My seven year old son has insulin levels ranging from 23 at 93, the average being 23 or less, and also has high triglyceride levels (266-304). We’ve been trying the low-fat diet and no sugar, but it doesn’t seem to work. Is there any other treatment for high triglycerides? I’m clueless.

I am presuming that the insulin levels were also done fasting and that glucose levels were done at the same time, and that they were normal, thereby excluding diabetes at the present time. You also did not comment, but for the time being, I will assume that your son is heavyset for his age.

These high levels of insulin suggest insulin resistance which means his body does not respond to insulin in the most efficient manner. He needs to make more insulin (compared to a thin person) to have the same effect of keeping the blood sugar normal. This is often the precursor to the development of type 2 diabetes, which, unfortunately, we are seeing more of in children. Recent data indicate that about 25% of obese pre-teens, have glucose intolerance when they undergo a formal, correctly performed, oral glucose tolerance test.

The combination of insulin resistance and high fat (triglycerides) is a large risk factor for future heart and blood vessel disease. You did not mention his cholesterol levels (especially the values of the “good” HDL cholesterol and the “bad” LDL cholesterol). The presence of high cholesterol, especially LDL, further increases risk of heart and blood vessel disease. The mainstay is a low-fat, low-carb diet, and this will true even if medications are started.

There are a variety of medication to lower the triglyceride and cholesterol levels. They are used in children but the optimal time to start them is not certain and may depend on a variety of factors. Some of these medications work on cholesterol better than triglycerides or vice versa. Experience in children has been somewhat limited — mostly because this epidemic of obesity in children is a relatively new phenomenon. The medications can have a variety of mild-to-potentially serious side effects so follow up will be important if your son’s doctor starts them.

As insulin levels go up, especially if there is glucose intolerance/diabetes, triglycerides often go up also. Conversely, with weight loss and/or lower insulin levels, the triglycerides can improve. In general terms, even with the best attempts to exercise and limit diet, triglycerides and cholesterol levels often only decrease by 10-20%. Medications may well be necessary.

DS

[Editor’s comment: Although it is of limited likelihood of success, don’t give up on the meal planning. Be sure that you have talked to a dietitian who is comfortable with kids; if you haven’t, ask for a referral.

WWQ]

[Editor’s comment: Also see What You Need to Know about Type 2 Diabetes in Children.

WWQ]