Not Your Daddy's Diabetes
Type 2 Affecting Children Younger and Younger

Alba Morales, MD, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences

As recently as 15 years ago, type 2 diabetes was commonly called "adult-onset diabetes" because only people over the age of 40 were affected by this serious disease. The number of children who suffer from type 2 diabetes has been growing at an alarming rate since the mid-1980s. The main clear cause for this dramatic change is the rise in childhood obesity among children in North America and many other parts of the world.

Sadly, at this moment, one out of three new cases of childhood diabetes is type 2 diabetes. A person with this kind of diabetes is able to produce insulin – the hormone that regulates blood sugars – but for several reasons, this insulin is not able to keep blood sugars under normal control. In contrast, a person with type 1 diabetes (also known as "childhood-onset diabetes") suddenly stops producing insulin and will always require insulin injections in order to survive.

Many scientific studies show that the health consequences of having type 2 diabetes at a young age seem to be worse than having type 1 diabetes at a similar age. It's also shown to be worse than having diabetes after the age of 30. For example, a person who developed type 2 diabetes before the age of 30 is more likely to develop kidney failure than a person who developed diabetes after the age of 30.

Early diabetes also increases the risk of heart attacks, stroke and blindness at an early age. In other words, an adolescent who developed type 2 diabetes at age 15 is more likely to suffer from the long-term complications related to diabetes than a child who developed type 1 diabetes at the same age. This means children who develop type 2 diabetes are more likely to experience kidney failure, stroke and heart attack down the line.

The medical options for treating type 2 diabetes in children are very few. At this moment, only insulin injections and a pill called metformin (also known as Glucophage) are approved for use in patients under the age of 18. Following a healthy diet and daily vigorous exercise are also part of managing diabetes in all persons with this disease.

Who is at risk to develop type 2 diabetes at a young age?

There are several well-known risk factors for developing type 2 diabetes at a young age. Think about whether any of these might apply to your child:

A record of high blood sugars in the mom or dad (even if it happened only during pregnancies for the mother).

A history of being overweight or obese (if you are unsure about whether your child is overweight, ask your family doctor to show you his or her growth curve and explain what it means).

A lifestyle with very little exercise (that may mean the only exercise your child gets is PE at school or walking to and from classes). The American Academy of Pediatrics recommends that every child gets at least 60 minutes of vigorous exercise every day. The activity should make the child breathe hard and increase their heart rate significantly in order to be effective.

How can you keep your child from developing type 2 diabetes?

Find out whether your child's weight is within the healthy range. Kids who carry extra weight tend to be taller, appear older and mature faster than their classmates. This can be noticeable as early as age 2 or 3 for some children.

Ask your child's doctor to show you his or her growth curve and what it means.

Ask your primary care doctor about healthy nutrition and how you can incorporate it in your lifestyle:

  • Which foods are most nutritious?
  • Which foods should I limit in my household?
  • What is a good portion size for the age of my child?
  • What are some good snack options?
  • How should I limit my child's screen time?

What are the early warning signs of type 2 diabetes?

The most common and visible physical finding in children with prediabetes and type 2 diabetes is a change in his or her skin called "acanthosis nigricans." It is a darkening and thickening of the skin most often seen at the back of the neck. Darker skin can also be found on the underarms, front of the elbows and knuckles, knees and under the breasts. Some parents will mistake this darker skin for "dirtiness" and will try to scrub it off without success.

Increased urination and thirstiness can also be found in children who have type 2 diabetes.

What should you do if you think your child may be developing type 2 diabetes?

Take your child to his or her pediatrician or primary care physician, talk about your child's risk factors for the disease and ask that your child be checked for diabetes.

Do not rely on the information obtained through the use of home monitors for blood sugar levels. These devices are not as accurate as the laboratory in a clinic or hospital, and they may provide you with wrong information.

What happens if my child is diagnosed with type 2 diabetes?

If your physician does not feel comfortable managing diabetes in children, you will most likely be referred to the Diabetes Clinic at Arkansas Children's Hospital.

If your child's blood sugar levels are mostly above 200 mg/dl, it is likely that he or she will need to start treatment with insulin injections and will need to be admitted to the hospital for insulin and diabetes education. During the two-day admission, the families are taught about the disease, diet, insulin injections and blood sugar monitoring.

If your child's blood sugar levels are on average lower than 200 mg/dl, it is likely that diabetes education and oral treatment of the disease will be done at the Outpatient Diabetes Clinic without requiring admission to the hospital.

Families with children who recently have been diagnosed with diabetes will get to meet with several members of the diabetes team including:

  • A doctor who is a diabetes specialist;
  • A certified diabetes educator, usually a nurse or dietitian;
  • A social worker who meets all the new families in our practice;
  • A dietitian/nutritionist;
  • A child psychologist (as needed); and
  • A pharmacy specialist (as needed).

Children with diabetes are seen in the Outpatient Clinic at ACH every three to six months depending on their needs.

Families are taught how to keep close communication with our diabetes team in between clinic visits. As children grow and change, their medication requirements also change. This means communication between families and the medical team is extremely important for the wellbeing of these kids.

Family support makes a big difference for anyone with type 2 diabetes. By opting for healthy lifestyle changes and emphasizing the importance of sticking to them, families can work together to give their kids a brighter and better future.


Hope Student a "Model" for Other Children with Type 2 Diabetes

At 12, Kazhya Henry has a lot to think about every time she sits down for a meal or wants to grab a snack. How many carbs does that food have? How will it affect her blood sugar? Is it a healthy choice?

These are the questions that children with type 2 diabetes have to ask themselves all the time. It can be challenging to get in that mind-set, especially with sugary foods and drinks as an ever-present temptation, but Kazhya has adjusted well.

"She is just a wonderful example of compliance and a positive attitude," said Geri Maxfield, RN, the school nurse who works with Kazhya at Beryl Henry Upper Elementary in Hope, Ark. "It's a hard diagnosis, but Kazhya has never come in with a sour attitude."

The sixth-grader reports to Maxfield's office each day for her blood sugar checks and to present a food diary.

"Kazhya is very careful about telling us what she ate and she understands how that affects her health," Maxfield said.

Like many people who are diagnosed as children, diabetes runs in Kazhya's family. Her grandmother had it, so Kazhya's mother, Tiffany Stuart, was familiar with the disease.

"We've made her treatment a family effort," said Tiffany. "At youth group, we take healthy snacks and ask other parents to do the same. We try to create an environment where nothing can stop her."

Kazhya is seen at the Arkansas Children's Hospital Type 2 Diabetes Clinic. As recently as last May, she had a hard time swallowing pills, so after her diagnosis, Kazhya needed insulin shots.

She's made enough progress that her doctors think she'll no longer need shots by the end of the year.

"We're so proud of how she's taken on this burden and learned how to make healthy decisions because of it," Tiffany said. "She's a great role model for her siblings, too!"