Type 2 diabetes in children
Type 2 diabetes in children
Type 2 diabetes in children is a chronic condition that affects the way your child's body metabolizes sugar (glucose).
Type 2 diabetes is a disease more commonly associated with adults. In fact, it used to be called adult-onset diabetes. But type 2 diabetes in children is on the rise, fueled largely by the obesity epidemic.
There's plenty you can do to help manage or prevent type 2 diabetes in children. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If diet and exercise aren't enough to control type 2 diabetes in children, oral medication or insulin treatment may be needed.
Type 2 diabetes in children may develop gradually. Some children who have type 2 diabetes have no signs or symptoms. Others experience:
When to see a doctor
Talk to 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 urination, increased hunger, weight loss, fatigue, blurred vision, slow-healing sores or frequent infections.
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although excess weight, inactivity and genetic factors seem to be important.
Insulin: The key for sugar
Glucose: The energy source
Liver: Production and storage
In type 2 diabetes, this process doesn't work well. 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.
Researchers don't fully understand why some children develop type 2 diabetes and others don't, even if they have similar risk factors. It's clear that certain factors increase the risk, however, including:
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.
The long-term complications of type 2 diabetes develop gradually. But eventually, diabetes complications may be disabling or even life-threatening.
Preparing for your appointment
Your child's family doctor or pediatrician will probably make the initial diagnosis of diabetes. However, you'll likely then be referred to a doctor who specializes in metabolic disorders in children (pediatric endocrinologist). Your child's health care team will also generally include a dietitian, a certified diabetes educator, and a doctor who specializes in eye care (ophthalmologist). If your child's blood sugar levels are very high, your child's doctor may send your child to the hospital for treatment.
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for any appointments you have with your child's health care team. Here's some information to help you get ready for your appointment, and what you can expect from your child's doctor.
What you can do
Your time with your child's doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For type 2 diabetes in children, some basic questions to ask your child's doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may come up during the appointment.
What to expect from your child's doctor
What you can do in the meantime
Tests and diagnosis
If your child's doctor suspects diabetes, he or she will recommend a screening test. The primary test used to diagnose diabetes in children is the:
If your child's random blood sugar test results don't suggest diabetes, but your doctor still suspects it, your doctor may do a:
Another test your doctor might use is a fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, your child will be diagnosed with diabetes.
Your doctor may also perform an oral glucose tolerance test. For this test, your child fasts overnight, and the fasting blood sugar level is measured. Then, your child drinks a sugary liquid, and blood sugar levels are tested periodically for the next several hours. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 to 11 mmol/L) indicates prediabetes.
If your child is diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which often require different treatment strategies because in type 1 diabetes, the pancreas no longer makes insulin.
After the diagnosis
The American Academy of Pediatrics (AAP) recommends A1C testing every three months to ensure blood sugar level goals are met. Your child's target A1C goal may vary depending on his or her age and various other factors. Ask your doctor what your child's A1C target is.
The American Diabetes Association has introduced a formula that translates the A1C into what's known as an estimated average glucose (eAG). The eAG more closely correlates with daily blood sugar readings. An A1C of 7 percent translates to an eAG of 154 mg/dL (8.5 mmol/L). That would mean that your child's average blood sugar levels are around 150 mg/dL (8.3 mmol/L) on most days.
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 insulin regimen or meal plan.
Other periodic tests
Treatments and drugs
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, certified diabetes educator and dietitian — to keep your child's blood sugar level as close to normal as possible.
Blood sugar monitoring
Testing is 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. Your child's doctor will let you know what your child's blood sugar target range is. The doctor may ask you to keep a log of your child's blood glucose readings, or he or she may download that information from your blood glucose meter.
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:
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. If your child is overweight or obese, gradual weight reduction will be a goal.
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.
Medication and insulin
Medication. The AAP recommends metformin (Glucophage) for all children who have type 2 diabetes. Metformin reduces the amount of sugar a child's liver releases into the bloodstream between meals. Side effects may include nausea, upset stomach, diarrhea, headaches and, rarely, a harmful buildup of lactic acid (lactic acidosis). Metformin isn't safe for anyone who has liver failure, kidney failure or heart failure.
Insulin. The AAP also recommends insulin therapy if your child:
Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Therefore, if insulin is necessary, it has to be delivered under the skin. Insulin delivery options include:
Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. 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. Initially, children whose blood sugar is above 200 mg/dL (11.1 mmol/L) or who have an A1C above 8.5 percent will likely be started on insulin therapy to stabilize the blood sugar. Once blood sugar levels are normalized, your child may be weaned off insulin and placed on metformin alone.
However, if blood sugar isn't well controlled with metformin and lifestyle changes, insulin will have to be given again. A long-acting insulin, such as insulin glargine (Lantus), is often used for type 2 diabetes in children.
Signs of trouble
Low blood sugar (hypoglycemia). If your child's blood sugar level drops below the normal 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.
Treating low blood 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. This is a medical emergency.
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.
Treating high blood sugar
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. Although this condition is more common in children with type 1 diabetes, it can occur in children with type 2 diabetes.
Treating increased ketones
Numerous substances have been shown in some studies to improve insulin sensitivity, yet other studies have failed to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, no alternative therapies are currently recommended for diabetes control. Some of the substances that have been studied in diabetes include:
If you'd like to try an alternative therapy for your child, discuss this with a doctor who is familiar with these alternative treatments. It's important to check with your child's doctor first to be sure that whatever treatment you'd like to try won't cause an adverse reaction with other medications your child may be taking. It's also important not to stop giving your child any prescribed medications, especially insulin, without first consulting your child's doctor.
Coping and support
Type 2 diabetes is a serious disease. Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile. Careful management of type 2 diabetes can reduce your child's risk of serious — even life-threatening — complications.
Counseling and support
Or, you can visit the American Diabetes Association website to check out local activities for people with type 2 diabetes. The American Diabetes Association also offers diabetes camp programs, online information, and an online forum for children and teens with diabetes.
Getting your child actively involved
Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with type 2 diabetes.
Healthy lifestyle choices can help prevent type 2 diabetes in children and its complications. And, if your child already has type 2 diabetes, lifestyle changes can reduce the need for medications. Encourage your child to:
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. The best diet for a child with diabetes is also the best diet for the whole family.
Keeping your child's eyes healthy
Last Updated: 2013-03-09
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