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November 29, 2007

Pills for Diabetes, Type 2 in Youth

Question from Petaluma, California, USA:

My 14-year-old daughter has been told by an pediatric endocrinologist that her body is creating too much insulin. Her blood sugar is normal at 84 mg/dl [4.7 mmol/L] and she has not been diagnosed with diabetes. They say she could easily get diabetes, but is not diabetic at this time. She weighs 240 pounds and the endocrinologist just prescribed 1000 mg of Glucophage a day for the insulin problem. The back of her neck has had a dark brown discoloring since she was three years old. Her pediatrician says it is from being insulin resistant. Her endocrinoligist calls it some name that sounds like aconcosis. The Glucophage instructions say it is for controlling high blood sugars but my daughter does not have high blood sugar so I am hesitant to give her this medication in case it is not right for her.

Answer:

You should go back to the prescribing endocrinologist and ask for a more in-depth consultation so that you can ask these questions specifically for your daughter. It sounds like she has a pre-diabetes condition caused by her severe obesity. The dark skin is called acanthosis nigricans (means blackened, thick skin) and is believed to indicate insulin resistance, the forerunner of frank diabetes, if the weight is not lost. The Glucophage (metformin) is a type 2 diabetes treatment medication that help with such insulin resistance and is likely being used because of the high insulin levels. It has been used for the treatment of diabetes for more than 30 years and has a good recent history of helpfulness in such situations as you describe for your obese daughter. In any case, it would be extremely important for your daughter and for you to chat in greater detail with the pediatric diabetes team, understand the rationale for the treatment and, more importantly, figure out how to decrease the calories and increase the daily activity to get the weight loss needed. If not, then likely this will slowly and steadily progress to needing more medications and perhaps even insulin, early heart disease, circulation and blood pressure problems, polycystic ovaries and menstrual problems, lipid abnormalities, liver abnormalities, etc. That’s the bad list. The good news is that weight loss cuts the insulin resistance and decreases the chances of all of these from occurring or progressing. There is an excellent book written by Dr. Francine Kaufman entitled Diabesity, that may be very helpful for you and your daughter to both read together.

SB