What is it?
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. 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, your child may need oral medication or insulin treatment to manage his or her blood sugar.
Type 2 diabetes in children may develop gradually. Some children who have type 2 diabetes have no signs or symptoms. Others experience:
- Increased thirst and frequent urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
- Increased hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become depleted for energy. This triggers intense hunger.
- Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight. Without the energy sugar supplies, muscle tissues and fat stores simply shrink.
- Fatigue. If your child's cells are deprived of sugar, he or she may become tired and irritable.
- Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.
- Slow-healing sores or frequent infections. Type 2 diabetes affects your child's ability to heal and resist infections.
- Areas of darkened skin. Some children who have type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.
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 and inactivity seem to be important factors.
Insulin: The key for sugar
Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach. When your child eats, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your child's cells. Insulin lowers the amount of sugar in your child's bloodstream. As your child's blood sugar level drops, so does the secretion of insulin from the pancreas.
Glucose: The energy source
Glucose — sugar — is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: the food your child eats and your child's liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.
Liver: Production and storage
The liver acts as a glucose storage and manufacturing center. When your child's insulin levels are low — when your child hasn't eaten in a while, for example — the liver releases the stored glucose to keep your child's glucose level within a normal range.
In type 2 diabetes, this process works improperly. 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:
- Weight. Being overweight is a primary risk factor for type 2 diabetes in children. The more fatty tissue a child has, the more resistant his or her cells become to insulin. The good news is that many children who have type 2 diabetes can improve their blood sugar levels simply by losing excess weight.
- Inactivity. The less active your child is, the greater his or her risk of type 2 diabetes. Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin.
- Family history. The risk of type 2 diabetes increases if a parent or sibling has type 2 diabetes — but it's difficult to tell if this is related to lifestyle, genetics or both.
- Race. Although it's unclear why, children of certain races — especially blacks, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes.
- Gender. Type 2 diabetes is more common in girls than in boys during childhood.
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.
- Heart and blood vessel disease. Diabetes dramatically increases your child's risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.
- Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your child's nerves, especially in the legs. This can cause tingling, numbness, burning or pain that may begin at the tips of the toes or fingers and gradually spread upward. Left untreated, your child could lose all sense of feeling in the affected limbs.
- Nonalcoholic fatty liver disease. Children with type 2 are more likely to develop nonalcoholic fatty liver disease, which can eventually lead to scarring of the liver and cirrhosis. Weight loss, along with good blood sugar control, may help this condition.
- Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your child's blood. Diabetes can damage this delicate filtering system. The earlier diabetes develops, the greater the concern. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
- Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy). Diabetes can also lead to cataracts and a greater risk of glaucoma.
- Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections.
- Skin conditions. Diabetes may leave your child more susceptible to skin problems, including bacterial infections, fungal infections and itching.
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:
- Random blood sugar test. A blood sample will be taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.
If your child's random blood sugar test results don't suggest diabetes, but your doctor still suspects it, your doctor may do a:
- Glycated hemoglobin (A1C) test. This blood test indicates an average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher the blood sugar levels, the more hemoglobin that has sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes. A result between 6 and 6.5 percent is considered prediabetes, which indicates a high risk of developing diabetes.
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 is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If it's 126 mg/dL 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 after two hours indicates diabetes. A reading between 140 and 199 mg/dL 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
At first, your child may need frequent — once a month or more — visits. Once your child's blood sugar is stabilized, he or she will regularly visit his or her doctor to ensure good diabetes management.
Your child's doctor will also check your child's A1C levels periodically. 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. That would mean that your child's average blood sugar levels are around 150 mg/dL.
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
In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your child's cholesterol levels, thyroid function, liver function and kidney function. The doctor will also examine your child to assess his or her blood pressure and make sure he or she is growing properly. Regular eye exams also are important.