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Type 2 Diabetes in Children

Definition :
Type 2 diabetes was once a condition confined to adults. But type 2 diabetes in children is on the rise, fueled largely by the current obesity epidemic. This increasingly common condition presents special challenges for parents and children alike.

Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose). Type 2 diabetes in children develops when a child's body becomes resistant to the effects of insulin — a hormone that regulates the absorption of sugar into cells — or when a child's pancreas produces some, but not enough, insulin to maintain a normal blood sugar level. Prediabetes, a precursor to type 2 diabetes, also is a concern. Left untreated, prediabetes can progress to type 2 diabetes.

Type 1 diabetes is a similar condition in which the pancreas produces little or no insulin.

There's no cure for type 2 diabetes in children, but there's plenty you can do to help your child manage — or prevent — the condition. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If diet and exercise aren't enough, your child may need oral medication or insulin treatment to manage his or her blood sugar.

Causes :
To understand type 2 diabetes in children, first you must understand how glucose is normally processed in the body.

Glucose is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: the food your child eats and your child's liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The hormone insulin comes from the pancreas, a gland located just behind the stomach. When your child eats, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your child's cells. Insulin lowers the amount of sugar in your child's bloodstream. As your child's blood sugar level drops, so does the secretion of insulin from the pancreas.

The liver acts as a glucose storage and manufacturing center. When your child's insulin levels are low — when your child hasn't eaten in a while, for example — the liver releases the stored glucose to keep your child's glucose level within a normal range.

In type 2 diabetes, this process works improperly. Instead of moving into your child's cells, sugar builds up in his or her bloodstream. This occurs when your child's pancreas doesn't make enough insulin or your child's cells become resistant to the action of insulin. Exactly why this happens is uncertain, although excess weight and inactivity seem to be important factors.

Risk Factor :
Researchers don't fully understand why some children develop type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including :

  • Weight. Being overweight is a primary risk factor for type 2 diabetes in children. The more fatty tissue a child has, the more resistant his or her cells become to insulin. The good news is that many children who have type 2 diabetes can improve their blood sugar levels simply by losing excess weight.
  • Inactivity. The less active your child is, the greater his or her risk of type 2 diabetes. Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more sensitive to insulin.
  • Family history. The risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes — but it's difficult to tell if this is related to lifestyle, genetics or both.
  • Race. Although it's unclear why, children of certain races — especially blacks, Hispanics, American Indians and Asians — are more likely to develop type 2 diabetes.

When to seek medical advice :
To diagnose type 2 diabetes before it does serious damage, diabetes screening is recommended for all children and adolescents at high risk of type 2 diabetes, even if they have no signs or symptoms of the condition.

Consult your child's doctor if you're concerned about diabetes or if you notice any of the signs or symptoms of type 2 diabetes — increased thirst and frequent urination, extreme hunger, weight loss, blurred vision, fatigue, slow-healing sores or frequent infections.

If your child is diagnosed with type 2 diabetes, he or she will need close medical follow-up. At first, your child may need weekly or even daily visits until his or her blood sugar stabilizes. Then checkups may be recommended every few months. A thorough yearly exam and regular eye exams also are important.

Symptoms :
Type 2 diabetes in children often develops gradually. Some children who have type 2 diabetes have no signs or symptoms. Others experience :

  • Increased thirst and frequent urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
  • Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become depleted for energy. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight. Without the energy sugar supplies, muscle tissues and fat stores simply shrink.
  • Fatigue. If your child's cells are deprived of sugar, he or she may become tired and irritable.
  • Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.
  • Slow-healing sores or frequent infections. Type 2 diabetes affects your child's ability to heal and resist infections.

Some children who have type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.

Diagnosis :
If your child's doctor suspects diabetes, he or she will recommend a screening test. Various blood tests can be used to screen for diabetes, including :

  • Random blood sugar test. A blood sample will be taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.
  • Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes, which indicates a high risk of developing diabetes. If it's 126 mg/dL or higher on two separate tests, your child will be diagnosed with diabetes.

If your child is diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which may require different treatment strategies. Type 1 diabetes is characterized by the need for insulin treatment. It often develops at a younger age than does type 2 diabetes. Type 2 diabetes, on the other hand, is more common in children who are obese. Sometimes type 2 diabetes can be managed without insulin treatment.

Complications :
Type 2 diabetes can be easy to ignore, especially in the early stages when your child is feeling fine. But type 2 diabetes must be taken seriously. The condition can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. Keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Short-term complications
Short-term complications of type 2 diabetes require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).

  • Low blood sugar (hypoglycemia). If your child's blood sugar level drops below his or her target range, it's known as low blood sugar. Your child's blood sugar level can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Watch for early signs and symptoms of low blood sugar, including sweating, shakiness, weakness, hunger, dizziness and nausea. Later signs and symptoms include slurred speech, drowsiness and confusion.

    If your child develops hypoglycemia during the night, he or she might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

    If your child has signs or symptoms of low blood sugar, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. If your child loses consciousness, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood.

  • High blood sugar (hyperglycemia). Likewise, your child's blood sugar can rise for many reasons, including eating too much, not taking enough insulin or illness. Watch for frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is dangerously high, call your child's doctor right away or seek emergency care.
  • Increased ketones in your child's urine (diabetic ketoacidosis). If your child's cells are starved for energy, your child's body may begin to break down fat — producing toxic acids known as ketones. Watch for loss of appetite, nausea, vomiting, fever, stomach pain and a sweet, fruity smell on your child's breath. If you suspect ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit. If your child has excess ketones in his or her urine, call your child's doctor right away or seek emergency care.

Long-term complications
Long-term complications of type 2 diabetes develop gradually. The earlier your child develops diabetes — and the less controlled your child's blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.

  • Heart and blood vessel disease. Diabetes dramatically increases your child's risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your child's nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and over a period of months or years gradually spreads upward. Left untreated, your child could lose all sense of feeling in the affected limbs.
  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your child's blood. Diabetes can damage this delicate filtering system. The earlier diabetes develops, the greater the concern. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy). Diabetes can also lead to cataracts and a greater risk of glaucoma. By adulthood, diabetes is a leading cause of blindness.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections.
  • Skin conditions. Diabetes may leave your child more susceptible to skin problems, including bacterial infections, fungal infections and itching.
  • Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your child's risk of osteoporosis as an adult.

Treatment for type 2 diabetes is a lifelong commitment of blood sugar monitoring, healthy eating, regular exercise and, sometimes, insulin or other medications — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan.

If managing your child's diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your child's blood sugar level as close to normal as possible.

Blood sugar monitoring
Depending on your child's treatment plan, you may need to check and record your child's blood sugar up to several times a day. This requires frequent finger sticks. But it's the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes.

Even if your child eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to:

  • Food. What and how much your child eats will affect your child's blood sugar level. Blood sugar is typically highest one to two hours after a meal.
  • Physical activity. Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level.
  • Medication. Any medications your child takes may affect his or her blood sugar level, sometimes requiring changes in your child's diabetes treatment plan.
  • Illness. During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level.

In addition to frequent blood sugar monitoring, your child's doctor may recommend regular glycated hemoglobin (A1C) testing. This blood test indicates your child's average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your child's blood sugar levels, the more hemoglobin he or she will have with sugar attached. Your child's target A1C goal may vary depending on his or her age and various other factors.

Compared with repeated daily blood sugar tests, A1C testing better indicates how well your child's diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your child's treatment plan.

Healthy eating
Contrary to popular perception, there's no diabetes diet. Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your child's meal plan.

Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle. Once you've covered the basics, remember the importance of consistency. To keep your child's blood sugar on an even keel, encourage your child to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

Physical activity
Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. Encourage your child to get regular physical activity. Sign up for a sports team or dance lessons. Better yet, get in the act together. Play catch in the backyard. Take a walk — or race! — through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine.

Remember that physical activity lowers blood sugar. If your child needs insulin treatment, check your child's blood sugar level before any activity. He or she might need a snack before exercising to help prevent low blood sugar.

Insulin and other medications
Some children who have type 2 diabetes can control their blood sugar with diet and exercise alone, but many also need oral medication or insulin treatment.

Metformin is the only oral medication that's approved for children and adolescents (age 10 and older) who have type 2 diabetes. Metformin reduces the amount of sugar a child's liver releases into the bloodstream between meals. Although the drug is effective, some brands are only for use in adults. Side effects may include nausea, upset stomach, diarrhea and, rarely, a harmful buildup of lactic acid (lactic acidosis). Metformin isn't safe for anyone who has liver, kidney or heart failure.

Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.

An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Examples include regular insulin (Humulin R, Novolin R, others), NPH insulin (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog) and insulin glargine (Lantus). Depending on your child's needs, the doctor may prescribe a mixture of insulin types to use throughout the day and night.

Inhaled insulin (Exubera) hasn't been approved for children.

The decision about which treatment is best depends on the child, his or her blood sugar level and the presence of any other health problems.

Healthy lifestyle choices can help prevent type 2 diabetes in children. Encourage your child to:

  • Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
  • Get more physical activity. Encourage your child to get active. Sign up for a sports team or dance lessons, or look for active things to do together.
  • Lose excess pounds. Help your child make permanent changes in his or her eating and exercise habits.

Better yet, make it a family affair. The same lifestyle choices that can help prevent type 2 diabetes in children can do the same for adults.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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