Diabetes 2

Our Young at Risk

If you have type 2 diabetes, your child, grandchild, niece, or nephew might be at increased risk for type 2 as well.

An alarming “epidemic” is striking Americans. And it’s costing our nation billions of dollars every year. More important, it’s devastating the lives of many of our young people and robbing them of their health and well-being.
The culprit: type 2 diabetes. Formerly considered a disease of older people, type 2 is now being diagnosed in the young in unprecedented numbers.
Type 2 diabetes occurs when the body’s cells cannot respond normally to a hormone called insulin (insulin resistance). It also occurs when the body cannot make as much insulin as it needs (insulin deficiency). Both genetic and environmental factors can lead to insulin resistance and insulin deficiency.

Genetic Factors

Although scientists are still looking for the exact genes that cause type 2 diabetes, we know that some people do have certain genes that put them at higher risk. If you have type 2 diabetes yourself, your child, grandchild, niece, or nephew also has a greater-than-usual risk of becoming a victim of the type 2 diabetes “epidemic.”
Clearly, there is not much we can do about the genetic factors except to pay close attention to the health of high-risk children. But we can control some of the environmenlal factors.

Environment

It’s well known that adults who eat too much and are not physically active are courting type 2 diabetes. Unfortunately, the same applies to children. Being a couch potato is not healthy for anyone. As a physician, I would say that such people are not in energy balance. That is, they take in more calories than they use.
That’s partly because kids and adults eat too much saturated fat, the kind found in French fries and other deep-fried foods, as well as in hamburgers and other red meats. They also consume too much simple sugar (carbohydrate), the kind found in candy, cakes, donuts, and regular sodas. In fact, they eat too many high-calorie, low-nutrient foods in general, such as potato and corn chips or other high-fat snacks. And they consume unhealthy food portions. Just look at the super-sized sandwiches served at fast-food chains!
Yet children don’t use up all those extra calories by being physically active. With the sharp rise in computer and Internet games, as well as the hours spent in front of the TV, too many of today’s kids have abandoned the playground and the athletic field.

Risk Factors

In addition to having a family member with type 2 diabetes, the following characteristics put children and teens at higher-than-average risk for type 2 diabetes:
• Being overweight. Children at or above the 85th percentile of the body mass index (BMI) are considered to be at risk for overweight. Children above the 95th percentile are considered overweight. (BMI is a measure of body fat based on height and weight. Click here to calculate your BMI)
• Gioing through puberty. Children who are in the midst of puberty and who are developing and growing seem to be at highest risk.
• Being in a particular ethnnic group. African Americans, Mexican Americans/Latinos, American Indians/Native Alaskans, and Asian Americans/Pacific Islanders are at highest risk.
• Having insulin resistance. Some of the signs include high blood pressure or high cholesterol or triglycerides.
Another sign of insulin resistance is a skin condition called acanthosis nigricans.This causes certain areas of the skin– generally at the neck and armpits and in areas where there are skin folds– to be darker and thicker than on other parts of the body. Skin with acanthosis nigricans looks as if it is dirty.
• Being born small or large. Children who are born small (less than five pounds) and children who are born large (greater than nine pounds) at full-term are also at higher risk. (Larger babies are generally born to women who have had gestational diabetes during pregnancy.)
• Girls who have a condition referred to as polycystic ovarian syndrome.

Symptoms And Treatment

As with adults, the symptoms of type 2 diabetes in young people include weight loss, thirst and excessive urination, fatigue, blurry vision, infections (including vaginal infections in girls), and sores that do not heal.

It’s likely that a young person diagnosed with type 2 diabete will be treated with insulin injections or with the diabetes pill called metformin. Although these are the only diabetes medicines presently approved for use in our younger population, studies are under way to determine if other diabetes pills may also be effective in children and teens. Young people with type 2 may also need to take medicine for their blood pressure and cholesterol.
Of course, it’s vital that kids with type 2 diabetes eat healthier, consume fewer fatty foods, increase their activity levels, and get down to a healthy weight if they are overweight.
But why wait for type 2 diabetes to develop? It’s so much better to prevent it in the first place by encouraging and enabling kids to adopt healthy habits as early and as quickly as possible.
What more precious gift could you give to a child you love?

Preventing type 2 diabetes in young people

As with adults, the most important way to prevent type 2 diabetes in young people is to exchange an unhealthy lifestyle for a healthy one.
It’s no coincidence that the epidemic of type 2 diabetes in children and youth mirrors the sharp rise in weight in these age groups. Today, as many as 15 to 20 percent of America’s teens are at risk for being overweight or are overweight. This is a startling and significant number.
To prevent this, we must feed our children healthy foods in appropriate amounts and get them to be more active.
If you have diabetes, show your children, nieces, nephews, and grandchildren that you are eating right, exercising, checking your blood sugar,taking your medicine, and taking as good care of yourself as possible.

Schools And Communities

We should not allow foods loaded with calories and fat to be available in the school setting, no matter what the school’s financial gain may be. We must also not allow sugar-sweetened sodas to be sold in our schools. Every food item sold in school should meet minimum nutritional requirements in order to ensure that it is good for our children.
Schools should also reinstate vigorous physical education programs for all children. We also need places in the community where children- and their families- can exercise safely.
It’s important for all of us to promote the principles of good health– exercise and good nutrition– throughout the country, from the fast-food industry to Madison Avenue to Hollywood.
We must work together to put an end to the rise of this devastating disease in our children.

from Diabetes Forecast
October 2003
by Francine R. Kaufman, MD

Francine R. Kaufinan MD has been an active volunteer with the American Diabetes Association since 1978 and is immediate past president of the Association. She is also professor of pediatrics, The Keck School of Medicine of USC, and the head of The Center for Diabetes, Endocrinology and Metabolism, Childrens Hospital Los Angeles.