Insulin Resistance in Children: What Do You Need to Know?

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. 

As overweight and obesity rates rise among pediatric patients, metabolic syndrome is becoming increasingly common. Insulin resistance often occurs with metabolic syndrome, which may contribute to further weight gain, cardiovascular health issues, 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 approaches to management.

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What Is Insulin Resistance?

Insulin has two main functions within the body: acting as a hormone to help manage blood glucose levels and as a signaling molecule for cells in virtually all body organs. Insulin resistance occurs when cells do not respond effectively to insulin stimulation. 

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. 

Insulin then works to help maintain blood glucose levels within a 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). 

But when this process is not functioning properly, 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. 

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, may contribute to 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, may lead to physical inactivity, fewer calories burned, weight gain, and metabolic complications.

Secondary Causes

There are additional secondary factors that may contribute to insulin resistance in children. 

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 factor that may contribute to insulin resistance in children. Variations in genes coding for insulin signaling or other genetic factors affecting mitochondrial activity, inflammatory mediators, and lipid metabolism can influence 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 may contribute to 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 managing 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:

• Fasting blood glucose
• Oral glucose tolerance testing
• Fasting insulin
• Hemoglobin A1c (HbA1c)
• HOMA-IR

Managing Insulin Resistance in Children

Lifestyle Changes and Diet

Diet plays a significant role in insulin sensitivity. A healthful diet can help support insulin sensitivity. On the other hand, a poor diet high in refined carbohydrates and proinflammatory foods may contribute to insulin resistance. 

• Emphasizing a diet of whole, nutrient-dense foods while also minimizing refined sugars and processed foods may help regulate blood glucose and support insulin sensitivity.
• Incorporating healthy fats like omega-3 fatty acids may help reduce inflammation and support insulin sensitivity.
• Prioritizing high-fiber foods like vegetables, fruits, whole grains, and legumes may help control insulin release and support 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 managing insulin resistance.

The Role of Physical Activity

Regular physical activity is essential in promoting insulin sensitivity. Studies show that adding regular exercise can support 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 supports 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. 

• 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. 
• All children should be encouraged to walk more and maintain active lifestyles during their daily activities.

Weight Management

Because overweight and obesity may increase the risk of insulin resistance in children, achieving and maintaining a healthy weight is central to managing insulin resistance. 

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, may help improve the inflammatory mechanisms of insulin resistance.

Medical Treatments

If diet, physical activity, and weight management strategies are not effective at managing insulin resistance in children, insulin-sensitizing medications, such as metformin and the newer glucagon-like peptide-1 (GLP-1) receptor agonists, may be considered. 

Metformin, in combination with diet and physical activity modifications, has been shown to support weight loss, body mass index (BMI) reduction, and improved insulin sensitivity in children with obesity. GLP-1 receptor agonists have also been shown to help lower weight, BMI, and hemoglobin A1c in pediatric patients who have obesity.

The Importance of Awareness and Early Action

Insulin resistance in children may increase the risk of developing type 2 diabetes mellitus. Early identification and management of insulin resistance may help reduce disease progression risk, but a comprehensive, multidisciplinary approach 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 may include 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 may include certain medications, PCOS, family history, genetic predispositions, and puberty.
• Insulin resistance in children should first be managed with diet and exercise modifications. Medications, like metformin and GLP-1 receptor agonists, may be considered.