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May 5, 2002

Diagnosis and Symptoms

Question from Ada, Oklahoma, USA:

My 11 year old identical twins (about 5 feet 2 inches tall, 155 pounds) had MRIs done because of low body temps (94F), and couldn't eat for 16 hours during which they had an intravenous GTT running, and they consistently had blood sugars of 200-400 mg/dl [11.1-22.2mmol/L]. They have been sick since a virus about four months ago, and now we have to check glucose consistently at least twice a day, and they are on metformin. One doctor said they have glucose intolerance and the neurologist said there is trouble in the hypothalamus. Their 13 year old brother (4 feet 6 inches tall, 67 pounds) is now having problems so I am taking him to the doctor. He is reacting like someone with hypoglycemia. I do not know if they ran an antibody test. Could they be in first stages of type 1 diabetes? I am very confused. Why would all three boys start having glucose problems at the same time? Seems a little odd. Any advice?


I think that all three of your children may have a condition called the insulin resistance syndrome. The clinical manifestations of this are very variable indeed, and, at present, the various biochemical and genetic bases are not well understood. The twins seem to have the most common form that includes obesity and glucose intolerance in their case (See Bergstrom E, Hernell O, Persson LA, Vessby B. Insulin resistance syndrome in adolescents., Metabolism 1996 Jul;45(7):908-14) to the point of having type 2 diabetes.

I would expect that the IV glucose tolerance test showed a fasting serum insulin level greater than 45microUnits/ml (some centers use a criterion of only 25 microUnits/ml), and perhaps they also show a skin condition called acanthosis nigricans in which there are areas of dark pigmentation at the base of the neck, in the groin and under the arms.

Glucophage [metformin] is part of the standard treatment for this, although its long term effectiveness has still not been confirmed. Diet and exercise are easily prescribed and enormously hard to implement.

At the other end of the clinical spectrum, other cases may show growth failure and hypoglycemia and this, I think provides the link to your eldest son if he also has a high elevated serum insulin level. I don’t believe that any of the children have type 1A (autoimmune) diabetes, so I wouldn’t think antibody testing will be helpful.