Ep. 95: 5 Signs Your Teen Has Metabolic Dysfunction—Even With “Normal” Labs

Metabolic dysfunction in teenagers is subtle. It's slow-moving. And it rarely announces itself with obvious symptoms, which means it's easy to miss until things have already been developing quietly for years.

In this episode, Dr. Jenny Gourgari, board-certified pediatric endocrinologist and obesity medicine specialist, walks you through five specific signs that may indicate your teen is experiencing insulin resistance or metabolic dysfunction, even when their routine lab work looks completely normal.

Because here's something most parents don't know: normal blood sugar does not mean normal insulin. And fasting insulin isn't even part of standard blood work. That gap is exactly why so many teens go undiagnosed for so long.

Dr. Jenny breaks down each sign in plain, parent-friendly language, what's happening in the body, why it matters, and what questions to bring to your teen's next doctor's appointment.

In this episode, you'll learn:

• Why labs can look normal while insulin resistance is already building underneath
• The 5 signs to watch for, from skin changes to mood shifts to unexplained weight gain
• Why persistent fatigue that sleep won't fix is a metabolic red flag
• How hunger patterns after meals can reveal what's happening with blood sugar
• Which lab tests to ask your doctor about, beyond just blood sugar
• Why this is not a willpower issue, and what you can actually do about it

Whether your teen has already been diagnosed with prediabetes or you simply have a gut feeling that something is off, this episode gives you the knowledge to walk into your next doctor's visit informed, prepared, and asking the right questions.

Do you worry your teen is gaining weight quickly or seems hungry all the time?
Are you afraid this could lead to prediabetes or diabetes later in life?

That’s why I created the “Healthy Weight Starts with Healthy Habits": A 7-Day Hormone Reset Program for Teens.

ONLY $25 - Learn more here !

I’m Dr. Jenny Gourgari—pediatric endocrinologist, certified in obesity medicine and a health coach. 
After helping hundreds of teens struggling with their weight and hormones, I’ve created a whole new path by doing what most programs miss: balance puberty hormones naturally and create habits that actually last.

Here's what makes this different:
✅ No dieting. No calorie counting. No shame.
✅ No more food fights between parents and teens.
✅ No weight obsession—just healthy habits
✅ Real science behind how puberty hormones affect weight
✅ A safe, supportive approach that prevents eating disorders

Because when teens understand their hormones and get the right support, they don’t just lose weight—they gain strength, energy, confidence, and freedom!

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Transcript

Metabolic dysfunction in teens is subtle. It's slow-moving, and it doesn't always show up dramatically. Today, I am gonna give you five signs to watch for so that when you sit down for the next appointment with your doctor, you walk in informed, you walk in prepared, and you are ready to ask the right questions.

I'm Dr. Jenny. I'm a board-certified pediatric endocrinologist and obesity medicine specialist, and this is exactly the kind of conversation I have with families every single week. Let's get into it.

Here's the thing about metabolic dysfunction: it doesn't always announce itself. That's what makes it easy to miss for everyone. But you, as a parent, you are watching your teen every day. You notice when something shifts, you notice when the energy changes, you notice when something just feels off. That observation is real data, and today I want to help you understand what to do with it, because the earlier we catch this, the more options we have.

That's why these conversations matter right now. Let me start by explaining what we are actually talking about, because the word metabolic gets thrown out a lot. Metabolic dysfunction means the body systems for managing energy, blood sugar, and hormones are not working as efficiently as they should. And here's the tricky part.

In the early stages, labs can look completely normal. The most common driver in teens is insulin resistance. What that means is the body's making insulin, but the cells have stopped responding to it properly. So what happens? The pancreas works harder and harder. It produces more and more insulin to try to compensate, and because of that, blood sugar can stay technically normal for years while the underlying problem is already developing underneath.

This is why stagger labs can come back reassuring while elevated insulin is quietly building up under the surface. And here's something important to know: fasting insulin is not always part of routine blood work. It isn't tested and won't be found. I want you to remember this: normal blood sugar does not mean normal insulin, does not mean no insulin resistance, and that distinction is crucial.

Now let's get into what those five signs are. You can grab a pen and write it down, or just keep watching if you're just watching on YouTube. Sign number one is dark patches on the skin. Have you ever noticed like a dark, almost velvety patch of skin on the back of your teen's neck? Or sometimes you can see this under their arms, or it can be in the skin folds around their elbows, or in the groin area. We call this acanthosis nigricans in medicine, and it's one of the most visible signs of elevated insulin levels.

What's happening is that the insulin is acting on the skin cells, and they leave this visible mark. Parents often think it's a hygiene issue. They try to scrub it off, they try to wash it, but it doesn't go away. So take a photo of this and bring it to the next appointment with your doctor. That one photo can completely change the conversation.

Now let's talk about Sign number two. Hunger that comes back quickly after a meal. If your tea needs a full meal and is hungry again an hour later, this is worth paying attention to. But here's what I want you to understand. The cause is rarely one single thing. The most common driver is actually meal composition. Highly semi-load meals think like white bread, sugary drinks, processed snacks 'cause blood sugar to rise fast and drop fast, and when it drops, hunger comes back quickly. This happens in any teen, not only those with insulin resistance. But having said that, research shows that teens that have insulin resistance can respond differently to certain meals.

So if they avoid having these high glycemic meals, and instead they have low glycemic meals, which is more protein and less carbohydrates, less refined carbohydrates, then they're not gonna have that big insulin spikes. So the meal composition matters more when you already have insulin resistance in the picture.

And also, constant hunger is not only due to insulin resistance. People who have diabetes can have constant hunger. So that's a step even further. People that have eating disorders can have constant hunger. So, how much they eat, how fast they eat, do they have other mood changes along with that? Are they craving only carbohydrates or are they craving all kinds of things? Highly semi-load meals, think like white bread, sugary drinks, processed snacks 'cause blood sugar to rise fast, and these are all things to consider when you discuss with your doctor. But hunger can sometimes be a hormone problem. It's not always a hunger hormone. It's absolutely worth investigating if. Sign number three. It is a fatigue that sleep will not fix. So we know that teenagers need at least eight to 10 hours of sleep in order to feel restored. And we know that most teenagers don't even get that much sleep, but there are teenagers who do sleep eight or nine hours, and they wake up exhausted. Now, that is not normal, and it's not just because of being a teenager; there can be something else going on. And here's the thing, there is a great relationship between fatigue and insulin resistance, that actually goes both ways. So if you're not sleeping well, that can increase your insulin resistance. And when kids don't get enough sleep, their insulin sensitivity gets worse, which means that sleep deprivation or irregular sleep can be a metabolic problem. So when you have a teen who isn't sleeping but not recovering, gaining weight, and showing other signs we're talking about today, you may be looking at this metabolic dysregulation cycle that could be at least partially due to insulin resistance, which worsens even more metabolic health, which can make the sleep even worse. So fixing the sleep is very important.

Sign number four, it's weight gain that keeps going and going up despite no clear change in eating. So what I mean by that is that your teen doesn't necessarily sneak food and doesn't necessarily lie to you when their weight keeps going up and up. Insulin is what we call an anabolic hormone.

It's a hormone that helps your body build fat. It does this by suppressing the release of fatty acids and by promoting fat synthesis in the body. So when the insulin is chronically elevated, the body is. Basically, storing fat, so they're not just gaining weight, all those teenagers with insulin resistance, they're gaining weight that resists their efforts. When they're trying to lose that fat, they eat less, they try harder, but nothing moves. So this can be a metabolic signal. It doesn't mean there is like a failure, and of course, that doesn't mean that's insulin resistant when somebody doesn't lose weight. What I'm saying is that there could be one of the reasons they could be like, maybe they are overeating, maybe they are not telling you the truth, maybe they are sneaking food when they're staying up late playing video games. I'm not saying that doesn't exist, but I'm also saying that if we know that is not the case, then that insulin resistance could explain that difficulty. And there are many factors that play a role in metabolism and fat distribution. It could be genetics, it could be sex hormones, or it could be different ages. So you are not gonna see the same pattern in every single teen. But the fact that it keeps happening and it won't reverse, then that can tell you that is worth paying attention to it, and it's at least worth investigating. If insulin is the culprit, if insulin is dysregulated, that's why the body will not break down fat, even though you are trying to do the best.

Okay, finally, it's mood changes. Now, I wanna be very careful here because I know that there's like this concept that when the insulin gets high, and then it gets low, there is this drop in the insulin. That can cause mood dysregulation, and that can happen, like a high-carb lunch can cause a mood dysregulation if you have low blood sugar.

However, true low blood sugar is not so common. So it may not be the reason for these mental health issues. However, there is a close relationship, and we know that kids who have insulin resistance are more common depression and anxiety. We know that kids with diabetes and kids with extra weight have more common anxiety and depression, and it's not just because of the weight. There is inflammation that has been associated with that, and there is metabolic dysregulation that is involved with that. And, if there are mood symptoms, that could be one reason that is related to that. Now, it can be other reasons too. Like teens can have anxiety, ADHD, eating disorders, depression, anxiety that have nothing to do with insulin resistance, right? So it's not all due to insulin resistance. But again, is this worth investigating? Yes, it is worth investigating if that is one sign that you see, particularly if from all those five signs, you don't just have one, let's say you have all five of them, right, or you have three of them. You see a pattern that is showing up again and again. Along with weight gain, fatigue, mood dysregulation, and difficulty losing weight, with regular periods in teenage girls with darkening around the skin. Those are things that would make you worry and would make you investigate more.

Now the question is, are there any labs that we can do that can help us find the answer? Because, as I mentioned earlier, just measuring the sugar and having a normal sugar level does not mean you don't have insulin resistance. You need to measure insulin, or you need to measure another test that is called hemoglobin A1C. And you can also measure cholesterol and triglycerides or do a lipid panel. That's when you can see higher triglyceride levels or higher cholesterol, which is also associated with insulin resistance. Now, there can be other hormones and can be, let's say hypothyroidism or high cholesterol, or high cortisol, that can be reasons for insulin resistance, or can be other things that can explain the symptoms of your child. And that's why it's very important that you discuss with your doctor and bring up all those concerns you have, and they can do the test. Now, also, sometimes we see liver abnormalities, so it's worth checking the liver because there's a liver inflammation, from insulin resistance and from weight gain, and sometimes you can have abnormal liver function tests.

So if you see multiple signs or at least two of the signs, you can discuss with your doctor. Is worth investigating whether my child has insulin resistance or pre-diabetes, and should we test for it, and your doctor will know what to do. You just bring up the information, you just bring up your concerns, and then you take it from there. Especially if their skin changes, I would say that's one of the strongest signs is if you have this darkening of the skin around the neck that I discussed. If you want more specific information, you can also go and see a pediatric endocrinologist. They can do more in a thorough evaluation, and you can start with the intervention. It's about giving your doctors the right information so they can put the things together and help you the right way.

As a pediatric endocrinologist, I've seen a lot of kids that come to me with insulin resistance, pre-diabetes, and, unfortunately, some with diabetes. So if nothing happens, the progression of insulin resistance is to pre-diabetes.

The progression of pre-diabetes is to diabetes, but thankfully, there can be almost 30 to 50% of teenagers that can reverse back to normal. So I don't want you to feel discouraged. If you have a new diagnosis of prediabetes of insulin resistance after you do the metabolic workup, just know that this is not a willpower issue. You can take the right steps and then fix that metabolic problem.

Now, the first thing is getting informed, and I hope this video was helpful to help you understand. Now, if you wanna learn more, I have a free resource. You can go to my lifestyleforteens.com and look on free resources. You'll find a link there about what to do when your kid has been diagnosed with prediabetes or insulin resistance. I also have some other free resources. I have some recipes that can help with insulin resistance, and also, I have developed a seven-day hormone reset program just to start the process of your teen and reverse this progression to diabetes.

And the fact that you watch this means that you are already ahead. You're doing great progress. You don't need to be devastated by any of this. This is all good news. This is reversible, and don't give up, be consistent, do small changes. That brings big results over time. Most people give up because they don't get the results right away, but this requires patience, persistence, and somebody to support you along the line.

I'll talk to you next week. Take care.