Insulin Resistance and Acanthosis Nigricans in Kids

What is Insulin and where does it come from?
Insulin is a hormone produced by an organ called the pancreas. Insulin tells many tissues of the body to allow sugar to enter the cells. We need sugar in our cells because it is the main energy source for our body. Sugar is the fuel for our body like gasoline is the fuel for a car.

Why is Insulin so important?
Our bodies convert the food that we eat into energy. This energy is used for our muscles, brain, and heart. Like a car, a steady stream of fuel is important for good performance. For our body to perform at its best, Insulin levels in the blood are constantly adjusted by the body to keep blood sugars normal at all times. In persons without diabetes, blood sugar levels will remain between 80-120 before meals no matter what or how much food has been eaten.

There are many things that raise the blood sugar, but insulin is the only hormone that can lower you blood sugar.

What is Insulin resistance?
Insulin Resistance happens when insulin is blocked or reduced. Even though there is plenty of insulin, the insulin does not work properly. When the insulin is not working well, the body has to make even more insulin just to keep blood sugars normal.

Why did you become Insulin resistant?
It is believed that Insulin Resistance is inherited by many persons, but there are other possible causes like medications or being overweight.

Does this mean you may have diabetes?
When persons are told they have Insulin Resistance only, this means they do not have high blood sugar or diabetes…YET, if they don’t take care of it, this will probably lead to diabetes.

What age can Insulin Resistance begin?
There is no exact answer for this. Some believe that a person may be born with this trait. Others argue that it happens when a person gains a lot of weight. In truth, both explanations could be true. We believe that many children in South Texas are born with a trait to develop Insulin Resistance. In other words, it’s in their genes. This makes it easier for them to gain weight more quickly than others, and it may make them eat more food than normal to feel “full”. We can’t change the things that were passed down from your family tree, so it’s not your fault. But we can do some things to fight back against the Insulin Resistance.

Why do people with Insulin Resistance gain weight?
The ability to produce and store fat is present in persons with Insulin Resistance and may even be higher than normal. Insulin makes the fat cells store unused energy as fat. And so, with high insulin levels, all that extra insulin will grab any extra fuel (from food) that is not being used for energy and store it as fat in your body. This equals to more weight gain!

High insulin levels can also cause rapid growth of muscle, bone, and other tissues. It is quite common for a child with insulin resistance to be not only heavier, but also taller and appear more mature for his years compared to other children the same age.

Why can Insulin Resistance make you feel hungry all the time?
High insulin levels may act to make persons hungrier and take larger portions of food before feeling “full”. This may be the reason that people with Insulin Resistance eat more than those without this condition.

Besides obesity, what other problems can Insulin Resistance cause?

As a result of being overweight, bone and joint injuries and even Obstructive Sleep Apnea (breathing that stops while you sleep) occur.

What is Acanthosis Nigricans?
Acanthosis Nigricans (AN) may be the reason you were referred here. AN is a discoloration of the skin (often dark) on the following areas:

Some persons with more severe cases may have the following:

Most parents have thought this skin change was due to dirt and have tried to scrub the area clean. This is not a skin infection or other skin disease, but an indicator that Insulin Resistance may be present. We have found that the amount of AN does not always reflect the severity of the Insulin Resistance.

What causes Acanthosis Nigricans?
In young persons, AN is a visible marker which strongly suggests insulin resistance. Higher than normal insulin levels in the blood stream causes the growth of darkened skin over certain areas of the body. There is no skin treatment that will get rid of AN. Acanthosis Nigricans may lighten up and possibly go away by treating the root cause: Insulin Resistance…but it can take months or years to do so.

Don’t be surprised about not ever hearing about AN. Many doctors and nurses don’t know what it is or what it represents. Because very few people have heard about it, many health professionals do not recognize AN as an early warning sign for diabetes and other health problems.

Insulin Resistance: What does this all mean?
Insulin resistance is extremely common in South Texas. Since Insulin Resistance is the first step leading to the development of type 2 diabetes (formerly known as adult diabetes) it is important we stop it before it can cause this serious condition. The only way to reverse this trend is by educating doctors, nurses, schools, and parents of what can happen if it is left untreated.

How can Insulin Resistance be diagnosed?
The following history and blood work will be obtained:

The blood sugar test will most often be normal but the insulin levels will usually be elevated.

How is Insulin Resistance treated?
At this time, Insulin Resistance can be attacked by only three ways:
Nutrition (diet), Exercise, and Medications. Not surprisingly, these are some of the same treatments used to also treat type 2 diabetes.

Nutrition (diet)
Making better food choices is vital to controlling your weight gain. If your parents are not good at making proper food choices, you may not be able to make good choices either. It is very important for the family to obtain professional help from an experienced nutritionist. You can start by reducing sugar and fried foods in the diet.

One visit to your nutritionist is not sufficient. Frequent visits are needed to answer questions and review eating patterns.

Exercise (physical activity, play)
Exercise allows the insulin you produce to work better on the muscle tissue. The effect is rapid and begins with the first episode of exercise. Even a small level of activity (such as a 15-20 minute walk) can improve the sensitivity of the body to insulin for a day or two. If exercise is regular enough, it can:

Medications
The decision to use any mediation for insulin Resistance depends on your situation and is made only after a careful medical examination and discussion with your doctor.

If your doctor feels you need medication, it is important you take it exactly as directed. If you run out or decide to stop taking it, you must notify your doctor immediately.

Putting It All Together
AN is a serious health threat. If left untreated, it could lead to diabetes and other serious illnesses in the future. You and your family can fight AN and insulin resistance but you cannot treat this by yourself. It is important for you to:

Remember…your body will not change overnight but every change you make can improve your health!

Contact Information

The Driscoll Children’s Hospital Diabetes Team:

Jennifer Amaral
Endocrinology and Diabetes

Stephen W. Ponder, M.D. C.D.E.
Endocrinology and Diabetes

Susan Sullivan, RN, CDE
Phyllis Secraw, RN, DE
Melissa Claire, RN, DE
Meaghan Wickersham, RD

Children's Diabetes and Endocrine Center
4th Floor in the Joseph M. Sloan Building
3533 S. Alameda St.
Corpus Christi, TX 78411
Clinic appointments: (361) 694-4986
Business Office: (361) 694-4864
Office Fax: (361) 694-4832

Further Reading

For Patients and Parents

Contact a Social Worker

Day Surgery

Child Life

Need a Spanish Interpreter?

Urgent Care Center - After Hours

Pediatric Specialties

Rights and Responsibilities

Patient Billing

Visiting a Patient

Health and Safety Programs

Support Groups

Miracle Stories

Additional Resources

Pastoral Care

Create a CarePage

Visit Carousel Gift Shop to
Send a gift to a patient

Volunteer Opportunities

Ways to Give