August 14, 2003
Genetics and Heredity
Question from Montgomery, Alabama, USA:
Three months ago, my 16 year old stepdaughter was diagnosed with PCOS along with insulin resistance, and she is currently on [metformin and vitamin B complex. Her 13 year old sister is following in her footsteps (mood swings, overweight, no exercise, not menstruating), and her 10 year old brother is same way (overweight, no exercise, mood swings). None of them have a healthy diet at home with their mother, and there is a family history of diabetes on both sides. What are the chances that the 13 and 10 year old are going to develop insulin resistance or type 2 diabetes?
These children are home schooled and do not have a daily exercise program. When the children are with me and their dad, I make them follow a strict diet because of the 16 year old, but this diet is not being followed at their mother’s home. How can I make my 16 year old stepdaughter understand the importance of diet and exercise to control this disease so that it does not get any worse and she ends up having to test her blood and do injections on a daily basis? How do I persuade my husband to convince the mother that the other children need to be tested also?
This is a difficult problem and really beyond the scope of an e-mail because not only is there a need to help the children with an important health issue, but inevitably this is entangled with the antagonisms of a divorce. I think what you should do is to try to get your husband to persuade the children’s mother to discuss the whole issue with the Medical Social Worker linked to the clinic looking after the daughter with Polycystic Ovary Syndrome. It may be that there is no such person in which case the next step would be to ask for help from the county mental health center either in their mother’s area or in the father’s.
The genetics of PCOS have not been defined. it is strongly familial, but the clinical picture is extremely variable which makes it hard to give any precise estimate for the younger daughter. (See Xita N, Georgiou I, Tsatsoulis A. The genetic basis of polycystic ovary syndrome. Eur J Endocrinol. 2002 Dec;147(6):717-25.)
What is clear and applies irrespective of gender is that obesity greatly enhances the chances of developing insulin resistance and type 2 diabetes in later life.