When Sugar is Not Sweet – Are Your Children at Risk for Type 2 Diabetes?

As type 2 diabetes grew into an American epidemic in the last 20 years, doctors focused their primary attention on the middle-aged, overweight couch potato. But new research suggests it’s our children we should really be worried about.

Separate studies published recently in the journals Pediatrics and the New England Journal of Medicine show that type 2 diabetes in kids can be more difficult to treat and more aggressive than in adults. Rarely seen in youth before the 1990s, type 2 diabetes is on the rise, with one-third of children and adolescents now overweight or obese. The Centers for Disease Control & Prevention (CDC) offers the grim projection that one-third of all babies born in the United States (and more than half of Hispanic babies) will develop diabetes during their lifetime.

“The new studies should be a wake-up call,” said pediatrician Tina Carroll-Scott, M.D., medical director of the Baptist Health-supported South Miami Children’s Clinic, which cares for low-income and uninsured children. “Researchers found that medications that help control blood sugar in adults don’t work as well in children and that sometimes kids need more than one medication. It’s a scary development and even more reason to detect the disease early.”

Michele Ponce, mother of prediabetic 16-year-old Jordan, is convinced that her decision to have her son tested early even though he had no symptoms may mean he’ll never develop full-blown diabetes. “I’m glad doctors are taking this seriously. When Jordan started gaining weight in second grade, the pediatrician just said he should try to lose weight,” she said. “There were no tests done.”

By age 12, when Jordan was even heavier, Ms. Ponce took him to pediatric endocrinologist Jose Perez-Rodriguez, M.D., of Baptist Children’s Hospital. Jordan’s blood sugar was in the prediabetes range; that is, above normal but not high enough for a diabetes diagnosis. From that day on, he has taken Metformin, a drug that helps control blood sugar.

What is Diabetes?
Diabetes occurs when the body can’t produce or properly use insulin, a hormone that helps cells absorb sugar from the bloodstream to give the body energy. If the sugar isn’t transported to the cells, it can build to dangerous levels in the blood. There’s no known way to prevent or cure type 1 diabetes, an autoimmune disease in which the insulin-making cells in the pancreas are attacked and destroyed. But type 2 diabetes, caused when insulin isn’t used properly, can be delayed and controlled by maintaining a healthy weight, eating properly and exercising. Diabetes’ longterm complications include amputations due to wounds that won’t heal, blindness, kidney failure, heart disease and stroke.

Symptoms for type 1 and type 2 diabetes are similar. There may be increased thirst and frequent urination, weight loss, blurred vision and fatigue. Generally, type 1 symptoms come on stronger and more quickly than type 2 symptoms, which may develop over many years and be subtle enough to ignore.

New recommendations from the National Institutes of Health call for diabetes testing for all kids to begin at age 10 or the onset of puberty, whichever comes first. Children who are overweight, have high cholesterol or a family history should have blood tests for diabetes every two years.

Who Gets Type 2 Diabetes?
More than 90 percent of the nearly 26 million people in the United States who have diabetes are diagnosed with type 2, according to the CDC. Native Americans, Pacific Islanders, African-Americans and Hispanics are more likely to get the disease than other ethnic groups.

Although there can be a genetic link or predisposition toward type 2 diabetes, obesity and a sedentary lifestyle are major risk factors. Doctors believe that the increase in type 2 diabetes among children is partially due to eating too much fast food and sugar-filled soda and overtime with video games and TV instead of playing outside or participating in sports.

Prevention
In a study of prediabetic adults called the Diabetes Prevention Program, weight loss of 7 percent (about 15 pounds) and an increase in activity (simply walking 30 minutes most days) resulted in a decrease of diabetes development by 60 percent. Doctors say children benefit from the same lifestyle improvements, emphasizing the importance of exercise and after-school sports.

“A modest weight reduction and an increase in physical activity are superior to any medication on the market,” said Dr. Perez-Rodriguez.

Although Jordan takes Metformin, he eats fewer fried and sugary foods and has grown taller while maintaining his weight. He’ll sometimes play basketball with friends. “There’s a chance Jordan will be able to reduce his medication or come off of it altogether,” Ms. Ponce said. “If I hadn’t taken him to a specialist when he was 12, he might already have type 2 diabetes.”

“I begin talking to parents about nutrition when their children are babies,” said pediatrician Judith Lederhandler, M.D. “I talk about converting to whole grains and eating fewer processed foods. At the six-month visit, I tell parents never to give kids juice.” (See page 23 for tips on making healthy snacks and lunches with your kids.)

“The weight issue is sometimes very complicated,” said Dr. Perez-Rodriguez. “It’s not just about willpower. I try to give realistic goals. I’ll say, ‘Let’s not gain weight over the next six months.’ If that patient comes back, has grown taller and not put on pounds, I say they deserve a medal.” Those with a genetic link, like Jordan, whose grandfather has diabetes, shouldn’t throw up their hands, he said. Instead, it’s reason to be even more careful.

If your child is diagnosed with prediabetes or diabetes, he or she may be prescribed medication. For help with all diabetes issues, Baptist Health’s Diabetes Care Centers offer counseling with a certified diabetes educator (with or without a prescription). For details, or to make an appointment, call 786-596-3696.

Tags: diabetes, eating healthy, pediatrics