Type 2 Diabetes

The Challenge of Type 2 Diabetes in Children

If you think back to when you were in grade school you might remember a fellow student who had diabetes. It seemed a rather mysterious condition—one that required him or her to get insulin shots and that necessitated the occasional cup of orange juice or trip to the nurse’s office. What this scenario brings to mind is type 1 diabetes, which is thought to be an autoimmune disease. Type 1 diabetes was formerly known as “juvenile-onset diabetes” and used to be the kind of diabetes associated with childhood. Today, however, the Centers for Disease Control and Prevention (CDC) reports type 2 diabetes is rapidly increasing among children and adolescents. In fact, type 2 diabetes, which used to be called “adult-onset diabetes,” is so prevalent among youngsters that it is no longer referred to as adult-onset diabetes.

According to the American Academy of Pediatrics, research shows that in 1990 less than 4 percent of children newly diagnosed with diabetes were type 2. Now, 30 to 50 percent of children newly diagnosed with diabetes have type 2 diabetes. Why is this disease affecting our kids and what can be done? To better understand the issue, it helps to have some background on what type 2 diabetes is as well as its causes.

Type 2 Diabetes Defined

After your body digests food, the final product used by the body for fuel is glucose (sugar). Insulin allows the body to turn the glucose that comes from food into energy. The American Diabetes Association defines type 1 diabetes as a metabolic condition resulting from the body’s inability to make insulin. This condition is thought to occur when the body attacks its own pancreatic cells, which make insulin. In type 2 diabetes either the body does not produce enough insulin or it is unable to properly use the insulin that it produces. When the body cannot respond to insulin, glucose builds up in the blood.

The longer a person has diabetes, the greater the chance he or she will develop one or more serious complications of this disease, including blindness, heart disease, and stroke. Frank Vinicor, MD, director of the CDC’s diabetes program says, “An increase in type 2 diabetes in young people means that we are going to have more people—adults and children—with diabetes. Also, they will have it for a longer time, which increases the rate of severe complications like blindness, renal failure, and amputations.” According to diabetes researchers, some teenagers are already developing complications from type 2 diabetes.

Type 2 diabetes usually begins with a condition called insulin resistance, a disorder in which the cells do not use insulin properly. To make up for this inefficiency, the pancreas produces additional insulin. Eventually, the pancreas is unable to keep up and blood sugar levels rise. Impaired glucose tolerance (IGT) is considered a prediabetic condition in which the blood sugar level is elevated, but is not high enough to be classified as diabetes. Research indicates that IGT may be reversible through diet and exercise.

How Do You Detect Type 2 Diabetes?

Caffeine’s Effect on Insulin
Does Caffeine Affect Insulin Sensitivity?
During the past few years a few studies have looked at the potential link between caffeine consumption and changes in the way in which the body responds to insulin. Although it has been found that caffeine consumption may reduce insulin sensitivity in humans (one study found reductions in insulin sensitivity following a relatively high intravenous—rather than oral—administration of caffeine), the physiological significance of this effect remains unclear. Additional research is required before any conclusions can be reached regarding caffeine’s impact on insulin sensitivity.

Type 2 diabetes can be difficult to detect in children because they may have very mild or no symptoms. For example, a recent study of children and prediabetes published in the New England Journal of Medicine (NEJM), found that 4 of the 112 obese adolescents in the study had silent type 2 diabetes, a form that doesn’t cause any symptoms. Knowing that diabetes diagnosis in children can be difficult, experts are working to define accurate diagnostic measures and establish prevalence in the U.S. population. And, both the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) are funding clinical trials to examine ways to prevent and treat diabetes in children.

As difficult as they may be to detect, symptoms and risk factors play a key role in diagnosing type 2 diabetes in children. Some symptoms include excessive thirst, frequent urination, tiredness or lack of energy, and acanthans nigrans (darkening of the skin between the fingers and toes and near the shoulder blades). Exhibiting just one of these symptoms does not mean that a child has type 2 diabetes, but a visit to the doctor may be in order.

In addition to the symptoms mentioned above, there are a number of risk factors for type 2 diabetes in children:

  • Overweight
  • Older than 10 years of age and in middle-to-late puberty (although some children with type 2 diabetes are younger)
  • A family history of type 2 diabetes
  • A member of certain racial/ethnic groups (African American, Hispanic/Latino, and American Indian)

All of these factors are important; however, it is becoming clear that obesity may be the most significant. “The epidemic of childhood obesity in the U.S. is paralleled by a marked increase in the frequency of type 2 diabetes,” according to the authors of the NEJM study. In fact, the study reports that IGT was highly prevalent among the children and adolescents with severe obesity—regardless of ethnic group. Twenty-one percent of the 112 obese adolescents studied had IGT, while 25 percent of the 55 obese children studied exhibited IGT.

Controlling Type 2 Diabetes in Kids

Research studies have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among at-risk children (those with IGT or other risk factors), but these changes can be challenging to the child and to the child’s family. What’s needed is a highly motivated child and a supportive and involved family. Without this, the chance of sustaining lasting lifestyle changes is greatly reduced.

Since being overweight is a major risk factor for type 2 diabetes in children, preventing inappropriate weight gain and/or losing weight is one of the most important lifestyle changes to be made. Combining weight loss efforts with regular, moderate physical activity and physical play will increase the chance of success. Enlisting the help of a registered dietitian to assist with goal setting, meal planning, and nutrition education can also help the child and his or her family deal with the day-to-day challenges of a weight-loss program.

Ongoing scientific research is being conducted to learn about new treatment and better therapies to manage type 2 diabetes as well as prevention efforts to delay onset and early diagnosis to reduce risk for complications. On the front line, however, the fact remains that parenting or caring for a child with type 2 diabetes is not easy. The good news is that there are numerous health care professionals and organizations reaching out to communities and families with practical advice and tips on healthy eating and physical activities for children and teens with diabetes. Some of the resources listed on this page may be helpful.

Want More Information about Type 2 Diabetes and Children?

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
This branch of the National Institutes of Health offers a variety of materials for consumers via its Web site niddk.nih.gov or by mail. In addition, NIDDK is funding clinical trials to examine ways to prevent and treat type 2 diabetes in children. To get more information about the studies, go to niddk.nih.gov/research.

American Diabetes Association

Via its Web site diabetes.org you can read up on the latest scientific information on type 2 diabetes. Its magazine, Diabetes Forecast, occasionally runs articles on diabetes and children. The magazine can be accessed at www.diabetes.org/diabetesforecast. Enter “children and type 2 diabetes” into the search engine to find articles on this issue.

Centers for Disease Control and Prevention

General information and statistics about type 2 diabetes can be found on the CDC Web site, cdc.gov. Look under the heading “Health Topic: Diabetes” and select a specific topic such as Research or FAQ’s.
Children with Diabetes and the Children with Diabetes Foundation
The Children with Diabetes Web site, childrenwithdiabetes.com, is packed with chat rooms, bulletin boards, information, and fun activities for diabetic children and their families. Also included are details on the foundation’s annual conference. The foundation site, cwdfoundation.org, offers support, information, and opportunities to donate. Go online with your child and check out the “Just for Kids” section.

American Dietetic Association

The organization’s Web site, eatright.org, has a variety of materials about type 2 diabetes, but few deal specifically with children. Look under the Nutrition Fact Sheets section for the one entitled “Healthy Habits to Help Manage and Prevent Type 2 Diabetes,” which discusses ways to support a diabetic child. In addition, you can find a local registered dietitian through their site or by calling (800) 366-1655.

American Academy of Pediatrics

A wide variety of books, articles, and news can be found on the Academy’s Web site, aap.org. Start with their “Parenting Corner.” In their “AAP Publications” section you can locate the Academy’s archived information.
Reprinted from IFIC
Food Insight
January/February 2003

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