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March 1, 2006

Other Illnesses

Question from Denver, Colorado, USA:

My daughter is an obese eight year old girl. She has been diagnosed with hyperinsulinemia. Her triglycerides are elevated, She has high blood pressure, is pre-menstrual and very well developed for her age. Her primary care physician referred us to our local children's hospital to see an endocrinologist. They said that her diagnosis is non-emergent and they don't need to see her until she is 10 years old. I have been researching the high insulin and found that it can cause an inability to concentrate for which my child has been put on Ritalin. I asked her provider about Ritalin and the effects on her already high blood pressure, but they didn't even check her blood pressure! I've called other endocrinology offices and they don't want to see her because of her age either. I don't care whether or not they are Medicaid providers, I'll pay for it myself. What do you recommend?

Answer:

You are correct to be concerned, but there is a lot that you can do as a parent while you wait to get an appointment. Most of this is a pre-diabetic condition and is associated with obesity, early sexual development (premature adrenarche, premature puberty), excess androgens from the ovaries or adrenal glands or both, darkening of the skin especially in the neck called acanthosis nigricans, hypertension, high lipids (cholesterol and/or triglycerides), high blood glucose levels, high insulin levels, hairiness. The common theme for all of this is called insulin resistance and seems to be the main culprit related to obesity. The key to “fix” such problems is decreasing calories, especially sugars and fats, increasing daily activity and weight loss. Sometimes, medications are used to help with the high insulin levels (i.e., metformin or one of the “glitazones”). So, please make an appointment, even if there is a long wait to see the specialist in your area who can provide some guidance. This is a major problem around the world because of the epidemic of obesity. It must become a responsibility, not only for primary care physicians and nurses but, more importantly, of parents to make the necessary changes in food and activity to reverse the obesity. Weight loss often produces remarkable improvement in all of these areas and can avoid progression to frank diabetes, heart attack, stroke, osteopenia, etc. Knowing your own family history can tell you how much a risk this is. The entire family must cooperate and change their own food and activity behaviors, cut back on television, IPOD, computer and telephone sedentary time. The bookstores have hundreds of books that can help you with practical advice. Also, go rent the DVD called “Super Size Me.” Another book that is helpful is called “Don’t Eat This Book” by Morgan Spurlock and a great new book by Dr. Francine Kaufman called Diabesity is now available that can also answer many of your questions and is available through the local bookstores and on-line bookstores as well. Even Dr. Phil has books on what to do about this now!

SB

[Editor’s comment: You may also wish to see if you can get your daughter an appointment at the Barbara Davis Center for Childhood Diabetes.

BH]