insatiable hunger

[NAMEJS]

Could my almost five-year old have a endocrinological problem?  She was born at 9.5 lbs and I am a type 1 diabetic.  She has always been pretty hungry but over the past year her hunger has sky rocketed.  She is given healthy snacks and meals but her hunger seems to be insatiable.  She will eat, and eat and eat....we demand that she stop and tell her she has had enough.  She cries, stating she is still hungry and has even tried to sneak more food.  I would like to rule out any physical/medical problem but don't know where to turn.  Her pediatrician simply recommends portion control, nutritious food.  The problem is beyond this though.  She REALLY seems to be hungry.  Please advise.  She is overweight (70 lbs at 4 years, 11 months) she is active and otherwise pretty healthy.  The pediatrician has checked her glucose at yearly visits and says she is ok.

[Deanna L Aftab Guy, MD]

Sometimes it is a viscious cycle, the heavier a child is the more insulin they make and the more hunger signal this causes and the heavier they get due to eating and insulin. So she may indeed have a genetic component on top of environmental influence. I would start with a good nutritionist, find out how to feed her rather than restrict, she may indeed need 2-3 snacks a day between meals, low carb and high fiber and higher protein and much much more water, take away sugared sodas, juice entirely(except hidden for your lows), and no more simple carbs-only higher fiber cereals, breads, brown rice, sweet potatoes instead of white ones, whole wheat pasta instead of regular, and portions are key. Also get her to drink water and skim milk and feed her but lower carb as mentioned so her insulin level is not high, this will give her body what she thinks she needs and believe it or not she will burn better with healthier calories, next find an activity or two or three that she loves, get her out of the home, carry the small healthy snacks with you and water galore and time the snacks for about 2-3 hours from each meal so she is not eating large meals to make up for prolonged fasting.
I see alot of obese children and feel so badly, work really hard but if the parents cannot get involved we are in trouble(rather I am in trouble cause I cannot do it alone!)
There are unfair genes so we cannot make her a skinny mini as I tell my girls, so work with her and firstly use a goal of weight maintainence-keep her weight the same for a month at least, then with time she will grow into her weight, and be less "overweight" for age. Thyroid functions are ok to check just to be sure but I would work on activity and diet with someone qualified for kids. Hang in there, this is a hard hard problem but so important and you are trying your best.