Type 2 Diabetes in Children
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This topic provides information about type 2 diabetes in children. If you are looking for information about type 1 diabetes, see the topic Type 1 Diabetes: Children Living With the Disease.
What is type 2 diabetes?
Type 2 diabetes is a lifelong disease that develops when the pancreas cannot make enough insulin or when the body's tissues cannot use insulin properly. Insulin is a hormone that helps the body's cells use sugar (glucose) for energy. It also helps the body store extra energy in muscle, fat, and liver cells.
Without insulin, the sugar cannot get into the cells to do its work. It stays in the blood instead. This can cause high blood sugar levels. A person has diabetes when the blood sugar stays too high too much of the time.
Over time, high blood sugar can cause problems with the eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes a person more likely to get serious illnesses or infections.
In the past, doctors believed that type 2 diabetes was an adult disease and that type 1 diabetes was a children's disease. Now, more and more children are getting type 2 diabetes.
Finding out that your child has diabetes can be scary. But your child can live a long, healthy life by learning to manage the disease.
What causes type 2 diabetes?
Doctors do not know exactly what causes diabetes. Experts believe the main risks for children getting type 2 diabetes are being overweight, not being physically active, and having a family history of the disease.
Also, the hormones released during the early teen years make it harder than usual for the body to use insulin correctly. This problem is called insulin resistance. It can lead to diabetes.
What are the symptoms?
Most children with type 2 diabetes do not have symptoms when the disease is first found. If there are symptoms, they usually are mild and may include:
How is type 2 diabetes diagnosed?
A simple blood test is usually all that is needed to diagnose diabetes. Your child's doctor may do other blood tests if it is not clear whether your child has type 1 or type 2 diabetes.
A doctor may test your child for diabetes if he or she is overweight, gets little physical activity, or has other risk factors for the disease. A risk factor is anything that increases your chances of having a disease. Some children are diagnosed with type 2 diabetes when they have a blood or urine test for some other reason.
How is it treated?
The key to treating diabetes is to keep your child's blood sugar levels within a target range. To do this:
You play a major role in helping your child take charge of his or her diabetes care. Let your child do as much of the care as possible. At the same time, give your child the support and guidance he or she needs.
The longer a person has diabetes, the more likely he or she is to have problems, such as diseases of the eyes, heart, blood vessels, nerves, and kidneys. But if your child can control his or her blood sugar levels every day, it may help to delay the start of or prevent some of these problems later on.
Even when you are careful and do all the right things, your child can have problems with high or low blood sugar. It is important to know what signs to look for and what to do if this happens.
Can type 2 diabetes be prevented?
Helping your child stay at a healthy weight and get regular exercise can help prevent type 2 diabetes.
Frequently Asked Questions
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The exact cause of type 2 diabetes is not known. But experts believe the disease develops in children the same way it does in adults. The body does not produce enough of the hormone insulin , or it cannot correctly use the insulin available (insulin resistance). Either or both of these conditions lead to excess sugar (glucose) in the blood.
Insulin resistance occurs when the body's cells do not correctly use insulin, which helps control the amount of glucose in the blood. The body then needs more insulin to control blood sugar levels. The pancreas produces more insulin to try to keep blood sugar levels normal. If it cannot produce enough insulin, blood sugar rises, and diabetes may develop.
Things that affect the body's resistance to insulin in childhood include:
Too little insulin
Normally, the pancreas produces more insulin than usual during puberty to support the rapid growth of the child. If the body cannot produce enough insulin to meet its needs, diabetes develops. Over time, the pancreas may produce less and less insulin, making the diabetes worse.
Children often have no symptoms of type 2 diabetes before they are diagnosed, because their blood sugar level has been rising so slowly. As a result, a child may have diabetes for several months or years before being diagnosed.
When children do have symptoms, the most common include:
Other possible symptoms include:
Type 2 diabetes usually develops in adulthood, but the number of children being diagnosed with the disease is rising. Children with type 2 diabetes are usually diagnosed during the early teen years. During this time, their bodies are growing and developing rapidly, placing a demand on the pancreas to produce additional insulin .
The hormones released during puberty can make it harder than usual for the body to use insulin correctly ( insulin resistance ). Also, children with type 2 diabetes are usually overweight, which also contributes to insulin resistance. If the pancreas cannot produce enough insulin to overcome the resistance, diabetes can develop.
Diabetes experts believe the disease progresses as it does in adults. The main risk factors for complications from diabetes are the length of time a person has diabetes and the degree of blood sugar control. A child who develops type 2 diabetes may have an increased risk of complications, because he or she will have the disease for a long time. Some complications that children and teens may develop include:
If a child's blood sugar levels remain high for a long time, he or she may grow at an abnormal rate—faster than normal for a while, then slower than normal later. If blood sugar levels stay high during puberty, normal changes and the start of menstruation may be delayed.
The way to prevent complications is to always keep blood sugar levels in a target range. This requires that your child follow his or her treatment plan daily and monitor blood sugar levels often. Your child also will need ongoing diabetes education and regular checkups. Other medical conditions, such as high blood pressure and high cholesterol, need adequate medical care also, because they raise the risk for diabetes complications.
Children with type 2 diabetes have to modify their lifestyles. Your child will be more successful if your whole family is involved. These lifestyle changes benefit everyone by reducing the risk for diabetes and heart disease.
What Increases Your Risk
The major risk factors for type 2 diabetes in children include:
Other things that increase risk include:
Medical conditions that contribute to the risk of complications in adolescence and beyond include:
Teens who have diabetes and smoke have a higher risk of complications from diabetes than do those who do not smoke.
When To Call a Doctor
Call 911 or other emergency services immediately if your child is:
Call a doctor right away if:
Call a doctor if your child:
Watchful waiting is a period of time during which you and your doctor observe your child's symptoms or condition without using medical treatment. Watchful waiting is not appropriate if:
Who to see
Most doctors can diagnose diabetes. After your child has been diagnosed, your doctor will work with you to build a treatment plan that fits your child's needs. Health professionals who may be involved in the treatment of children with type 2 diabetes include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Many children have had no symptoms before they are diagnosed with type 2 diabetes. Usually, the illness is discovered when a blood or urine test taken for another reason shows diabetes.
If a doctor suspects that your child may have type 2 diabetes, he or she will do a medical history, physical exam, and blood glucose testing. If the results of these tests meet the criteria for diagnosing diabetes established by the American Diabetes Association (ADA), your child has diabetes.
Other possible tests
If it is hard to tell whether your child has type 2 or type 1 diabetes, your doctor may do a C-peptide test or an autoantibodies test. (Autoantibodies are produced when the body's immune system does not work right.) These tests may not be able to confirm the type of diabetes your child has. Getting a definite diagnosis may take months or years. In either case, your child's sugar levels will need to be controlled right away.
Sometimes a doctor will do a quick home blood sugar test or a urine test for sugar to see whether a child may have diabetes. Although these tests are simple and can show possible diabetes, additional testing is needed to make sure your child actually has the disease.
Monitoring tests if diagnosed with diabetes
Because your child is at risk for diabetes complications (eye, heart, kidney, nerve, liver, and blood vessel problems), he or she needs to see a doctor regularly for tests to monitor type 2 diabetes.
If your child is overweight and gets little or no exercise, he or she may be at risk for type 2 diabetes. Early detection and treatment for type 2 diabetes can prevent or delay problems from the disease.
Treatment of type 2 diabetes in children focuses on keeping blood sugar levels within a target range. Children may need higher blood sugar goals than adults, because their bodies are still developing. Also, they may not be able to recognize symptoms of low blood sugar . To reach his or her target blood sugar, your child needs to eat healthy meals of appropriate portion size and get daily exercise. Treatment also may include medicine.
A healthy diet with the right amount of calories will help your child achieve target blood sugar levels and maintain a healthy weight. The meal plan designed for your child will spread carbohydrate (starches and sugary foods) throughout the day. This helps prevent high blood sugar after meals as well as weight gain. A registered dietitian can design a meal plan that not only fits your child's needs but also is a healthy eating plan for your family. For more information, see the topic Healthy Eating for Children.
If your child is overweight, he or she may need to lose weight (or stay at the same weight and not gain more). This depends on his or her age, development, and other risk factors.
Being physically active
Physical activity is extremely important. It helps the body use insulin correctly and helps control weight. Your child does not have to start a rigorous exercise program, but being more active can help control blood sugar. For example, your child could play outside with friends, take brisk walks with family members, and take part in individual or team sports.
Experts recommend that teens and children (starting at age 6) do moderate to vigorous activity at least 1 hour every day. 1 And 3 or more days a week, what they choose to do should:
It's okay for them to be active in smaller blocks of time that add up to 1 hour or more each day.
Limit your child's screen time. Have your child take breaks from computer, cell phone, and TV use and be active instead.
Your child may need medicines if eating healthy meals and getting regular physical activity have not lowered your child's blood sugar to his or her target level.
Checking blood sugar, blood pressure, and cholesterol
Your child's blood sugar level may need to be checked regularly, for example, before breakfast and 2 hours after meals.
If your child has high blood pressure or high cholesterol, those conditions need to be treated.
What to think about
Some children have very high blood sugar levels when they are diagnosed with type 2 diabetes. A child with a very high blood sugar level may develop the serious chemical imbalance diabetic ketoacidosis and need to be treated with insulin in a hospital. After blood sugar returns to a target level, the child usually no longer needs insulin. His or her own body may start making enough insulin again.
Treating diabetes with medicine increases the risk for low blood sugar episodes. Your child's doctor will determine the target range for your child's blood sugar that will prevent damage from diabetes while causing as few low blood sugar episodes as possible.
The lifestyle changes needed to control diabetes can be especially hard for a child or teen. Your child will have a better chance of being successful if the whole family is involved. Eating a healthy diet and getting regular exercise may help other family members avoid diabetes.
Teens who have depression or an eating disorder may have difficulty keeping their blood sugar at a healthy level. Also, teens who smoke or use alcohol or other drugs have problems with blood sugar control. Support groups may help teens deal with diabetes management issues, which can improve the teens' perception of diabetes care and blood sugar control.
Healthy meals, physical activity, and weight control can help prevent diabetes or can prevent or delay complications if your child has diabetes. A registered dietitian can help you build a healthy meal plan for your child. Your doctor, exercise specialist, or certified diabetes educator also can help your child find ways to become more physically active.
Weight loss is appropriate if your child is overweight and he or she has reached adult height. In some severe cases, weight loss before your child reaches his or her full adult height may be needed. See the Interactive Tool: What Is Your Child's BMI?
Having a blood sugar level that is higher than normal but not yet at the level of diabetes ( prediabetes ) increases a child's risk for type 2 diabetes. If your child has prediabetes, eating a healthy diet and increasing physical exercise may make his or her blood sugar return to a normal range and possibly prevent type 2 diabetes. Your child will still need to see a doctor regularly to check for signs of the disease.
Your child needs to eat healthy meals with appropriate portions to support growth and prevent weight gain. The meal plan for your child will also spread carbohydrate throughout the day to prevent high blood sugar after meals. For information on healthy eating and weight management, see the topic Healthy Eating for Children.
Encourage your child (age 6 to 17) to do moderate to vigorous activity at least 1 hour every day. Limit the amount of time your child watches TV and uses the computer and cell phone. You can help your child or teen be active by looking for ways to make activity more fun and by being active along with your child.
For children age 2 and older: The American Academy of Pediatrics advises parents to limit screen time to 2 hours a day or less. And it's best for children younger than 2 to not watch TV, watch movies, or play games on a screen.
Work with your child's teachers and school to make a plan to handle your child's special needs, including testing blood sugar and eating snacks when needed.
Your child can take part in the same activities as other children. For safety:
Home blood sugar monitoring
You and your child will need to monitor his or her blood sugar frequently to know how well it is under control. Talk with your doctor about a target range for your child. Young children may need a higher blood sugar goal than adults because of growth needs and to prevent very low blood sugar (hypoglycemia). As your child grows older, the goal can be lowered so that it is closer to the recommended target range.
Your child may not need to take insulin if his or her blood sugar levels are staying within a target range with meal planning, exercise, and possibly other medicine. But at some point your child may need to take insulin because the pancreas may produce less and less insulin.
If your child takes insulin, you and your child need to know how to prepare and give a shot.
Other important issues include:
What to think about
Childhood and the teen years are a difficult time to be diagnosed with diabetes. Normal developmental changes may interfere with your child following his or her treatment. Teens with diabetes may rebel against treatment or participate in risky behavior, such as using drugs or drinking alcohol.
You play a major role in helping your child become independent in his or her diabetes care. Allow your child to do as much of the care as possible. But give your child the support and guidance he or she needs. Your child will be more successful if your family is physically active and has healthy eating habits.
The same medicines are used to treat adults and children with type 2 diabetes. These medicines increase insulin production, make the body better able to use insulin (decrease insulin resistance ), or slow the intestinal absorption of carbohydrate .
Sometimes a child needs more than one medicine to adequately control diabetes. Two or more medicines taken together may work more effectively than a single medicine. Taking two medicines together also may reduce possible side effects by allowing lower doses of each. But in some cases, taking two medicines can increase the risk of certain side effects, such as low blood sugar ( hypoglycemia ).
Some children need daily insulin shots—alone or with other medicines. Even if your doctor does not prescribe daily insulin, your child may need to take insulin temporarily when first diagnosed or during illness or surgery. At some point in adulthood, he or she will likely need insulin, because over time the pancreas does not produce enough insulin. Insulin also may be needed during pregnancy and breast-feeding.
If your child has high cholesterol or high blood pressure, medicine for those conditions may be needed. Even blood pressure slightly above normal increases the risk for eye and kidney damage from diabetes.
Medicines that decrease insulin resistance:
Medicines that increase insulin production:
Medicines that slow intestinal absorption of carbohydrate:
If you are having trouble controlling your blood sugar with pills, your doctor may suggest one of these medicines, which are given as a shot:
Some doctors treat children with insulin injections.
Medicines to control blood pressure and cholesterol
Some children may need medicines to lower their blood pressure and cholesterol to reduce the risk for later complications.
What to think about
Metformin is the medicine of choice for children with type 2 diabetes. It usually keeps blood sugar levels within a target range without increasing the likelihood that the child will gain weight. If after 3 to 6 months of treatment with metformin the child's blood sugar levels are not consistently within a target range, other medicine usually is added.
Insulin may be given as a single nighttime dose, as several smaller doses throughout the day, or both. Insulin doses for children with type 2 diabetes are usually high—to overcome the body's resistance to insulin —which may increase the risk for weight gain.
Although alpha-glucosidase inhibitors are safe for children, they may cause abdominal gas, making them less acceptable to teens than other diabetes medicines.
When obesity is severe in older adolescents with type 2 diabetes, gastric bypass or other similar surgery may be considered as a last resort. For more information, see the topic Obesity.
Children who have type 2 diabetes should not try to lose weight by following a fad diet or by enrolling in a quick-fix weight loss program. Most doctors recommend that overweight children eat a healthy diet that provides appropriate calories to prevent further weight gain.
Weight loss is appropriate if your child is overweight and he or she has reached adult height. In some severe cases, weight loss before your child reaches his or her full adult height may be needed.
Other types of treatment for diabetes are provided by therapists or others who do not operate within mainstream medical practice. None of these complementary therapies have been proved to be effective in treating diabetes. But your child may benefit from safe, nontraditional therapies that complement conventional medical treatment for the disease. Talk with your doctor before seeking any complementary therapies for your child.
Other Places To Get Help
Last Revised: August 1, 2012
Author: Healthwise Staff
U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
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