways possible to become more physically active. Exercise (or as kids call it, play!) can have a very beneficial effect on insulin resistance. The best way to do this is to encourage activities that other family members engage in as well — walking or hiking together, family swims, bike riding, and so on. Making it a family activity can help avoid the child feeling judged or singled out for what might be perceived as the “punishment” of having to exercise. It should be fun. Demanding that a heavy child to go out and exercise alone is seldom effective in the long run. It can also be helpful, when trying to increase youngsters’ activity levels to simultaneously reduce the amount of TV or computer time, which is spent in a totally sedentary fashion. For help with best ways to manage her foods, I highly recommend How to Get Your Kid to Eat but Not Too Much by Ellyn Satter. Food restriction in youngsters can backfire if not handled appropriately. This book can help make it much easier to support your daughter in managing her food choices as well as possible in this difficult situation.