My son was diagnosed hyperinsulinemia. He is 9 years old and the endocrinologist put him on Glucophage [metformin, a pill for Type 2 diabetes] twice a day. I haven’t found much information on Glucophage in treatment of hyperinsulinemia and I was wondering if you had any information on it.

It is difficult to answer your question without knowing a good deal more about the circumstances. For example what were the actual conditions on which the diagnosis of hyperinsulinemia was based, was this because of hypoglycemia or was your son thought to be diabetic? Was the level a ‘fasting’ one or was it part of an intravenous glucose tolerance test and if so how long after the glucose was given?

The most likely circumstance in which Glucophage might be given would be if your son’s endocrinologist thought that he had a degree of insulin resistance thought to be due to Type 2 diabetes. This is a form of diabetes that, although much less common than Type 1a or autoimmune diabetes in children, is being increasingly reported. It can be distinguished from Type 1B diabetes and from the various forms of MODY (Maturity Onset Diabetes in the Young) by having a high blood sugar level, a negative antibody test, a subacute onset and normal or modestly elevated serum insulin levels. Subjects are often overweight and with a significant family history. Glucophage acts mainly be reducing the output of glucose from the liver and diminishes intestinal absorption of glucose.

Glucophage would not be used or be appropriate if there was any thought that the hyperinsulinemia was due to an insulinoma. Anyway I am sure the endocrinologist can explain why he/she is using Glucophage and in addition you might do some exploring in PubMed, which is the National Library of Medicine.

DOB
Additional comments from Dr. Stuart Brink:

I assume that your son is overweight and perhaps also has acanthosis, hypertension, hyperlipidemia and perhaps also premature adrenarche. These are all conditions associated with the future development of type 2 diabetes. Often more commonly seen in Black, Hispanic, Asian-American, or American Indians, but also in Caucasians who are overweight. There is some intriguing experimental data that looks very promising about using medications like Glucophage (metformin) to bring down the insulin levels by combating insulin resistance. Weight loss and vigorous daily exercise are incredibly helpful but very difficult for such people including children. There are no long-term studies on such use so you should stay in close contact with your endocrinologist so follow such measurements sequentially and prove if the Glucophage is helping. One of the key researchers is Lourdes Ibanez from Barcelona and she reported on her studies in Boston at the recent Lawson Wilkins pediatric endocrine society meetings.

Glucophage is generally a medication that does not have many side effects and has the potential for improving all these situations.

SB
Additional comments from Dr. Larry Deeb:

While not FDA approved for hyperinsulinism, it is approved to treat diabetes in 9 year old. Type 2 diabetes presents with increased insulin. Glucophage improves insulin resistance. I do this in my practice.

LD