My 15 year old daughter had positive results for Severe Insulin Resistance this September 2009 along with AN. Her starting baseline insulin level was 180 pmol/l which rose to 335 mmol/l. (Consistant with Insulin Resistance). Her glucose baseline was normal at 5.0 mmol/l but rose after 2 hours to 9.0 mmol/l. I suspect her sugars go lower than this, so maybe she is already type II diabetic I dont know, but this is the only explanation I have since she wakes up shakey & jittery and limp, has an unquenchable thirst & has constant water infection after water infection....

Can anybody tell me whether she should be checking her glucose levels through the day checking for highs and lows?

We dont get to discuss these results or see the Endocrinologist until November 20th 2009. Apart from getting the above results, we have NOT seen the Endocrinologist since July 09. Her Glucose Tolerance Test was done August 09 and the FULL results were posted this 26th September 09. (These full results were only given after I demanded Metformin along with the full results of her impaired glucose tolerance with AN, otherwise we would have no idea !!!

We went to see a Dietician today (5th Oct) and she simply said that she should follow a healthy diet with plenty of carbs (!) because she needed them. I tried to imply a LOW Carb diet & she said that wasnt essential and what was important right now was that my daughter ate 3 meals a day and to forget about losing weight (BIG NO NO!)

Any advice on whether she should be testing her bloods would be much appreciated. Also whether you think following a Low GI Carb diet would help. Any other advice about seeing another specialist or paying for a private dietician (?!) would be much appreciated...

PS she has raised Testosterone levels, low cholestrol levels and low tricyglyroid levels.....
Thankyou x

Has your daughter seen a GYN for possible PCOS--polycystic ovarian syndrome?
Does she have regular periods? You mentioned Acanthosis Nigricans--does she have the darkened patches in her axilla, groin, around the neck area? Does she have skin tags?

I'm sorry I'm not used to the measure of glucose that you're using but it sounds very much like diabetes. It cannot hurt to take her blood sugars--particularly when she has the jitters, limp and shakey. I might suggest--Fasting in the morning and 2 hour post parandials (2 hours after meals) to start.

A carbohydrate controlled diet would be extremely beneficial to your daughter. It will help improve and balance her blood sugars. It will help to balance her insulin response. You did not say if your daughter is overweight? If so it will help her lose weight. With balanced insulin response she may see a more regular pattern to her periods if they have been irregular. Please remember that a carbohydrate controlled diet and a low glycemic diet are not the same thing. One thing I wouldn't do is follow the advice of a dietician--who spouts eat healthy, watch portions blah, blah, blah. If you daughter is indeed diabetic and/or PCOS a carbohydrate controlled diet is a must.

Did your health provider do a fasting insulin?

So much more history I would need to know.

Good luck. If she is indeed diabetic and or PCOS--please come back to the boards--both of you for surpport.

marginally better.

alright, lets get something clear here. excess carbs cause insulin resistance and diabetes. So do dieticians. And from your response I think you already know that. So I encourage you to stick with what you know and don't be pressured by the almighty doctor.

Hi

Thankyou for your replies....

My daughter is approximately 70lbs (5 stone) over weight. Her baseline fasting result was okay, but the result done after 2 hours was 335 (anything greater than >100 is decreed abnormal). Since her baseline result showed as ok on the day, and only the glucose insuline levels were abnormal, they have said she is Severely Insulin Resistant. This would be as I expected because her Acanthosis Nigricans is quite bad. She has dark patches under her armpits with boils, skin tags etc. She also has it under her breasts, across her stomach, inner elbow, groins, knuckles and badly all over the back of the neck....

The reason why this condition first come to light was because the problem really excelerated after she took mefenamic acid for bad period pains. She had a reaction to the medication and her lips & fingers swelled and she had extremely bad stomach pains, blurred vision etc which immediately caused incredible tiredness along with her blacking out... She immediately stopped taking the medication. I thought the black neck looked strange anyhow so I looked for names of eczma to match what she had and came across AN. Most English doctors havent heard of the AN condition so I demanded her be referred to an Endocrinologist and here we are with confirmation that she does have it.

Needless to say she still has bad period pains, they remain regular and last for about 9 days, but nobody has done anything else with this side of her problem. -

Were totally in the dark with a useless so called specialist who doesnt understand why she has such fatigue (and freely admitted that he isnt an expert in this field, who actually is I really dont know!) and a dietician who wants her to consume a healthy diet with plenty of carbs! Laughable I know...

So what now..... Where do I go from here? I will avidly follow any advice you can offer. Englands NHS sucks.... lol

Sharon x

oops entered my reply twice in error..... see above for my response...x

I agree with the other posters also. I think it's a good idea to pick a controlled carb plan that resonates with you and then just do it by the book. Even though I've read all of them and personally follow one like England's Groves, a newer book that's one of the simplest ever is The Leptin Diet by Richards. So simple. Just five rules. It would be a good start coming from SAD and if it doesn't make a dent you can get more technical as you learn more about controlled carb.

Any controlled carb plan, it will help with the fatigue, the hormones, the cholesterol, the triglycerides, the skin issues, the overweight - they are all effects of too high insulin all day.

What is she eating now? Is she eager to make diet changes?

If she's carb addicted another good book for effective family-wide changes is DesMaisons' Little Sugar Addicts. It teaches about the biochemistry and takes the shame out of eating behavior so families actually enjoy learning about and putting to use some new understandings. My two teenage DDs did, and we now talk about overweight and issues like that with interest and compassion instead of frustration and shame.

5 Rules below...

--------------

She is eating modest portions 3 times a day consisting of porridge at breakfast or eggs. lunch we struggle for ideas & tea time is veg, lean meat, small baked potato, or small portion of pasta/rice - (she is 15 years old now, but since she was 12 years was only ever eating one meal a day in the evening because eating breakfast and dinner was piling on even more weight rapidly!).

Her meals are now lower in carbs, but I really could do with knowing just how many carbs she should be consumin in a day (how many ~ breakfast, lunch and Tea time?) for it to reduce the effects of AN and to also help her lose weight....

Am I looking at Carbs or just the Carbohydrates of which sugars??? It all gets so confusing.... I have only ever done Weight Watchers and concentrated on saturated fats, so should I be counting points and fitting in 'x' amount of carbs a day within this sort of program? or do I totally ditch the idea of Weight watchers pointing combined with carb counting????

We really need to sort her out (especially her fatigue) as she hasnt been to school since May 2009 and she is in her final year 11 of english schooling....(and failing in her grades because of it)...

Well if it makes you feel any better the nutritionists and doctors in Canada are just as uneducated in the benefits of low carb eating. I am not a doctor or nurse and I have never heard of AN before ... so please take my opinion with a grain of salt.

I would recommend low carb for you daughter, not just low GI. I would also suggest eliminating all grains and dairy for a period of a few weeks if she can - grains and dairy often cause inflamation in the digestive track and it seems her body has enough to deal with right now so easing up on these two will give her body a chance to recoupe a bit, even if she can't fathome going forever without them. Eating high fat is essential to eating low carb because you don't really want excess protien - the body converts excess protien to sugar. Aim to replace carbs with fat.

There are also some suppliments that she can take that may help normalize blood sugars - if she's on other medication you may want to research or talk with a doctor on possible side effects of the combinations with her existing medications. She should take these with food.

Chromium (500-1000mcg)
Vanadyl sulfate (30 - 60mg)
Lipoic acid (300-600 mg)
CoQ10 (90 - 180 mg)
Biotin (7.5 - 15 mg)
Inositol (800-1600 mg)
Zinc (90 - 180 mg)
Niacinamide (300 - 600 mg)
Magnesium (300-600 mg)
Selenium (100-200 mcg)
B vitamin full spectrum complex

Best of luck!

The less the better. If a person is not insulin resistant she can withstand a certain amount of carbs, but as some here have testified, when you become severely resistant and overweight, you pretty much have to treat carbs as the bad guy all around.

Best way to reduce her temptation is to get the carbs out of the house. If you avoid them too then she knows that you practice what you preach and is more likely to follow the plan. besides, what is good for her is good for you too

I'd suggest eliminating anything that looks like a carb (bread, pasta, rice, crackers, cookies, etc). For example, she could have bacon and eggs for breakfast. A nice salad with chicen and cheese (maybe a chicken ceasar or something - watch the salad dressings for sugar though) for lunch, or maybe some chicken wings if they are not breaded, and for dinner a nice steak with some veggies. She should not be hungry, and be encouraged to eat if she feels deprived. As long as she's eating meat, cheese, and veggies she should be avoiding any major insulin responses. And yes, totally ditch the idea of calorie counting - she'll lose weight without having to do that. It's only once people get close to their goal weight that they may have to consider calories.

If she's missing the feeling of 'breads' there are some good recipies on this site. I eat the flax muffins almost daily.

The biggest concern right now should be stabilizing her blood sugars, not losing weight ... weight loss will come with this eatting style though, but please ensure she understands the most important thing is to avoid an insulin response from food.

If she doesn't eat enough or ends up with low blood sugar (hypoglycemia) give her about 5 M&M's (no more, no less) and wait 15 minutes. Orange juice is often given, but it's not a good idea because that will cause a huge insulin reaction putting her back on the roller coaster.

Well I would say yes, totally ditch the idea of WW points combined with carb counting. WW points are all about keeping the fat low - with higher points allocated to low and no fat items regardless of what they may be. They still are stuck in the totally exploded mindset that low fat is healthy for you.

Any items acceptable for low carb would probably have so high a WW point value that it would be hard to get enough to eat in a day and still stay within any sort of "official" WW point limit.

As to number of carbs? Best idea is to pick a plain and read the book, as different plans allocate different numbers of carbs. Seejay mentioned Barry Groves's plan which I think is a good one also, and it is a higher carb than many others, such as Atkins - though still quite low compared to most people's standard diets. If you want to get some info about Barry's ideas you can check out his website at: ttp://www.second-opinions.co.uk/

Of course Atkins is perennially popular here. Other people do Protein Power, South Beach, paleo-style eating. They are restrict and allow different things so it's probably easiest to review them and pick one that seems best to you and give it a go.

You can go here http://forum.lowcarber.org/forumdisplay.php?f=68 to find write-ups of many of the popular plans.

Bit worried about the reply to eating high fat... I dont want her to have clogged up arteries & high cholestral too....

We do eat healthy and the rest of the family do not suffer weight problems not even slightly (neither do my 3 other children). As a family we have always eaten low fat foods, sugar free drinks and have only ever eaten wholemeal breads, pasta, basmati rice etc. (My dad was an early vegetarian health fanatic so I know a balanced meal from experience). We never did have masses of junk and dont go for bought processed meals, we cooked from scratch (unlike many of her friends), so we could never understand why she has this condition. She must have been born with this condition because from day 1 she has always struggled with her weight & has nearly always had a dirty neck.... My husbands mother was type II diabetic & so was my mother so I can only think that she inherited it through them... So is low fat & low carb (how ever many grams a day what do you think) the way to go then?

I updated my last reply before seeing your next replies... Looks like low carb is the way to go. I shall have a good look at ttp://www.second-opinions.co.uk/ and the books, links that youve suggested. Thankyou all.
Any more info is very much appreciated. xx

Definitely not!!!

Low carb, yes. Low fat, no! Oh, so much a no!

Dietary fat does not cause high cholesteral or type 2 diabeties - this is the greatest falacy of the modern world! In fact, dietary fat is necessary and good for us - even saturated fat is good for us. I suggest you read the book Good Calories, Bad Calories by Gary Taubes - it will be an eye opener for you. Please don't try to do low carb and low fat!

Type 2 Diabeties is is 100% enviornmentally causes so even though you thought your relatives were healthy, they were victoms of too much carbohydrate.

It's certainly very possible your daughter has a metabolism very different from the rest of the family. Your diet as you describe may indeed work for the rest of the family but is about the worst possible thing you could give someone suffering from insulin resistence.

Of course this is a bit of pain if it means having to prepare two different meals, and singling out your daughter as being the different one from the rest of the family. But things like "wholemeal breads, pasta, basmati rice" are deadly for someone suffering from severe insulin resistance and possibly related syndromes. Your daughter just may have been the unlucky one in the genetic sweepstakes.

Certainly if *I* were to eat a diet such as the one you describe I would probably be shortly back up to almost 400 pounds and/or dead from diabetes complications - yet it's quite similar to the one my sister follows and remains skinny on