Insulin resistance in young people
"Previously insulin resistance and type 2 diabetes were conditions almost only seen in adults but with the rise in childhood obesity, they are now being diagnosed in children and adolescents. The MBF Foundation is proud to support The Children's Hospital at Westmead's project to assess whether a higher protein and lower carbohydrate diet is more effective at reducing insulin resistance in overweight adolescents than a higher carbohydrate diet.” Dr Christine Bennett, Chair, MBF Foundation Steering Committee and Bupa Australia Chief Medical Officer.
What is insulin resistance?
Insulin resistance is a condition where the body produces insulin but does not respond to it properly. Insulin is a hormone produced by the pancreas that helps the body use glucose for energy. The body breaks food down into glucose, and insulin helps cells take in and use glucose.
When people are insulin resistant, their muscle, fat and liver do not respond properly to insulin and their bodies need more insulin to help glucose enter cells. As a result the body produces more insulin and eventually the pancreas has difficulty keeping up with the demand. People with insulin resistance have higher levels of insulin and glucose in their blood.
Insulin resistance increases the chances of developing type 2 diabetes. Family history, excess weight and physical inactivity can contribute to insulin resistance.
Insulin resistance or pre-diabetes?
Pre-diabetes is a condition in which blood glucose levels are higher than normal, although not high enough to be called diabetes. Insulin resistance and pre-diabetes usually have no warning signs or symptoms. People may have one or both conditions without any symptoms for several years.
How common is pre-diabetes?
There has been a significant rise in adolescents with insulin resistance and/or pre-diabetes. The incidence of insulin resistance is unknown but the incidence of type 2 diabetes is increasing. In Western Australia, between 1990 and 2002, type 2 diabetes increased on average 27% per year in adolescents. In NSW, more than 10% of adolescents with newly diagnosed diabetes have type 2. It is estimated that there are at least 10 times the number of adolescents with clinical insulin resistance and/or pre-diabetes compared to those with type 2 diabetes. 1
It is estimated that about two million Australians have pre-diabetes – half of whom don't know they have it. 2
Does pre-diabetes lead to type 2 diabetes?
Type 2 diabetes in young people, as in adults, is thought to result from insulin resistance. During puberty, hormonal changes can contribute to insulin resistance, and type 2 diabetes is more likely to be diagnosed at this time.
Type 2 diabetes is a condition in which the body can't use insulin properly or the body doesn't make enough insulin, or both.
In young people, type 2 diabetes is especially serious because the condition is active for a longer time and complications such as heart disease and kidney disease are also likely to occur at a younger age.
Which young people are at risk of type 2 diabetes?
Children and adolescents most at risk of developing type 2 diabetes are those who are:
- Overweight or obese
AND have any two of the following:
- Blood relatives with type 2 diabetes
- An Aboriginal or Pacific Islander or other high risk ethnic groups
- Signs of insulin resistance diagnosed by the doctor. 2
How is insulin resistance diagnosed?
Your doctor will organise for a blood test. If the result from this test is not definite, a further test known as an oral glucose tolerance test (OGTT) will be arranged. The results from these tests can be used to show if your blood glucose level and response to glucose are in the normal, insulin resistant, pre-diabetes or diabetes range.
From the age of ten years, young people at risk of type 2 diabetes should have a fasting blood test every two years.2
How is insulin resistance treated?
The main aim of treating insulin resistance is to prevent the development of type 2 diabetes. In some cases lifestyle changes may be all that is required. If a healthy lifestyle is not enough, medications may be used to help reduce insulin resistance.
Important lifestyle changes include:
- Losing weight, which will help the body become more sensitive to insulin and use glucose more effectively.
- Being physically active by doing at least 30 minutes of moderate intensity at least five days of the week. This helps to manage weight and reduce blood glucose levels.
- Implementing healthy food choices and eating habits as a family. Reduce the amount of fat, sugar and salt in the family diet.
- Eating more fruit, vegetables and high fibre foods.
Sources:
- The Children's Hospital at Westmead
- Diabetes Australia-NSW