Diabetes experts around the country have noticed an alarming increase in the cases of type 2 diabetes among children and adolescents.
A Growing Problem
"Up until five years ago, we had probably been seeing about one to two children per year who presented with type 2 diabetes [in our practice]," says Kenneth Jones, MD, chief of pediatric endocrinology and diabetes at the University of California at San Diego and a member of the ADA consensus panel. "But over the past five years, we have seen those numbers jump to 14 to 16 cases per year."
In this study all but one were overweight, and 83 percent were obese. The researchers also found that most of the youngsters with type 2 diabetes were from ethnic minority populations and had a skin condition known as acanthosis nigricans (a dark skin discoloration often found on the neck, which is common in adults with type 2 diabetes). A majority of the children in the study also had close relatives with type 2 diabetes. And two studies of Native Canadian populations also showed increasing numbers of children with type 2 diabetes and a link to obesity.
Silva Arslanian, MD, professor of pediatrics at the Children's Hospital of Pittsburgh and a member of the ADA consensus panel, studies insulin resistance during childhood growth and development. She says it is important for parents and doctors to be alert to the signs of diabetes in children and for doctors to make an accurate diagnosis, because the therapeutic approaches will be very different."
Is your child excessively thirsty?
Does your child have to urinate more frequently than usual?
Is your child unusually tired for no apparent reason?
Does your child seem to lack energy?
Just because your child has one of the symptoms above doesn't necessarily mean he or she has diabetes. But a visit to the doctor may be in order if there is any change in the way your child is feeling. When you make the doctor's appointment, make it clear that you want your child tested for diabetes. If your doctor dismisses your concerns, be firm and insist on a blood glucose test. If your doctor refuses to test for diabetes or does not take your concerns seriously, it may be time to find a new doctor.
Type 1 Or Type 2?
Type 1 diabetes is an autoimmune disease that results in the destruction of the insulin-producing cells of the pancreas. Because it usually affects children and young adults, it used to be called "juvenile-onset diabetes."
Type 2 diabetes usually does not develop until adulthood and used to be called "adult-onset diabetes." It occurs either because the body doesn't make enough insulin, the cells of the body become resistant to insulin, or a combination of both. Usually people with type 2 diabetes are older, overweight, and sedentary. And that may be why, as Maureen observed, physicians are reluctant to diagnose or even test children and adolescents for type 2 diabetes.
To make an accurate diagnosis, a physician has to put together many different factors. Typically, children with type 1 diabetes are not overweight and may have even recently lost weight. They may be thirsty all the time and need to urinate frequently. Usually a child with type 1 diabetes is extremely tired and may even develop a dangerous condition called diabetic ketoacidosis, which is characterized by severe elevations of blood glucose and a buildup of acids in the blood. Ketoacidosis can lead to severe dehydration, loss of consciousness, coma, and even death. The symptoms may come on suddenly and do not usually last long before medical care is sought. Approximately 5 percent of children with type 1 diabetes have a close relative with the disease.
In contrast, children with type 2 diabetes are most likely overweight or obese, and have only mild symptoms of thirst and frequent urination. Most children with type 2 diabetes have high blood glucose levels (over 200 mg/dl) without ketoacidosis. Often, children with type 2 diabetes have a strong family history of type 2 diabetes, and are frequently members of ethnic minority populations, and are of African, Hispanic, Asian, or Native American descent. Type 2 diabetes in children is also more likely to occur during adolescence and is more common in girls than in boys.
The best way to deal with type 2 diabetes in children is to prevent it from developing in the first place. Not surprisingly, the panel recommended that all kids at risk for type 2 diabetes keep their weight under control and get plenty of exercise.
Ideally, the prevention of type 2 diabetes would include a public health approach that targets all children. School- and community-based programs should be developed to promote improved eating habits and physical activities for all children and their families, the panel concluded.
"There has been an enormous increase over recent years in the number of obese children in this country," says Jones. "The biggest jump has occurred in the last decade. It's a shame that these days, when we see the nation as a whole getting more obese, schools are cutting back physical education programs. Now more than ever, those programs should be increasing."
Nancy Touchette is a writer from Baltimore, Md.
Copyright © 2000 American Diabetes Association
Last updated: 10/00