From Macon, Missouri, USA:
Our daughter just turned 12 years old. About six months ago, we were informed she has an insulin resistance problem and acanthosis nigricans. She also has mutated, aggressive scleroderma, a swallowing problem, allergies, petit mal seizures, a very severe "acral bone dysplasia" of the hands/feet. She is not overweight. She has other problems too, but I will not continue on for now.
One of my questions is how can we prevent my daughter from kicking over into diabetes in the future? She is not overweight.
If you may be able to answer my questions concerning diabetes, I would be grateful. I will just die if this little child with so much going on ends up with diabetes also on top of all her other health concerns. Also, her toenails are very deformed, and extremely thick,painful. Do toenail changes happen in children with insulin resistance and acanthosis? Just wondering.
Insulin resistance, acanthosis nigricans, lipodystrophy, scleroderma, and bone and nail changes have all been variously associated and in one recent report some components were linked to a very rare form of autoimmunity in which there were antibodies to the insulin receptor sites on the cell surface. There is no clear way to preventing possible future insulin dependence, but obviously weight conservation is important. It is possible that at some later stage the drug metformin may help to keep blood glucose levels within the normal range.
Additional comments from Dr. Stuart Brink:You ask excellent research questions but science and medicine do not have any clearcut answers for any of them. Understanding the interplay between genetic predisposition and environmental trigger factors is still in its infancy. You should stay in close contact with your daughter's medical team and perhaps arrange a consultation with a pediatric endocrinologist familiar with acanthosis nigricans, early forms of diabetes and autoimmune problems such as those which run in your family.
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