Type 2 Diabetes in Children
Type 2 diabetes was once considered to be an adult disease, however, the diagnosis of children having type 2 diabetes is growing at an alarming rate. According to the SEARCH for Diabetes in Youth study, the prevalence of type 2 diabetes of American children, ages 10-19, rose by 35% between 2001 and 2009. As children have become less physically active, and more obese, the incidence of type 2 diabetes has increased.
Type 1 diabetes verses Type 2 diabetes:
Type 1 diabetes is an autoimmune disease in which the body does not produce insulin. It most often occurs in children and young adults. Insulin injections are required to sustain life.
Type 2 diabetes is the more common type of diabetes in which the body does not make enough insulin or does not use insulin properly (insulin resistance). Type 2 diabetes is more commonly seen in those who are overweight and inactive. Children with type 2 diabetes frequently have family history of type 2 diabetes.
Most important risk factors for type 2 diabetes:
- Obesity (obesity is the strongest predictor for developing type 2 diabetes)
- Lack of physical activity
Testing for Type 2 diabetes in children. Who should be tested?
According to the 2015 Standards of Medical Care in Diabetes, testing for type 2 diabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes. Testing should start at age 10 years or at the start of puberty (if puberty occurs at a younger age), and be repeated every 3 years.
Risk factors include:
- Family history of type 2 diabetes in first or second-degree relative
- Race/ethnicity (American Indian, African-American, Hispanic, Asian/Pacific Islander)
- Signs of insulin resistance or conditions associated with insulin resistance
- Acanthosis nigricans (areas of darkened, velvety skin discoloration in the body folds and creases, such as around the neck, armpits and groin)
- Hypertension (high blood pressure)
- Dyslipidemia (elevated LDL cholesterol and/or low HDL cholesterol)
- Polycystic ovarian syndrome (A hormone disorder causing enlarged ovaries with small cysts on the outer edges)
Pre-diabetes (there is a strong risk of developing type 2 diabetes if pre-diabetes is diagnosed)
Impaired fasting glucose: 100-125 mg/dL
Impaired glucose tolerance: 140-199 mg/dL
A1C: > 5.7-6.4 %
Fasting blood glucose: > 126 mg/dL
2-hour oral glucose tolerance test: > 200 mg/dL
Acute symptoms (see below) plus casual blood glucose: > 200 mg/dL
A1c: > 6.5 %
Signs and symptoms of Diabetes:
- Frequent urination
- Increased thirst
- Weight loss
- Frequent infections
- Blurred Vision
- Slow healing cuts
- Often times, there may be no symptoms at all (which is why it is so important to have regular visits with your doctor to perform blood lab testing)
- Lifestyle: lifestyle changes including healthier diet choices and increased physical activity is the first line of treatment.
- Oral Medication: Metformin is the only oral diabetes medication approved for children in the treatment of type 2 diabetes. Metformin acts by decreasing the livers glucose output and increasing insulin sensitivity in the liver and muscles. The most common side effect is an upset stomach. This is usually temporary. Use of Metformin may also result in some weight loss and improvement of dyslipidemia (elevated LDL cholesterol and/or low HDL cholesterol).
- Insulin: Insulin injections may be needed at initial diagnosis if ketosis (excessive amounts of ketone bodies in the blood, which are formed when fat is used for energy) is present. Insulin may also be necessary if A1c is above target goal of >7.5 % after 3-6 months of being on Metformin.
Lifestyle modifications that help promote healthy weight and may reduce the risk for type 2 diabetes:
- Physical activity
- Children and adolescents should be physically active for at least 60 minutes each day
- Plan family activities, such as a bike ride or a game of Frisbee as the park
- Behavior modification
- Decrease screen time. TV, computer and video game time should be less than 2 hours per day
- Avoid eating in front of TV
- Plan family meals
- Diet changes
- Eliminate sweetened beverages
- Water and low fat milk are healthier choices than regular pop and juice drinks
- Avoid excessive intake of diet beverages
- Eat out less often
- To save time, and avoid the temptation of going out for fast food, try preparing meals for the week on a Sunday
- If you do go out to eat, avoid fried foods, share a meal, or ask for a to go container so you can take ½ of your meal home
- Increase fiber
- Recommended fiber amount for children is their age plus 5 (i.e. a 10 year old child should aim to have 15 grams of fiber per day)
- Increase fruit and vegetable intake. Aim for 5 servings per day
- Bring lunch to school instead of buying school lunch
- Use nutrition labels as a tool to help with portion control. For example instead of pouring a bowl full of cereal, measure out a single serving using household measuring cups
- Eliminate sweetened beverages