Why do children become insulin resistant?

Interview: Dr. Tirthankar Chowdhury, Endocrinologist, Apollo Hospital


World Diabetes Day falls on November 14, and theme for 2021-23 is 'Access to Diabetes Care'.

One in 10 adults worldwide have diabetes, with over 90 percent having type 2 diabetes. Nearly half of them are undiagnosed. Adopting and maintaining healthy habits can delay or prevent type 2 diabetes and its complications. In India, there are approximately 97,700 children with type 1 diabetes mellitus (T1DM). The country also has a high number of undiagnosed diabetes cases, with estimates showing that 77 million individuals had diabetes in 2019, expected to rise to over 134 million by 2045.

An interview with Dr. Tirthankar Chowdhury, endocrinologist, Apollo Hospital, on the World Diabetes Day.

What is insulin resistance?

Insulin is a naturally occurring essential hormone required by the human body, made by the pancreas. It helps the movement of glucose from the blood into the body cells to be stored as energy for the systematic functioning of the body. When the pancreas functions correctly, it releases the insulin to bring the glucose levels in the bloodstream to a normal range. However, when the pancreas does not work as required- it does not make or release the required insulin to complete the normal cycle of glucose uptake into the cells, resulting in glucose build-up in the blood leading to uncontrolled blood sugar levels. This inability of the body to respond to insulin (thus leading to elevated blood glucose levels) is insulin resistance.

Is insulin resistance a permanent condition? 

Insulin resistance can be temporary or chronic. While temporary insulin resistance can be due to several reasons, chronic insulin resistance results from a combination of genetic, physiological, environmental, and behavioral factors. It can lead to pre-diabetes and eventually cause Type-2 diabetes. Insulin resistance can affect anyone, although the condition is more common in people over 45, today even children develop insulin resistance at an early age.

What are the common indicators of insulin resistance? 

As the indicators for insulin resistance are complex, it is essential for healthcare practitioners and family members to identify the risk factors for insulin resistance, especially among children. Insulin resistance commonly occurs in overweight or obese children, especially those who are physically inactive. Additionally, children with a family history of diabetes are more likely to develop insulin resistance. Physical indicators of insulin resistance are skin tags or skin darkening around neck and armpits, while medical indicators are high body mass index and fasting blood sugar. While the cases of insulin resistance in children vary depending on many factors, it has been reported that it is more prevalent among girls than boys.

How is insulin resistance diagnosed? 

Although there is no single laboratory test to diagnose insulin resistance, when healthcare practitioners identify the risk of insulin resistance in children, they recommend certain tests. The markers of the body mass index, the plasma glucose level, the fasting insulin level, and a lipid profile, among others are then corroborated with clinical findings to gauge the condition. However, as insulin resistance and obesity go hand in hand, doctors recommend tests to rule out weight-related issues including fatty liver, sleep apnea and PCOS.

What is the treatment of insulin resistance?

Positive lifestyle changes are the most effective way to treat insulin resistance in children. Weight management through a healthy, balanced diet with regular physical activity can improve blood sugar, blood pressure and lipid levels. Since children are still growing, it is crucial to build healthy habits by limiting junk food and sugary beverages, reducing screen time, and setting a sleep pattern. Working with a healthcare provider to ensure children are not stressed about the proactive treatment is equally essential. However, lifestyle changes alone may not always improve insulin resistance, and some children may need medication.

What are the complications of insulin resistance?

When insulin resistance is left untreated, it can result in prediabetes and type 2 diabetes which will increase the risk of developing complications associated with blood vessels affecting the heart, kidney, and nerves. It also affects the central nervous system and causes complications such as dementia, stroke, and mood disturbance. Non-alcoholic fatty liver disease is also intricately related to insulin resistance. An increasing worldwide prevalence and incidence of insulin resistance among children is causing a great deal of concern to healthcare professionals treating children.

What is the significance of World Diabetes Day?

It calls for timely screening, systematic monitoring, and efficient management of the condition. There are various patient support programs like Humrahi that provide access for diabetes care, whilst educating parents and family members alike. Let us pledge to work towards nipping the issue in the bud through disease awareness, preventive measures, and treatment adherence.

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