20 Questions about Acanthosis Nigricans & Insulin Resistance in Kids

1. What is Acanthosis Nigricans?
2. Why is Acanthosis Nigricans so important?
3. Where can Acanthosis Nigricans be found?
4. What causes Acanthosis Nigricans?
5. What is Insulin and where does it come from?
6. Why is Insulin so important?
7. What is Insulin Resistance?
8. Why did you or your child become Insulin Resistant?
9. Does this mean you may have diabetes?
10. What age can Insulin Resistance begin?
11. Why do people with Insulin Resistance gain weight?
12. Why can Insulin Resistance make you feel hungry all the time?
13. Besides obesity, what other problems can Insulin Resistance cause?
14. What is Obstructive Sleep Apnea?
15. What are the symptoms of Obstructive Sleep Apnea?
16. How can I tell if my child has Obstructive Sleep Apnea?
17. Why is it important to treat OSA?
18. Insulin Resistance: What does this all mean?
19. How can Insulin Resistance be diagnosed?
20. How is Insulin Resistance treated?

1. What is Acanthosis Nigricans?

Acanthosis Nigricans is a skin condition that signals high insulin levelvs in the body. Insulin is produced by an organ called the pancreas. Insulin is important because it helps “carry” the glucose or sugar to the cells in your body. High insulin levels indicate that the body is resisting the insulin that is being produced. As a result the pancreas produces more insulin than needed, and through time, it can stop producing enough insulin to take the glucose to the cells of the body. Acanthosis Nigricans is important because these markings can help identify persons run the risk of developing diabetes in the future.

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2. Why is Acanthosis Nigricans so important?

Acanthosis Nigricans is important because of the increasingly alarming rates of persons developing type 2 diabetes. Until recently, it was believed that children could not develop type 2 diabetes. However, children can. Screening for Acanthosis Nigricans can help identify persons who have high insulin levels and who may be at risk for developing the disease. Once identified, the necessary measures to lower the insulin levels and reduce the risk of developing the disease. Once identified, the necessary measures to lower the insulin levels and reduce the risk of developing diabetes can be taken. Exercise and proper nutrition will help the body become more sensitive to insulin and lower insulin levels. Similarly, the Acanthosis Nigricans markers will begin to fade.

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3. Where can Acanthosis Nigricans be found?

Acanthosis Nigricans (AN) may be the reason you’re here. AN is a discoloration of the skin (often dark) on the following areas:

Some children and adults with more severe cases may have the following:

Most parents have thought this skin change was due to dirt or poor hygiene and have tried to scrub the area clean. It never helps. This is not a skin infection or other skin “disease,” but a marker that Insulin Resistance is present. We have found that the amount and severity of Acanthosis Nigricans does not always reflect the severity of the Insulin Resistance problem.

Darker skinned persons with Insulin Resistance are more likely to show Acanthosis Nigricans compared to lighter skinned persons with the same problem. In lighter skinned persons with AN, the skin area may actually appear tan and velvety instead of dark and rough. This may make AN more difficult to diagnose.

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4. What causes Acanthosis Nigricans?

In persons of all ages, AN is an easily seen marker for Insulin Resistance. It is believed that the higher than normal insulin levels in the blood stream causes the growth of darkened skin over parts of the body that bend (neck, elbows, knees) or that rub against each other a lot (armpits, waistline, groin). There is no good skin treatment that will get rid of AN. Acanthosis Nigricans can 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 hear about it, many health professionals do not recognize AN as an early warning sign for diabetes and other health problems, but this is starting to change.

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5. What is Insulin and where does it come from?

Insulin is a hormone. The hormone insulin is produced by an organ called the pancreas. Insulin tells many tissues of the body to allow blood sugar to enter each of our body’s cells. We need this sugar in our cells because it’s the main energy source for our body. In other words, sugar allows our body to function, like gasoline allows a car to run.

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6. Why is Insulin so important?

Our bodies convert the sugar in the food we eat into energy. This energy is used to provide fuel 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 sugar normal at all times. In healthy person, blood sugar levels will remain between 70-110 mg/dl before breakfast and well below 200 mg/dl before all other meals no matte what or how much food has been eaten earlier.

There are many things that raise the blood sugar, but insulin is the only hormone that can lower you blood sugar. There is no substitute!

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7. What is Insulin Resistance?

Insulin Resistance is the condition is that happens when the action of insulin is blocked or reduced. The body makes enough insulin but it does not work well. When the insulin is not working well, the body has to make even more insulin just to keep blood sugars normal.

Eventually, the pancreas can’t produce enough insulin to keep the blood sugar normal. Having to make so much insulin for so long burns out the pancreas. This results in abnormally high blood sugars (diabetes).

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8. Why did you or your child become Insulin Resistant?

It is believed that Insulin Resistance is inherited by many persons (i.e., runs in families), but there are other possible causes like certain mediations or being very overweight.

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9. 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.

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10. 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 usual. 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.

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11. Why do people with Insulin Resistance gain weight?

The ability to produce and store body 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 means more weight gain!

High insulin levels can also cause more 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 or her years compared to other children the same age.

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12. Why can Insulin Resistance make you feel hungry all the time?

High insulin levels may act to make persons more hungry and eat or drink larger portions of food before feeling “full”. This may be the reason that people with Insulin Resistance eat more food, more often, than those without this condition.

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13. Besides obesity, what other problems can Insulin Resistance cause?

Scientist have found that having high insulin levels over long periods of time can increase the risk of the following conditions:

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

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14. What is Obstructive Sleep Apnea?

Overweight persons may have difficulty breathing normally during sleep. They may breathe loudly (snore), and because of the weight of body tissues in the neck, may temporarily stop breathing for short periods of time during sleep. The spells occur during the early stages of deep sleep. When such an episode occurs, the person will awaken and start breathing normally again. However, the person has been prevented from getting the proper level of deep sleep. These apneas may happen several times a night.

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15. What are the symptoms of Obstructive Sleep Apnea?

OSA is often confused in children with Attention Deficit Disorder (ADD). It is common for OSA to be mis-diagnosed as ADD. In severe cases of OSA, the child will experience any or all or the following signs.

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16. How can I tell if my child has Obstructive Sleep Apnea?

If your child is experiencing any two or three of the above signs and symptoms, a referral to a children’s sleep specialist should be made. The sleep specialist will perform a sleep study to determine the severity of the problem. Sleep studies are painless and only require the person to fall asleep for several hours while breathing patterns, heart rate, EKG and brainwave patterns are monitored. This study can be done in a hospital or a special sleep study center.

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17. Why is it important to treat OSA?

If not treated, OSA can cause serious heart and lung damage in 1 out of 10 persons. Much more often, OSA is a major cause of poor school performance and lost work and income potential. Children with OSA are always tired and don’t like to exercise and play as much as other children. This makes their weight problem even worse! In fact, OSA must be treated if there is any hope of effectively treating Insulin Resistance. Like Acanthosis Nigricans, until now Obstructive Sleep Apnea has been under-recognized by doctors as being a serious health problem for children.

The best treatment for OSA is weight loss, but this may take several years to accomplish if it is the only treatment. In that time, severe damage can be done to the child’s health as well as their school performance. One treatment often used is the removal of the tonsils and adenoids, which allows better breathing at night. Some children may wear a special mask to help them breath more effectively at night. The choice of treatment is made by the severity of the problem and the sleep specialists medical opinion.

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18. Insulin Resistance: What does this all mean?

Insulin Resistance is extremely common in South Texas. Researchers have found that between 10 and 25% of South Texas children and adults are at risk for developing Insulin Resistance. 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 health problem. The only way to reverse this trend is by educating doctors, nurses, schools, and parents of what can happen if it is left untreated. Prevention is the key.

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19. How can Insulin Resistance be diagnosed?

Acanthosis Nigricans is a powerful tool for identifying persons with Insulin Resistance. The medical evaluation of a person with AN includes a thorough medical history and physical examination by an experienced physician.

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. Remember Acanthosis Nigricans and Insulin Resistance does not automatically mean DIABETES! However, a recent study showed that about one out of 100 teenagers in South Texas may have type 2 diabetes and not even know it!

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20. 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.

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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 (dietitian). Unless you are trained dietitian, you have probably gotten most of your education about food from commercial sources (television, radio, newspaper and magazines). All the sources are usually trying to sell you something, usually their food. The level of knowledge about proper nutrition is quite poor. It is one of the reasons that there are so many diet books and programs sold in this country. Fortunately, you don’t have to be a rocket scientist to make better food choices. Simply avoiding high calorie foods and drinks can have a major effect on slowing down weight gain. For example, drinking one 12 ounce can of regular soda pop (any kind) a day will result in 16 lb. weight GAIN every year. The nutritionist can get you off to a good start if you (and your family) are ready to make the necessary changes.

One visit to your nutritionist is not sufficient. Frequent visits are needed to answer questions and review eating patterns to keep you “on track”.

Exercise (physical activity, play)
Exercise allows the insulin your body already makes to work better on the muscle tissue. The effect of exercise is rapid and begins with the first episode of exercise! Even a small amount 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:

The average child in this country spends 38 hours a week being “entertained” electronically (television, computers, video games, etc…). By adult standards, that the equivalent of a full time job! During this time, most kids are not physically active. This severe amount of inactivity increases the risk of gaining weight…lots of it! Also, many children eat snack foods and/or colas while watching television, making the problem even worse.

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. There are now medicines used to treat Insulin Resistance, but they must be used with caution in young persons since they have not been formally approved for use by the FDA. Nevertheless, they have been used very successfully over many years in adults with diabetes due to Insulin Resistance.

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

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