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September 27, 1999

Diagnosis and Symptoms, Weight and Weight Loss

Question from California, USA:

My 15 year old daughter recently had a fasting insulin blood test. Her father has type 1 diabetes, onset at 24 years of age. Her insulin levels in her blood were high, around 100. My daughter has a problem with her weight and upon discussing the blood results with her doctor and a nutritionist, we were told this may be part of the problem. We were also told that she is probably prediabetic. Should we be seeking out any type of medication at this point to lower her insulin levels? Would lowering her insulin levels help with the weight problem? We are putting her on a diabetic type diet.

Answer:

If her father does indeed have Type 1A (autoimmune) diabetes, which is by far the commonest form of diabetes in Caucasian children and young adults, then your 15 year old daughter has about a 7% chance of one day developing the same condition, a chance that is already diminishing as she gets older. Assuming that she has a normal fasting blood glucose level then the surest way to evaluate pre-diabetes is to get an antibody test and a number to contact for further details is 1-800-425-8361. I am not quite sure why an insulin level was asked for unless it was part of an intravenous insulin/glucose tolerance test: certainly a high fasting blood insulin level would be against a diagnosis of type 1A diabetes and a single level without the coincident glucose level is in any case hard to interpret. It is true that in diabetics who may be getting too much insulin that there is an increase in appetite which may lead to weight problems; conversely some teenage girls with diabetes may sometimes take less than their proper dose of insulin in order to lose weight. However to extrapolate this into proposing to reduce insulin levels in a girl who is overweight but in whom there is at present no evidence of pre-diabetes would be ill advised.

I wonder if there may have been some misunderstanding here as to what the doctor actually said. You are left nonetheless with the extraordinarily difficult problem of being overweight in a teenage girl with all the psychosocial issues that this may lead to. To suggest a disciplined diet and regular vigorous physical exercise is easy, to sustain it is terribly hard. Group therapy as in Weight Watchers Anonymous can sometimes be a great help and in the near future there may be a clearer understanding of the possibilities of some of the new drugs in this age group.

DOB