My eight-year-old daughter was diagnosed with hyperinsulinism. Her blood sugar was 83 mg/dl [4.6 mmol/L] and her insulin was 30. We eat really healthy and exercise daily. I was concerned because she keeps putting on weight, mostly in her abdomen. She is around 130 pounds and is 5 feet tall. She is irritable, tired, and has problems in school (she is also getting tested for ADD). The endocrinologist simply called me, told me the results, and prescribed metformin. Should I seek another opinion to get further testing? Could there be an underlying issue? Is it inevitable that she will get diabetes? Also, we have a family history of type 2 diabetes and two of my sisters have PCOS. Can it be PCOS at age eight? She has pubic hair but the doctor was not concerned with early puberty. Can testing for PCOS be performed this soon?

Unfortunately, what you are describing is likely all directly or indirectly the result of her obesity. What is causing this is difficult to know for sure. She has early, but otherwise normal, puberty from your description, perhaps technically only premature adrenarche but this, too, is directly a reflection of the excess body fat/obesity. This could progress to full early puberty or could stay with just acne, body odor and hair issues. Your family history suggests that this may have some genetic basis, but the key will be to achieve sustained slow and steady weight loss – thus the need for fewer calories and, at the same time, more exercise to provide increased energy expenditure. Even though difficult to achieve and sustain, this will work. Metformin should help with the insulin resistance and perhaps even with some of the weight gain. If there is a component of what will become PCOS in the future, the metformin also may help in this regard. We also check for vitamin D levels and find them to be abnormally low as well as associated with osteopenia and osteoporosis even in young kids like your child. This is also related to the metabolic syndrome and the obesity. Blood lipids are frequently abnormal especially the low HDL and high triglycerides but LDL and total cholesterol could also be abnormal. It does not sound like you need another opinion, just some support from the current team to get the weight moving downwards and staying off. If there is a specific weight loss program at the hospital, clinic or local YMCA/YWCA, this would be another source of support.

SB