Should I have known? If I had seen these signs of insulin resistance earlier would have made it impact? Was I blind, oblivious, or in denial about what was happening to my child?
My husband is muscular and my daughter Sprout is muscular. I always assumed her elevated BMI was because she was on the lower side in height, with a very muscular build for a child. It was not until insulin related acne started at nine and the weight began to gain centralized to her stomach that I considered she may have something going on to be concerned about. I did not see the seriousness in this until it smacked us in the face with blood test proof and new doctor concerns. Looking back, there were more Insulin Resistance symptoms at an earlier age that I just did not connect. Many parents do not see their child as overweight, despite what the growth charts and BMI say.
Forgive yourself for not knowing what you didn't know before you learned it.
In addition to shorter stature and higher BMI percentile for their age, many symptoms in children are actually quite hidden until children hit a puberty age. The signs that occur early may seem separate and unconnected, not pieces of a bigger puzzle.
Most people think insulin resistance is just a lead up to blood sugar issues, but really it can affect so many bodily systems and can be disguised as completely unrelated ailments and anomalies. Some of these symptoms have a widely known connection to IR and others are more obscure. Here is what I wish I had known then, organized by the age you are most likely to first notice them.
Earlier than you think
SECTION 1: TODDLER TO EARLY CHILDHOOD (Ages 2–7)
Symptoms most parents miss at this age because insulin resistance "isn't supposed to happen yet"
This is probably the most difficult time to recognize declining insulin sensitivity. It is easy to write off symptoms as normal growth or separate; All toddlers have pot bellies. Almost all kids get like twelve colds a year when in daycare, right? Isn't my kids’ stomachache a façade to get out of eating the broccoli on their plate? The symptoms are easy to explain away, and nobody is looking for insulin resistance in a five-year-old. I was not either. I was just trying to get through the week.
WELL-KNOWN SYMPTOMS:
Abdominal Weight Gain: Not all overweight gain, rather centralized around the belly.
Frequent Illness / Slow Recovery: Getting sick more than peers and taking longer to bounce back
LESSER-KNOWN SYMPTOMS:
Recurring Stomach Aches: Chronic stomach discomfort without a clear cause.
Yeast / Fungal Overgrowth in Skin Folds: Recurring yeast that keeps coming back despite treatment.
Bedwetting Recurrence: A previously dry child beginning to wet the bed again.
Night Terrors / Disrupted Sleep: Nighttime waking or terrors without obvious cause.
Shorter Stature Than Expected: Consistently tracking below what you would expect given your family's height.
Middle years
SECTION 2: MIDDLE CHILDHOOD (Ages 7–10)
The window where metabolic patterns begin showing up physically, often mistaken for "just growing"
This is the window where things became more impossible to ignore. Sprout never had Acanthosis Nigricans (darkened patches of skin) or skin tags like many children do. What I did not realize then is that not all children with insulin resistance present the same way or have the same cluster of symptoms. The absence of the most well-known symptoms doesn't mean the others don't count. These other middle school signs show up as a child that eats dinner but is starving an hour later. The kids whose mood crashes out completely disproportionately, the kids who can’t focus.
Wait… isn't this any teenager? See, this goes to show why this is just so hard to connect these dots.
WELL-KNOWN SYMPTOMS:
Acanthosis Nigricans: Dark, velvety skin patches on the neck, armpits, or groin that won't wash off.
Skin Tags: Small soft growths appearing in the same areas as the dark skin patches.
Insatiable Hunger: Finishing a full meal and feeling ravenous again shortly after.
Intense Sugar and Carb Cravings: A Compulsive drive toward sugar and starchy foods beyond normal preference.
Energy Crashes and Fatigue: Exhaustion after meals or low energy throughout the day.
LESSER-KNOWN SYMPTOMS:
Shakiness or Feeling Faint Between Meals: Trembling, sweating, or lightheadedness before the next meal arrives.
Recurring Boils or Skin Infections: Boils or bacterial Skin infections that keep coming back without clear cause.
Difficulty Concentrating / Brain Fog: Trouble focusing at school, poor memory, and persistent mental sluggishness.
Mood Swings and Emotional Dysregulation: Emotional outbursts or crashes that seem widely out of proportion to the trigger.
Early Puberty Signs: Puberty body changes, body odor, or hair arriving earlier than expected.
When Puberty Hits
SECTION 3: PRETEEN / PUBERTY ONSET (Ages 10–13)
Where insulin resistance and hormonal changes amplify each other…and where most kids finally get a diagnosis, often years too late
Most parents don't know that puberty itself causes a natural temporary drop in insulin sensitivity. In children who already have insulin resistance, puberty doesn't just amplify the symptoms, it can accelerate them significantly. This is the age where kids may get a diagnosis, but they may have been symptomatic for years. This is a tough time- The feeling of sitting in the doctor's office being handed advice that does not always account for the reality of feeding an eleven-year-old who has opinions about dinner before you have even fired up the stove. If you are in this phase, you are not alone.
WELL-KNOWN SYMPTOMS:
Persistent Acne Resistant to Treatment: Early or severe acne that doesn't respond to typical treatments.
Elevated Fasting Insulin (Lab): Insulin levels above normal range on a fasting blood draw- a test you have to specifically request.
Prediabetic Blood Glucose Range (Lab): Blood sugar trending in the wrong direction, but not diabetes.
LESSER-KNOWN SYMPTOMS:
Excess Hair Growth in Male Patterns in Girls: Unexpected hair appearing on the chin, upper lip, abdomen, or inner thighs.
Irregular or Painful Periods: Cycles that are heavy, erratic, or brutally painful from the start.
Elevated Cholesterol or Triglycerides (Lab): A lipid panel showing high triglycerides or low HDL.
Thyroid Dysfunction (Lab): Low or sluggish thyroid function.
Stretch Marks without significant weight change: Stretch marks appearing on the hips, thighs, or abdomen without major weight gain.
Whether your intuition is tugging on you, a doctor's visit raised flags, or you are just now connecting the dots about symptoms that are not resolving, know that even doctors may miss the signs.Your next step is to ensure that your child is receiving a full metabolic work up including Insulin levels- not just glucose. In-office glucose tests such as A1C, and fasting glucose tests may not show insulin resistance.
You are catching this at an early age where insulin levels are high and are not 'unlocking' the cells to shuttle in glucose. It is early enough that your child may not have full dysfunction, so the warning sign is the high insulin itself. Just know that wherever you catch the progression of this disorder, you are here now working for your child and that matters.
Keep following along or subscribe as we dive into this topic more fully in the future and explore what we can do about this now.
Until next time,
Sherry
Key references include ADA Standards of Care 2025, Frontiers in Endocrinology, and Life Pediatric Endocrinology.