Type 2 Diabetes

Diabetes [die-uh-BEE-tees] affects your child’s ability to turn food into energy. Diabetes is a metabolism [meh-TAB-uh-lis-um] disorder — a problem with the way your child’s body uses digested food for growth and energy.

Glucose is a type of sugar that is the body’s main source of energy. When your child eats, your child’s body breaks food down into glucose. In a body that does not have diabetes, glucose from food is absorbed into the bloodstream during digestion. As the amount of glucose in your child’s blood begins to rise, the body sends a signal to the pancreas, which releases a hormone called insulin.

Insulin allows the glucose to enter the body’s cells by acting as a key to the cell for the glucose to enter the cell. Once inside the cell, most of the glucose is used for energy right away. Some glucose is stored by the liver for later use.

All people’s blood glucose levels go up and down throughout the day. They rise after a meal, then drop again as the body uses up the glucose provided by the food. With insulin helping glucose get into the cells, and the liver preventing blood glucose from dropping too low, blood glucose levels remain within normal limits.

When your child has diabetes, their body either can’t make insulin or can’t respond to it properly. It has trouble getting glucose out of your child’s bloodstream and into their cells to be used for energy. When this happens:

• Your child’s cells are starved for energy, even though their blood contains large amounts of glucose. Your child can feel fatigue, hunger, and other symptoms.
• Your child’s blood glucose gets too high. Unused glucose builds up in your child’s bloodstream. Over time, high levels of blood glucose can damage your child’s nerves and blood vessels, and cause a variety of health complications.

There are two main types of diabetes: type 1 and type 2. Type 2 is often called “adult” diabetes because it’s most common in adults. But it’s becoming more and more common in children and teens.

Most people with diabetes have type 2 diabetes. If your child has type 2 diabetes, they might have one or both of the following problems:

• Your child’s cells don’t use insulin properly. The insulin can’t fully “unlock” the cells to allow enough glucose to enter. This is called insulin resistance.
• Your child’s pancreas doesn’t produce enough insulin. There are too few insulin “keys.” This is called insulin deficiency.

Often when type 2 diabetes is first diagnosed, the problem is insulin resistance. But as the disease progresses, the pancreas may also produce less insulin. Unlike type 1 diabetes, type 2 usually comes on gradually.

Sometimes — but not always — symptoms are the first clue that a person has diabetes. These common symptoms may be caused by high blood glucose levels, and may go away once blood glucose is controlled.

• Feeling tired often. Untreated diabetes makes you feel tired and weak because the body is having trouble getting energy from glucose.
• Needing to urinate (pee) often, and being very thirsty. When your child has high blood glucose, their body loses more fluid than normal. To replenish these fluids, they drink more and more. They’ll urinate more as well.
• Being unusually hungry. Many children may report that they’re hungry all the time. That’s because even though they may have plenty of glucose in their bloodstream, their cells are starving for energy. In response, their bodies prompt them to eat more.
• Feeling numbness or tingling in the hands and feet. This is a result of nerve damage caused by high blood glucose. Unless the damage is severe, these sensations may slowly go away when your child’s blood glucose returns to normal.
• Having blurred vision. When your child’s blood glucose is high for days in a row, the lenses of your child’s eyes tend to swell. This makes it harder to focus and harder to see clearly.
• Getting infections often, or having cuts and sores that are slow to heal. High blood glucose can increase your child’s risk for infections for two reasons:
• The bacteria and fungi that cause infection grow faster in a high-glucose environment.
• Your child’s immune system – which is responsible for fighting infection – doesn’t work as well with high blood glucose.

If your child has symptoms of diabetes, make an appointment to see your child’s healthcare provider to see if diabetes is actually the cause.

Also call your child’s healthcare provider is if your child has been diagnosed with diabetes, and:

• They are not getting better when they are sick.
• They have high glucose that does not go down.
• They have low glucose that you cannot get to come back up to normal.

Although no one knows exactly why type 2 diabetes develops in some children and not in others, there are several factors that have been shown to increase a child’s risk of developing type 2 diabetes. For example, scientists have shown that type 2 is more likely to occur in children who:

• Are overweight. Being overweight doesn’t cause diabetes, but it may trigger it in some children. Having too much body fat promotes insulin resistance. Children who carry the extra weight around their waistline — sometimes called an “apple-shaped” body — have a higher risk than children who carry their excess weight on their hips and thighs.
• Are physically inactive. Inactivity promotes obesity and insulin resistance.
• Have a family member with type 2 diabetes. Type 2 diabetes often runs in families. In fact, the genetic link for type 2 is much stronger than it is for type 1 diabetes.
• Are African American, American Indian/Alaskan Native, Hispanic American, or Pacific Islander. Because the tendency to develop type 2 may be inherited, your child’s ethnic background is also a factor. Children in these groups are at higher risk.
• Have abnormal cholesterol levels.
• Have high blood pressure. High blood pressure and diabetes often occur together and are a dangerous combination for your child’s heart and blood vessels.
• Have a mother who had gestational diabetes while pregnant with them.

Although no one knows exactly why type 2 diabetes develops in some children and not in others, there are several factors that have been shown to increase a child’s risk of developing type 2 diabetes. For example, scientists have shown that type 2 is more likely to occur in children who:

• Are overweight. Being overweight doesn’t cause diabetes, but it may trigger it in some children. Having too much body fat promotes insulin resistance. Children who carry the extra weight around their waistline — sometimes called an “apple-shaped” body — have a higher risk than children who carry their excess weight on their hips and thighs.
• Are physically inactive. Inactivity promotes obesity and insulin resistance.
• Have a family member with type 2 diabetes. Type 2 diabetes often runs in families. In fact, the genetic link for type 2 is much stronger than it is for type 1 diabetes.
• Are African American, American Indian/Alaskan Native, Hispanic American, or Pacific Islander. Because the tendency to develop type 2 may be inherited, your child’s ethnic background is also a factor. Children in these groups are at higher risk.
• Have abnormal cholesterol levels.
• Have high blood pressure. High blood pressure and diabetes often occur together and are a dangerous combination for your child’s heart and blood vessels.
• Have a mother who had gestational diabetes while pregnant with them.

Although symptoms may suggest that your child has diabetes, only blood tests can tell you for sure. Blood glucose testing directly measures your child’s glucose levels at the time of testing. The main tests for diabetes include:

• HbA1c (sometimes just called A1C). This test measures your child’s average blood glucose level over a period of time. The test can be done any time during the day, whether or not your child has eaten recently.
• Fasting plasma glucose (or FPG). This test measures the amount of glucose in the liquid part of your child’s blood — called the blood plasma. Before having this test your child needs to not eat or drink anything but water for at least 8 hours.

Part of diagnosing your child’s diabetes is figuring out the type of diabetes your child has. To do this, your child’s healthcare provider may look at several things, such as:

• Symptoms. Type 1 comes on suddenly, while type 2 is more gradual. The symptoms your child has may also differ based on the type of diabetes you have.
• Risk factors. Your child’s healthcare provider will consider your child’s age, body weight, and other factors to see if your child fits the profile for type 2 diabetes.
• Results from other blood tests. In addition to blood glucose tests, your child’s healthcare provider may want to run tests for insulin, antibodies, ketones, C-peptide, and other substances in your child’s blood.

The goal of diabetes treatment is to level your child’s blood glucose levels to help their glucose stay in the target range. Type 2 diabetes is treated with a combination of diet, exercise, and oral medicine. In some cases, injections of insulin or other medicines are needed to help control blood glucose levels.

Lifestyle change includes:

• A personal exercise plan. Getting regular exercise is a key piece of your child’s treatment.
• A meal plan. Eating more wisely is one of the best things you can help your child do to help them protect their health.
• Medicine. Depending how your child responds to the other parts of their management plan, your child’s healthcare provider may prescribe a medicine called metformin.
• Insulin therapy. If your child’s glucose does not come into control with lifestyle change and metformin, your healthcare provider may recommend insulin shots.

Your child’s healthcare providers can help get your child on a program to help your child stay in good health. To make sure your child’s glucose levels are staying within range, your child’s healthcare provider may ask you to help monitor your child’s glucose levels on a regular basis to help track them, and help make sure they stay within normal range. Sometimes if they are not within normal range, you may also have to give your child medicine to help their levels return to normal range.

In addition, your child’s healthcare providers may recommend other treatments to manage related conditions, such as high blood pressure.

Doctors don’t know exactly what causes type 2 diabetes, but there are some steps you can take to lower the chance your child will get this disease. These include:

• Help your child stay at a healthy weight
• Help your child be active every day
• Make sure your child eats healthy foods

Diabetes is a problem with the way the body uses glucose, a type of sugar that is your body’s main source of energy. The kind of diabetes know as type 1 is more common in children and type 2 diabetes is most common in adults. Type 2 diabetes is becoming more common in children and teens — especially those who are overweight.

Diabetes needs careful management, but you and your child can learn to manage it expect good outcomes.