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February 22, 2003

Complications, Type 2

Question from Charlotte, North Carolina, USA:

My daughter has had diabetes for about fourteen months, she just had a visit with her endocrinologist, and her hemoglobin A1c was 5.8%. We were all very excited, but it is slowly coming up. Today she noticed a brown patch on her neck under her chin. Is this normal for someone with type�1 diabetes? Her period, which she's only had for a year are not quite regular yet (maybe every other month), and I worry about that ovarian disease. Will this brown discoloration go away or get worse? What causes it?


The syndrome that you were probably thinking of is called the Polycystic Ovary Syndrome (PCOS). You will need to discuss this possibility with your daughter’s endocrinologist, but the main characteristics are irregular menstruation, hyperandrogenism, antibody negative diabetes that initially does not require insulin, and evidence of insulin resistance.

There is a tendency to be overweight and the brown spot is probably a skin condition called Acanthosis Nigricans. This latter is unlikely to go away spontaneously and treatment is rather unsatisfactory although a variety of approaches from nicotinamide to plastic surgery have been successfully employed. Treatment of the diabetes with metformin is a course to consider.