Type 2 diabetes
accounts for 90% of diabetes in adults and has tripled in frequency in the past 30 years so that it now affects 6.5% of the U.S. population. Even more concerning is that since the 1990s, the prevalence of type 2 diabetes among children has also increased dramatically. Since at all ages obesity is the single most important risk factor for type 2 diabetes, most experts attribute this dramatic rise to a world in which children eat too much food and get too little exercise.
Diabetes develops when the body loses its ability to respond properly to insulin, a sugar the body extracts from carbohydrates in food. Under normal circumstances, rising glucose levels in the blood cause the pancreas to produce the hormone insulin. Insulin allows the glucose in the blood to enter the cells of the body and be converted into energy.
In type 2 diabetes the body’s cells become progressively less sensitive to insulin and therefore very large amounts are required for glucose control. Unfortunately, the pancreas cannot maintain this elevated level of insulin production indefinitely, and eventually the body loses the ability to produce all the insulin it needs. At this point blood sugar rises, and a blood test will generally indicate type 2 diabetes. Despite these high blood sugar levels, symptoms of diabetes may either be absent or so mild as to escape attention.
In contrast,
type 1 diabetes
, occurs only after the pancreas is severely damaged by the body’s immune system. The damaged pancreas can no longer produce adequate amounts of insulin. Therefore, instead of the high levels of insulin and insulin resistance seen in type 2 diabetes, very low levels of insulin occur in type 1 diabetes. As a result, sudden serious illness requiring emergency insulin treatment is quite common in type 1 diabetes.
Obesity is the major cause of most type 2 diabetes because the tissues of overweight people frequently become resistant to insulin. Since physical activity improves tissue sensitivity to insulin, physically inactive people also have tissues that are more insulin resistant.
The short-term effects of type 2 diabetes include:
- frequent urination
- increased thirst
- weight loss
- fatigue
The long-term effects of type 2 diabetes include:
- Eye disease and vision loss (retinopathy)
- Kidney disease
-
Heart disease and circulatory problems including
stroke
- Nerve damage (neuropathy)
- Skin and bone damage that may lead to limb amputation
- Reduced life expectancy
According to the American Diabetes Association (ADA), doctors should screen children for diabetes if they are significantly overweight and have two other risk factors. Screening should begin at age 10 or puberty, whichever comes first, and be repeated every two years. In addition to obesity, the risk factors for type 2 diabetes include:
- Family history: a close relative with type 2 diabetes
- Ethnicity: African American, Hispanic/Latino, Asian American, Native American, and Pacific Islander descent
-
Signs of insulin/conditions associated with insulin resistance:
- Thickening and darkening of skin at the back of the neck or under the arms (acanthosis nigricans)
- Enlarging abdominal size (central obesity)
- Cholesterol disorders
- High blood pressure (hypertension)
- Polycystic ovary syndrome (irregular periods in association with obesity)
-
Having a mother who had diabetes during pregnancy (
gestational diabetes
)
If diabetes is detected by an elevated level of sugar in the urine, a blood test must be done to confirm the diagnosis. The most commonly used test is the fasting plasma glucose, a blood test performed after a person has fasted for eight hours. A fasting plasma glucose (blood sugar) level of 126 or greater on two separate occasions is diagnostic of diabetes.
Managing their blood sugar levels requires major life-style changes for children. To succeed, children need adult supervision and support. The entire family should work with a diabetes team (doctor, nurse, social worker, dietician, and exercise counselor) to develop a healthy lifestyle.
Children living with type 2 diabetes need daily strategies to maintaining normal blood sugar levels. These include:
-
Planning healthy meals
- Eliminate regular sodas, limit carbohydrates and fruit juice, and eat whole grains and vegetables.
- Count grams of carbohydrates and read food labels.
- Aim to lose 5% to 7% of body weight.
-
Increasing physical activity
- Exercise moderately at least 30 minutes, five times a week. Increase heart rate by walking briskly, riding bikes, swimming, dancing, etc.
- When taking insulin, plan for periods of low blood sugar and carry short-acting glucose or carbohydrates.
-
Monitoring and taking medications
- If directed by the doctor, check blood sugars two or more times a day. This involves pricking the finger or arm and applying a drop of blood to a meter with a glucose-sensitive strip.
- Have regular eye and foot exams to detect and treat early vision and circulatory problems.
- Monitor blood pressure and cholesterol levels.
- Take medication and/or insulin injections as prescribed to control blood sugar, blood pressure, and cholesterol. Metformin (an oral medication that lowers the amount of insulin the body has to make) is approved for children aged 10 and above.
The primary preventive measures for type 2 diabetes are maintaining a healthy weight and getting regular exercise. A nationwide study showed that diet and exercise reduced the risk of developing diabetes by 58%.
Parents, teachers, and doctors should encourage children to eat smaller meals with fewer carbohydrates and to become more physically active. A diet with age appropriate calorie intake and five or more daily servings of fruits and vegetables is ideal for diabetes prevention. Vigorous daily exercise should also be encouraged either in or after school
To help families reduce their risks and manage their conditions, the Diabetes Prevention Program provides the “Small Steps, Big Rewards: Your Game Plan for Preventing Type 2 Diabetes” program. Likewise, the American Diabetes Association and other organizations are promoting diabetes awareness among physicians, educators, and community groups. As more people become aware of the risk factors for type 2 diabetes, more children will benefit from a healthier lifestyle.
