Children with insulin resistance are becoming fatter, suffering from diabetes, and even developing acanthosis nigricans!

Diabetes is not exclusive to adults, be careful, obese children may also be affected! Xiaojie, a sixth-grade elementary school student, has been getting fatter and fatter recently. In particular, there are always dark brown lines on his neck and armpits that cannot be washed away. After visiting the hospital, he was diagnosed with acanthosis nigricans. The culprit turned out to be being overweight, which caused symptoms of insulin resistance.

Dr. Li Ruhao, a pediatric endocrinologist at Far Eastern Hospital, said that according to Taiwan's 2015 data, about 30% of elementary and junior high school students are overweight or obese, and are at high risk of the three highs and diabetes. (Photo provided by Far Eastern Hospital)

Xiaojie's glycosylated hemoglobin level was as high as 7.3%, and he was diagnosed with type 2 diabetes, but this also caused acanthosis nigricans. After 3 months of treatment, Xiaojie's glycosylated hemoglobin level has now dropped to 6.7%, and he has recovered well.

Obese children have insulin resistance, which leads to type 2 diabetes

Dr. Li Ruhao, a pediatric endocrinologist at Far Eastern Hospital, said that according to Taiwan's 2015 data, about 30% of elementary and junior high school students are overweight or obese, and are at high risk of the three highs and diabetes. Many children develop type 2 diabetes at a young age due to obesity. The reason is that obesity causes insulin resistance, which affects the ability of insulin to lower blood sugar. In the early stages of type 2 diabetes, in order to lower blood sugar, insulin will try to "win by quantity" and be secreted in large quantities. However, as the disease progresses, insulin secretion will become "exhausted" and not enough to lower blood sugar, leading to diabetes.

Diabetic insulin resistance, why does acanthosis nigricans occur?

As for why insulin resistance causes acanthosis nigricans? Insulin resistance refers to high insulin concentration in the blood. In addition to making people fatter and fatter, it also causes high blood sugar, so it is a precursor to diabetes. Insulin acts on the insulin-like growth factor receptors on keratinocytes or fibroblasts, promoting cell proliferation, thus causing local skin roughness and darkening. Therefore, acanthosis nigricans itself is a manifestation of insulin resistance.

Common types of diabetes in children include type 1 diabetes caused by autoimmunity, in addition to type 2 diabetes caused by obesity.

What should children pay attention to when they suffer from diabetes? Dr. Li Ruhao pointed out that once blood sugar reaches a certain level, the sugar in the blood will leak out through the urine, so it is called diabetes. The sugar lost in the urine not only takes away nutrients, but also water, so the body will feel hungry and thirsty, leading to a vicious cycle of eating more, drinking more, urinating more and losing weight. Fortunately, drugs for type 2 diabetes are improving rapidly, and many new drugs that have shown good efficacy in adults have also been tested in large-scale clinical trials in children.

Diagnosis of childhood diabetes requires careful assessment of whether it is type 1 or type 2

Common types of diabetes in children include type 1 diabetes caused by autoimmunity, in addition to type 2 diabetes caused by obesity. The islet cells in the pancreas that secrete insulin are completely destroyed due to attacks by the immune system or other factors. They can only secrete a very small amount of insulin and are unable to lower blood sugar, which in turn causes type 1 diabetes. In fact, type 1 diabetes is the most common form of diabetes in preteens.

Dr. Li Ruhao reminds us that not all overweight and obese children with diabetes have type 2 diabetes. Some overweight children have type 1 diabetes due to the aforementioned immune system destroying pancreatic islet cells. Conversely, some children whose clinical manifestations resemble type 1 diabetes may also have type 2 diabetes. Therefore, they require careful evaluation and comprehensive consideration by a specialized physician to accurately diagnose and formulate the most appropriate treatment strategy.