One of the most important things a pediatrician or family practitioner can do for his young patients is to educate them and their families about Type 2 diabetes, says endocrinologist Bresta Miranda.
It’s a disease that used to affect people who had reached their 60s, but it’s now occurring in children as young as 10.
In the United States, more than 5,000 youths are diagnosed with Type 2 diabetes each year, according to data collected from 2008 to 2009 as part of the SEARCH for Diabetes in Youth Study. That’s up from 2002 to 2005 when there were about 3,600 new cases a year, as reported in the New York Times.
This is a major health concern because uncontrolled Type 2, like all diabetes, can have serious long-term consequences, including amputations, nerve damage, kidney failure, blindness and heart disease.
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“The crux of the problem is that we are seeing a generation of people who will develop the complications we now associate with the elderly much sooner in life,” says Dr. Jose E. Perez-Rodriguez, pediatric endocrinologist at Baptist Children’s Hospital. “We will not have to wait until age 70 to see kidney failure, nerve damage and eye sight problems. It’s very different when you start having high blood sugar at 10 years old instead of at 40.”
To understand diabetes, you need to know that the body counts on the pancreas to produce insulin. This hormone is necessary for the conversion of blood sugar into energy, explains Miranda, a physician who is interim director of the Kosow DRI Diabetes Treatment Center at the Diabetes Research Institute at the University of Miami Miller School of Medicine.
Both Type 1 and Type 2 diabetes result when the body no longer produces enough insulin to regulate blood sugar.
In Type 1 diabetes, the pancreas is compromised so it can’t make enough insulin. But those suffering Type 2 diabetes have functioning pancreases that produce insulin. However, their cells use the insulin inefficiently.
This insulin resistance means that although they may have high levels of insulin in their blood, their blood sugar levels remain uncontrolled, explains Dr. Sarah Hart-Unger, a pediatric endocrinologist at Joe DiMaggio Children’s Hospital in Hollywood.
After a while, the pancreas can no longer produce these large quantities of insulin, blood sugar rises to above 180 mg/dcl and the patient is deemed to have Type 2 diabetes.
In the short term, you may not even know your child has the disease because it’s asymptomatic until it’s diagnosed by a family doctor or pediatrician who orders an A1C blood test. It measures your average blood sugar level for the past two to three months.
Early symptoms a parent might recognize include thirst and increased urination resulting from the body’s need to remove excess sugar from the blood. Normally the liver filters the excess glucose. But when there’s too much blood sugar, the body dilutes it with water and filters it through the kidneys, resulting in these symptoms.
Parents can also keep an eye out for a brown thickening of the skin on a child’s neck. These are called acanthosis-nigricans, which result from high insulin levels; not high glucose. No one really understands why they develop but they are a fairly dependable sign of a problem.
As the disease progresses undiagnosed, a child may become acutely ill experiencing vomiting, abdominal pain, weakness, fatigue, blurry vision and rapid breathing. If these symptoms occur, get your child to the emergency room immediately, Hart-Unger urges.
There are numerous factors that can put your child at increased risk for developing Type 2 diabetes.
Mothers with gestational diabetes are more likely to have children who develop the disease than mothers with normal blood sugars. Babies who are premature or have low birth weights also tend to develop Type 2 diabetes around puberty.
And Native Americans, African Americans and Hispanics are more prone to the disease than those from other ethnic backgrounds, Perez-Rodriguez says.
Although you don’t have control over these genetic factors, there are changes you can make to decrease the risk of your child developing the disease.
One of the most important is feeding your child a balanced diet served in moderate portions that keeps him at a healthful weight. This is important because obesity can actually trigger a child’s genetic disposition to develop diabetes, says Perez-Rodriguez.
When it comes to eating right, there’s no need to make a special meal for your diabetic child. “What we recommend is what every healthy person should be eating,” Hart-Unger says.
A healthful diet begins with eating whole foods instead of processed ones and consuming only the number of calories your body needs to burn for energy. Calories can be easier to control if you eat meals and snacks at specified times instead of grazing throughout the day.
When it comes to food choices think fruits, vegetables, lean meats, whole grains, non-fat dairy products, beans, poultry and fish. The doctors also recommend you skip the sweetened beverages such as fruit juices, sports drinks, punch and soda that are high in sugar and low in fiber.
Controlling the amount of physical activity in which your child participates also is important in fending off Type 2 diabetes because activity helps the body use insulin more efficiently.
“Activity may be more important than weight control,” Perez-Rodriguez says. If you have two children who weigh the same but one plays soccer and the other plays video games, the active one has less risk of developing Type 2 diabetes than the inactive one, he explains.
So if your child is diagnosed with Type 2 diabetes or has high blood sugar levels that have not yet reached diabetic levels, you can help combat the disease by watching your child’s diet and insisting he or she spend less time in front of the television and more time riding a bike or playing in the park.
“These lifestyle modifications — a balanced, sensible diet and at least 150 minutes of exercise a week — are our main lines of defense against this disease and its complications,” Miranda says.
The Doctor Recommends
Because she has two young children, Dr. Sarah Hart-Unger, a pediatric endocrinologist at Joe DiMaggio Children’s Hospital in Hollywood, has had to decide what is best for them when it comes to preventing Type 2 diabetes.
She has turned to registered dietitian and family therapist Ellyn Satter and her book, “How to Get Your Kid to Eat: But Not Too Much” (Bull Publishing, 1987). “I subscribe to many of her recommendations,” Hart-Unger says. You can learn more by visiting www.ellynsatterinstitute.org/