|
The Challenge of Type 2 DiabetesIn Children
|
|
National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) American Diabetes Association Centers for Disease Control and
Prevention Children with Diabetes and the
Children with Diabetes Foundation American Dietetic Association American Academy of Pediatrics
|
If you think
back to when you were in grade school you might remember a fellow student who had
diabetes. It seemed a rather mysterious condition —
one that required him or her to get insulin shots and that necessitated the occasional cup
of orange juice or trip to the nurse’s office. What this scenario brings to mind is
Type 1 diabetes, which is thought to be an autoimmune disease. Type 1 diabetes was
formerly known as “juvenile-onset diabetes” and used to be the kind of diabetes
associated with childhood. Today, however, the Centers for Disease Control and Prevention
(CDC) reports Type 2 diabetes is rapidly increasing among children and adolescents. In
fact, Type 2 diabetes, which used to be called “adult-onset
diabetes,” is so prevalent among youngsters that it is no longer referred to as
adult-onset diabetes. According to the American Academy of Pediatrics, research shows that in 1990 less than 4 percent of children newly diagnosed with diabetes were Type 2. Now, 30 to 50 percent of children newly diagnosed with diabetes have Type 2 diabetes. Why is this disease affecting our kids and what can be done? To better understand the issue, it helps to have some background on what Type 2 diabetes is as well as its causes. Type 2 Diabetes Defined After your body digests food, the final product used by the body for fuel is glucose (sugar). Insulin allows the body to turn the glucose that comes from food into energy. The American Diabetes Association defines Type 1 diabetes as a metabolic condition resulting from the body’s inability to make insulin. This condition is thought to occur when the body attacks its own pancreatic cells, which make insulin. In Type 2 diabetes either the body does not produce enough insulin or it is unable to properly use the insulin that it produces. When the body cannot respond to insulin, glucose builds up in the blood. The longer a person has diabetes, the greater the chance he or she will develop one or more serious complications of this disease, including blindness, heart disease, and stroke. Frank Vinicor, MD, director of the CDC’s diabetes program says, “An increase in Type 2 diabetes in young people means that we are going to have more people — adults and children — with diabetes. Also, they will have it for a longer time, which increases the rate of severe complications like blindness, renal failure, and amputations.” According to diabetes researchers, some teenagers are already developing complications from Type 2 diabetes. Type 2 diabetes usually begins with a condition called insulin resistance, a disorder in which the cells do not use insulin properly. To make up for this inefficiency, the pancreas produces additional insulin. Eventually, the pancreas is unable to keep up and blood sugar levels rise. Impaired glucose tolerance (IGT) is considered a prediabetic condition in which the blood sugar level is elevated, but is not high enough to be classified as diabetes. Research indicates that IGT may be reversible through diet and exercise. How Do You Detect Type 2 Diabetes? Type 2 diabetes can be difficult to detect in children because they may have very mild or no symptoms. For example, a recent study of children and prediabetes published in the New England Journal of Medicine (NEJM), found that 4 of the 112 obese adolescents in the study had silent Type 2 diabetes, a form that doesn’t cause any symptoms. Knowing that diabetes diagnosis in children can be difficult, experts are working to define accurate diagnostic measures and establish prevalence in the U.S. population. And, both the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) are funding clinical trials to examine ways to prevent and treat diabetes in children. As difficult as they may be to detect, symptoms and risk factors play a key role in diagnosing Type 2 diabetes in children. Some symptoms include excessive thirst, frequent urination, tiredness or lack of energy, and acanthans nigrans (darkening of the skin between the fingers and toes and near the shoulder blades). Exhibiting just one of these symptoms does not mean that a child has type 2 diabetes, but a visit to the doctor may be in order. In addition to the symptoms mentioned above, there are a number of risk factors for Type 2 diabetes in children:
All of these factors are important; however, it is becoming clear that obesity may be the most significant. “The epidemic of childhood obesity in the U.S. is paralleled by a marked increase in the frequency of Type 2 diabetes,” according to the authors of the NEJM study. In fact, the study reports that IGT was highly prevalent among the children and adolescents with severe obesity — regardless of ethnic group. Twenty-one percent of the 112 obese adolescents studied had IGT, while 25 percent of the 55 obese children studied exhibited IGT. Controlling Type 2 Diabetes in Kids Research studies have found that lifestyle changes can prevent or delay the onset of Type 2 diabetes among at-risk children (those with IGT or other risk factors), but these changes can be challenging to the child and to the child’s family. What’s needed is a highly motivated child and a supportive and involved family. Without this, the chance of sustaining lasting lifestyle changes is greatly reduced. Since being overweight is a major risk factor for Type 2 diabetes in children, preventing inappropriate weight gain and/or losing weight is one of the most important lifestyle changes to be made. Combining weight loss efforts with regular, moderate physical activity and physical play will increase the chance of success. Enlisting the help of a registered dietitian to assist with goal setting, meal planning, and nutrition education can also help the child and his or her family deal with the day-to-day challenges of a weight-loss program. Ongoing scientific research is being conducted to learn about new treatment and better therapies to manage Type 2 diabetes as well as prevention efforts to delay onset and early diagnosis to reduce risk for complications. On the front line, however, the fact remains that parenting or caring for a child with Type 2 diabetes is not easy. The good news is that there are numerous health care professionals and organizations reaching out to communities and families with practical advice and tips on healthy eating and physical activities for children and teens with diabetes. Some of the resources listed in the sidebar may be helpful. Source: Food Insight January/February 2003
|
