WHAT IS THE CONCERN WITH TYPE 2 DM AND CHILDREN?

People with type 2 diabetes (T2DM) have higher than normal blood glucose (sugar) levels. The pancreas, an organ located in the abdomen just behind the stomach, produces insulin. Insulin helps sugar from the bloodstream enter your body’s cells, where it’s used for energy. This process controls the amount of sugar in your blood, keeping it from getting too low or too high. T2DM occurs when the body becomes resistant to the effect of insulin and then cannot make enough so that sugar builds up to abnormally high levels in the blood.

Usually, T2DM develops in middle age or later. Although T2DM is rare in children, over the past two decades, more and more cases have been reported. Most youth with type 2 diabetes develop it when they are teenagers. If left untreated or poorly controlled, over the years, T2DM can lead to blindness, kidney failure, nerve damage, heart disease, stroke and high blood pressure.

WHO IS AT RISK?

A number of factors can increase the risk of T2DM in youth:

• Overweight or obesity.
• Lack of exercise.
• Family history of diabetes in a parent or sibling.
• Ethnic background of African American, Hispanic, American Indian, Asian, or Pacific Islander origin.
• Being born to a mother who had gestational diabetes (diabetes during pregnancy).

Other signs and symptoms that increase risk for T2DM include:

• Acanthosis nigricans (dark shiny patches on the skin between the fingers or toes or on the back of the neck).
• Polycystic ovary syndrome.
• High blood pressure.
• High cholesterol.

While the best way to prevent T2DM during childhood is to maintain a healthy weight, if T2DM is present, early diagnosis and effective treatment are crucial.

HOW IS TYPE 2 DIABETES DIAGNOSED IN CHILDREN?

Many things are taken into account when assessing your child’s growth. For example, the heights of a child’s parents are an important indicator of how tall a child is likely to be when fully grown. A child born to parents who are below average height will most likely grow to have an adult height below average as well. The rate of growth, referred to as the growth velocity, is also important. Children who are not growing at the same rate as their friends will slowly drop further down on the growth curve as they age; for example, crossing from the 25th to the 3rd percentile line. Such crossing of percentile lines on the growth curve is often a warning sign of an underlying medical problem affecting growth.

What causes poor growth or short stature?

Three blood tests can be used to check the levels of sugar in the blood (plasma) and diagnose T2DM:

• Fasting plasma glucose—Blood is drawn after you fast (go without food) overnight or for at least 8 hours.
• Random plasma glucose—Blood is drawn at any time.
• Oral glucose tolerance test—This test requires that you fast for at least 8 hours. Blood is drawn before you drink 8 ounces of a sugary solution and 2 hours after.

Your doctor will review the results of these tests. If the tests indicate diabetes, your doctor will discuss treatment options.

HOW IS TYPE 2 DIABETES IN CHILDREN TREATED?

For some children, the disease can be managed initially by diet and exercise.

In addition, your doctor may check your child’s bone age (x-ray of left hand/wrist), which may help in a child older than 7 years predict how tall the child will be as an adult.

If the child’s weight is not improved, however, he or she will need to take medication to control blood sugar levels.

Presently, both metformin and insulin have been approved to treat children with T2DM. Over time, more medications will be approved for use by children; check with your child’s doctor for more options. Specific treatment depends on the individual child and his/her blood glucose level. Your family and diabetes care team should work together to find the best approach for your child.

WHAT UNIQUE ISSUES DO CHILDREN FACE WHEN THEY HAVE TYPE 2 DIABETES?

Having a disease like T2DM has psychological and social, as well as physical, effects on young people. Its successful treatment requires personal motivation and self-management— following a healthy nutrition plan, being physically active, regularly monitoring blood sugar levels, and taking medication as prescribed. Complying with a treatment plan can be hard for pre-teens and teens who do not want to be different from their peers. They may fear being ostracized which can interfere with diabetes management.

WHAT IS THE PARENT’S ROLE?

A critical factor in managing T2DM in a child or teen is family support and involvement. The entire family should follow a healthy lifestyle, including diet and exercise. This not only benefits the child with T2DM but also may help prevent the disease in siblings.

Work with your child to create a plan for taking medications and monitoring glucose levels. Support your child and encourage your child to talk freely about concerns and problems.