Insulin resistance is a common metabolic dysfunction that can affect adults or children. The majority of cases of insulin resistance in children are in those with obesity, and the incidence has increased by more than 50% in certain groups of children in recent years.Β
As overweight and obesity rates rise among pediatric patients, metabolic syndrome is becoming increasingly common. Insulin resistance often occurs with metabolic syndrome, driving the predisposition to further weight gain, cardiovascular disease, and type 2 diabetes mellitus.
This article provides a comprehensive review of insulin resistance in children, including the potential causes, relevant risk factors, signs and symptoms, and approach to treatment.
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What Is Insulin Resistance?
Insulin has two main functions within the body: acting as a hormone to reduce blood glucose levels and as a signaling molecule for cells in virtually all body organs. Insulin resistance occurs when cells do not respond to insulin stimulation.Β
Knowing how insulin works is necessary to understand insulin resistance. In a healthy patient (child or adult), insulin is released by the beta cells of the pancreas in response to increased blood glucose, which occurs after carbohydrates are ingested. When a patient eats carbohydrates and the body metabolizes them, blood glucose increases, signaling to the pancreas to release insulin.Β
Insulin then works to restore blood glucose levels to the normal range by instructing cells on how to use glucose, either sending it to various organs for energy or storing it as fat (adipose tissue).Β
But when this process is dysfunctional, insulin resistance occurs. Poorly responsive insulin receptors and chronically elevated blood glucose levels continually stimulate the pancreas to produce more and more insulin in an ongoing cycle.Β
As blood glucose remains elevated and insulin resistance worsens, it can lead to first prediabetes and then type 2 diabetes. Insulin resistance can also occur in type 1 diabetes, which is discussed separately.
Can Children Develop Insulin Resistance?
Many people consider insulin resistance to be a condition that affects only adults. However, it can occur in children as well, and it is becoming increasingly common as the rates of overweight and obesity in children increase rapidly.
Leading Causes of Insulin Resistance in Children
Here are primary and secondary causes you should know about:
Primary Causes
Several primary factors are the leading causes of insulin resistance in children.
A poor diet, high in processed and proinflammatory foods, significantly drives insulin resistance in children. Diets high in processed foods include large amounts of refined carbohydrates and added sugars, often in sugary beverages, packaged snacks, and sweets.
A sedentary lifestyle, including minimal physical exercise and more screen time, promotes physical inactivity, fewer calories burned, weight gain, and metabolic complications.
Secondary Causes
There are additional secondary factors that cause insulin resistance in children.Β
The use of certain medications is associated with insulin resistance in children:
- Glucocorticoids
- Immunomodulators
- Growth hormone
- Hormonal contraceptive drugs
- Anti-seizure medications
- Antipsychotic drugs
Specific genes are another secondary cause of insulin resistance in children. Variations in genes coding for insulin signaling or other genetic factors affecting mitochondrial activity, inflammatory mediators, and lipid metabolism can cause insulin resistance.
The impact of puberty on insulin sensitivity is less often discussed but is a crucial secondary risk factor for insulin resistance in children, especially in obese adolescents. Puberty is a time marked by notable changes in hormonal and metabolic health. Around puberty, insulin sensitivity decreases to a degree comparable to the insulin resistance observed during pregnancy. This physiologic decrease in insulin sensitivity resolves in most patients, but in obese adolescents, it is more likely to progress to worsened insulin resistance.
Conditions Associated with Insulin Resistance
Specific metabolic health concerns linked to insulin resistance include obesity, polycystic ovarian syndrome, and a family history of type 2 diabetes.
- Obesity is an independent risk factor for insulin resistance in adults and children.
- Polycystic ovarian syndrome (PCOS) in adolescents often results in hyperinsulinemia, which directly causes insulin resistance and the associated negative metabolic impacts.
- A family history of diabetes is associated with higher rates of insulin resistance in children.
Identifying Insulin Resistance in Children
Insulin resistance in children can have characteristic physical findings, especially in the later stages of diagnosis.
- Abdominal obesity, including accumulation of fat tissue around the abdomen, both subcutaneous fat (under the skin) and visceral fat (surrounding the organs)
- Acanthosis nigricans, which are dark skin patches usually found in the axilla or along the back of the neck
- Skin striae, from rapid excess skin stretching, most commonly over the abdomen
However, findings may be less apparent in children's early stages of insulin resistance. Appropriately diagnosing and treating early-stage insulin resistance in pediatric patients requires regular physician visits, weight monitoring, and developmental assessments.
Diagnosis and Testing
Diagnostic testing for insulin resistance includes several assessments:
Managing Insulin Resistance in Children
Lifestyle Changes and Diet
Diet plays a significant role in insulin sensitivity. A healthful diet can help preserve or restore insulin sensitivity. On the other hand, a poor diet high in refined carbohydrates and proinflammatory foods promotes insulin resistance.Β
- Emphasizing a diet of whole, nutrient-dense foods while also minimizing refined sugars and processed foods helps regulate blood glucose and improves insulin sensitivity.
- Incorporating healthy fats like omega-3 fatty acids helps reduce inflammation and improves insulin sensitivity.
- Prioritizing high-fiber foods like vegetables, fruits, whole grains, and legumes helps control insulin release and promotes insulin sensitivity.
Children have unique nutritional needs of fats, carbohydrates, and proteins to support this vital time of physical and brain growth, so it is essential to ensure children consume a nutrient-dense, balanced diet full of health-promoting foods while treating insulin resistance.
The Role of Physical Activity
Regular physical activity is essential in promoting insulin sensitivity. Studies show that adding regular exercise can improve insulin sensitivity as much as weight reduction.
- Exercise increases glucose uptake in muscles
- Exercise burns calories, promoting a healthy weight
- Exercise builds muscle to increase strength and promote a healthy metabolism
- Exercise modulates inflammation and improves fatty acid metabolism
Children can participate in physical activity in different ways than adults. Active play is a great way to encourage movement through enjoyable activities. The recommended amount of exercise for children differs by age.Β
- School-age children can be physically active through less structured outdoor play and group activities.
- Adolescents may benefit from more structured games and activities, including team sports, competitive play, and defined exercise sessions.Β
- All children should be encouraged to walk more and maintain active lifestyles during their daily activities.
Weight Management
Because overweight and obesity significantly increase the risk of insulin resistance in children, achieving and maintaining a healthy weight is central to managing insulin resistance.Β
Improving diet and increasing physical activity should be the initial steps in any weight management program. Studies indicate that weight loss, which results in a loss of adipose tissue in obese children, directly improves the inflammatory mechanisms of insulin resistance.
Medical Treatments
If diet, physical activity, and weight management strategies are ineffective at controlling insulin resistance in children, insulin-sensitizing medications, such as metformin and the newer glucagon-like peptide-1 (GLP-1) receptor agonists, may be used.Β
Metformin, in combination with diet and physical activity modifications, demonstrates success in weight loss, body mass index (BMI) reduction, and improved insulin sensitivity in children with obesity. GLP-1 receptor agonists have also been shown to lower weight, BMI, and hemoglobin A1c in pediatric patients who have obesity.
The Importance of Awareness and Early Action
Insulin resistance in children significantly increases the risk of developing type 2 diabetes mellitus. Early diagnosis and management of insulin resistance help reduce disease progression risk, but a comprehensive, multidisciplinary treatment plan is required for the best outcomes.
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Key Takeaways
- Insulin resistance affects not only adults but also children.
- The leading causes of insulin resistance in children are a poor diet and a sedentary lifestyle.
- As the incidence of overweight and obesity in children increases, the incidence of insulin resistance also increases.
- Additional risk factors for insulin resistance in children include certain medications, PCOS, family history, genetic predispositions, and puberty.
- Insulin resistance in children should first be treated with diet and exercise modifications. Medications, like metformin and GLP-1 receptor agonists, may be helpful.
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