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 sugar 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:
Having to urinate more often.
Feeling a little more thirsty than normal.
Losing a
little weight for no clear reason.
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 as close to normal as possible. To do
this:
Keep track of your child's blood sugar
levels. This will help you and your child learn how different foods and
activities affect his or her blood sugar. Your doctor can teach you and your
child how to do this.
Teach your child to make healthy food
choices.
Help your child to eat about the same
amount of
carbohydrate at each meal. This helps keep your
child's blood sugar steady. Carbohydrate affects blood sugar more than other
nutrients. It is found in sugar and sweets, grains, fruit, starchy vegetables,
and milk and yogurt.
Talk to your doctor, a diabetes educator, or a dietitian
about an eating plan that will work for your child. There are many ways to
manage how much and when your child eats.
Help your child stay active. Your child does
not have to start a strict exercise program, but being more active can help
control blood sugar. For example, your child could play outside with friends,
take walks with family members, or take part in sports.
Set a good
example. It will be easier for your child if the rest of the family also eats
well and gets regular exercise. This may also reduce the risk that other family
members will get the disease.
If your child needs medicine for
diabetes, make sure that he or she takes it as prescribed.
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 eye, heart, blood vessel, nerve, and
kidney. 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.
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
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.
Factors that affect the body's
resistance to insulin in childhood include:
Developmental stage. Insulin resistance
normally increases about 30% during puberty, probably because of the effects of
growth hormone.1
Being female. Girls seem
to develop more resistance to insulin than boys.
Race. The body's
resistance to insulin is about 30% higher in African-American teens than in
white teens.2
Body composition. Insulin
resistance increases as the amount of
fat around the waist increases.
Activity. Exercise may improve how the
body's cells use insulin and get the sugar they need.
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:
Slight increase in the frequency of urination.
If your child has already learned to use the toilet, he or she may have started
wetting the bed during naps or at night.
Slight increase in
thirst.
Other possible symptoms include:
Increased
tiredness.
Nausea.
Blurred vision.
Frequent
infections and slow-healing wounds or sores.
Weight loss.
What Happens
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 make it more difficult 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.
Very little is known about the way type 2
diabetes becomes worse over time in children because, until recently, few
children had the disease. Diabetes experts believe the disease progresses as it
does in adults, causing damage to the eyes, kidneys, heart, blood vessels, and
nerves. The main risk factors for complications 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.
Complications can lead to serious disabilities, such
as blindness, and early death.
Studies show that when children
develop diabetes, complications begin to develop in young adulthood. Delayed
diagnosis and failure to keep blood sugar levels in a
normal or near-normal range can lead to early
development of complications. The longer a child has diabetes, the more likely
it is that complications will develop in young adulthood.3
Children and teens may develop eye disease
(diabetic retinopathy) and kidney disease (diabetic
nephropathy).4
Children and teens rarely
have symptoms of nerve disease (diabetic neuropathy).4
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 beginning of menstruation may be delayed.
The way to prevent complications is to always keep blood sugar levels at a
target level. 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 as well 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 developing diabetes and heart
disease.
What Increases Your Risk
The major risk factors for
type 2 diabetes in children include:
Being overweight.
Getting little or no physical activity.
Family
history. At least 75% of children with type 2 diabetes have a parent, sister,
or brother with the disease.2
Other factors that increase risk include:
Race. African-American, Hispanic, Native
American, Asian-American, and Pacific Islander children are at greater risk for
developing type 2 diabetes than white American children.
Being
female. Girls are more likely to develop the disease than boys.
The
child's mother having diabetes that developed during pregnancy (gestational diabetes).
Medical conditions that contribute to the risk of
complications in adolescence and beyond include:
Drowsy, confused, breathing fast, and your
child's breath smells fruity. Your child may have high blood sugar, called
hyperglycemia. A life-threatening condition called
diabetic ketoacidosiscould be present.
Call a doctor immediately if your
child is vomiting and cannot keep down liquids and has a blood sugar of 250
mg/dL or higher.
Call a doctor if your child:
Is sick for more than 2 days (unless it is a mild illness,
such as a cold), and your child:
Has been vomiting or had diarrhea for
more than 6 hours.
Has blood sugar levels that
are often above 250 mg/dL and
urine tests for ketones show more than 2+ or moderate
or higher ketones.
Has a blood sugar level that stays below the target range
after eating some
quick-sugar food.
Has a blood sugar level
that stays high after taking a missed dose of insulin or oral diabetes
medicines or after taking an extra dose of insulin (if prescribed by the
doctor).
Has frequent problems with high or low blood sugar
levels. The insulin dose or schedule may need to be changed.
Is having
problems following the meal plan or getting physical activity, and you want
help.
Watchful Waiting
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:
You think your child may have symptoms of
type 2 diabetes. A simple blood test is all that is needed to determine whether
your child has the disease.
Your child is overweight and gets
little or no exercise. He or she is at risk for developing diabetes. Early
detection and treatment for type 2 diabetes can prevent or delay complications
from the disease.
You have been told that your child has
prediabetes. This condition can lead to type 2
diabetes. If your child eats a healthy diet and exercises regularly, he or she
may not develop diabetes.
Who To See
Most doctors can diagnose diabetes. After your child
has been diagnosed, your doctor will work with you to develop 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:
A
certified diabetes educator (CDE). A CDE is a
registered nurse, dietitian, doctor, pharmacist, or other health professional
who has special training and experience in caring for people with
diabetes.
A
registered dietitian, to help develop a daily meal
plan for your child and your family.
A
psychologist, to help with emotional or family issues
that might affect treatment.
An exercise specialist, to help your
child and family plan a program of regular physical activity.
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.
A doctor may want to assess your child for type 2 diabetes if he or she
has a
body mass index (BMI) or weight above the 85th
percentile for his or her age and gender or weighs more than 120% of ideal and
has any two of these risk factors:5
Family history of type 2
diabetes
Being a Native American, African-American, Latino,
Asian-American, or Pacific Islander
Signs of not being able to use
insulin properly (insulin resistance) or conditions associated with it, such
as:
Some children have very high blood sugar levels at the time
of diagnosis. A child with very high blood sugar can become confused, sleepy,
or unconscious, and may develop
diabetic ketoacidosis (DKA), which is an emergency.
DKA is most common in people with
type 1 diabetes and in some African-American people
who have type 2 diabetes.
If a doctor suspects that your child may
have type 2 diabetes, he or she will do a
medical history,
physical examination, 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.
If a
child has no diabetes symptoms, two blood tests done on separate days are
needed to confirm the diagnosis. Two types of tests used to diagnose diabetes
are:
A
blood glucose test. A fasting blood sugar test (done
after not eating or drinking for 8 hours) is preferred.
A
glucose tolerance test. The child has a fasting blood
sugar test and then drinks a sweet liquid with a certain amount of glucose in
it. The child's blood sugar is tested two hours later.
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 distinguish 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 indicate 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 throughout life.5
Kinds and frequency of tests and examinations for type 2 diabetes5
Frequency
Exams and tests
Every 3-6 months
Have a medical checkup to review blood
sugar levels since the last checkup and evaluate whether your child's treatment
plan needs to be changed. Bring your child's home blood sugar records to this
appointment. Keep a record with notes of special issues such as changes in
diet, in activity, and when your child has low blood sugar problems. Bring this
record to the appointment too. During each visit, the doctor will check your
child's blood pressure.
Have a hemoglobin A1c or similar blood test (glycosylated
hemoglobin or
glycohemoglobin) to estimate your child's average
blood sugar level over the previous 2 to 3 months. This test may be done every
3 to 6 months.
Your child may need to have a blood sugar test
(blood glucose test). If so, you may want to run a
home blood sugar test when your doctor draws blood for
the test. This is a good way to check the accuracy of your home meter.
Every 6 months
Have a dental exam to check for gum
problems.
Every year
See an eye specialist
(ophthalmologist) for an exam, including
ophthalmoscopy. If your child is at low risk for
vision problems, your doctor may consider follow-up exams every 2
years.
Have a screening test for kidney function.
Urine tests look for the amount of protein in the
urine (proteinuria), an indicator of kidney damage. Usually, you give a single
urine sample, to test for an
albumin-to-creatinine
ratio. Some doctors do a urine test for protein that estimates protein but does
not provide a ratio. Another way to test kidney function is to do a 24-hour
urine collection. This may be better because protein levels can be different at
different times of the day. Home urine collection kits are available.
Your child may need a thorough medical examination of his
or her feet at least once a year. Yearly foot exams are recommended for all
people with diabetes, and it may help your child understand the importance of
proper foot care.6
At the time of diagnosis and as
needed
After blood sugar levels are under control
Every
year if the child has blood sugar levels above a target range and high
LDL cholesterol
Every 5 years if the child
has low risk and does not have a family history of the disease
Have a
cholesterol and triglyceride level test to see whether
diabetes may be raising the cholesterol level in your child's
bloodstream.
Have liver enzymes tested to see whether diabetes and
obesity may be harming liver function.
Early Detection
Starting at age 10 or at the beginning of
puberty, a child who has a
body mass index (BMI) in the 85th percentile or higher
for his or her age or whose weight is more than 120% of ideal and has two of
the following risk factors needs to be tested for diabetes every 2
years:5
Family history of type 2
diabetes
Being a Native American, African-American, Latino,
Asian-American, or Pacific Islander
Signs of not being able to use
insulin properly (insulin resistance) or conditions associated with it, such
as:
If the results of a glucose test show that your child's
blood sugar is higher than normal but not yet at the level of diabetes (prediabetes), the test should be repeated 3 months
later to see whether your child has developed diabetes.4 If your child eats a healthy diet and gets regular exercise,
he or she may not develop diabetes.
Treatment Overview
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.
Healthy eating
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 fits your child's
needs. For more information, see the topic
Healthy Eating for Children.
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
participate 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.7 And 3 or more days a week,
what they choose to do should:
Make them breathe harder and make the heart
beat much faster.
Make their muscles stronger. For example, they
could play on playground equipment, play tug-of-war, lift weights, or use
resistance bands.
Make their bones stronger. For example, they
could run, do hopscotch, jump rope, or play basketball or tennis.
It's okay for them to be active in smaller blocks of time
that add up to 1 hour or more each day.
For children older than
age 2: The American Academy of Pediatrics advises parents to limit TV time to 2
hours a day or less. For children age 2 and younger: To help your child's brain
develop, it's best to talk, play, sing, or read together instead of letting him
or her watch TV.
Medicines
Your child may need medicines if 3
months of eating healthy meals and getting regular physical activity have not
lowered your child's blood sugar to his or her target level.
Oral medicines for diabetes help the body
produce more insulin, decrease the body's
resistance to insulin, or slow the absorption of
carbohydrate from the intestine. Your child may need one medicine at some times
and more than one at other times.
Some children need daily
insulin shots-alone or with oral 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. If the
progression of diabetes cannot be stopped, your child eventually may need to
take insulin daily.
Checking blood sugar, blood pressure, and cholesterol
Your child's blood sugar level needs to be checked regularly. Your child
will probably have to test before breakfast and 2 hours after meals.
If your child has high blood pressure or high cholesterol, those
conditions need to be treated.
High blood pressure is usually treated with
angiotensin-converting enzyme (ACE) inhibitors because
these medicines also protect the circulatory system and the kidneys from damage
caused by diabetes. Sexually active teens should be warned that ACE inhibitors
should not be taken during pregnancy.
Weight loss and
well-controlled blood sugar can help lower your child's cholesterol. Your
child's doctor may recommend medicine if these lifestyle changes do not lower
cholesterol. Sexually active teens should be warned against becoming pregnant
while taking these medicines.
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 insulin or some oral
medicines (or both) increases the risk for
low blood sugar episodes. Your doctor will determine
the 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 necessary to control diabetes can be especially difficult 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 developing diabetes.
Teens who have
depression or an
eating disorder may have difficulty keeping their
blood sugar at a healthy level. In addition, 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.
Prevention
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. One study found that 25% of children between the ages of 4 and 10 and
21% between the ages of 11 and 18 who were very overweight had
prediabetes.8 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.
Studies have shown that lifestyle changes
can prevent or delay type 2 diabetes in adults.9 But
experts are not sure whether lifestyle changes will have the same effect in
children. Studies on preventing type 2 diabetes in children and teens are
ongoing. Some clinical trials show that a program of physical activity and
healthy eating can decrease
insulin resistance and control blood glucose.10
Diabetes prevention may begin in infancy: some
evidence shows that breast-feeding lowers a child's risk of developing
diabetes.11
Home Treatment
Healthy eating
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.
For help
learning about carbohydrate counting, see:
Encourage your child (age 6 to
17) to do moderate to vigorous activity at least 1 hour every day. If your
child enjoys watching TV or playing computer and video games, limit the time
spent in these activities.
Guidelines for child and teen fitness may be helpful
in encouraging your child to play sports and take vigorous walks or go
bicycling with family members.
For children older than age 2: The
American Academy of Pediatrics advises parents to limit TV time to 2 hours a
day or less. For children age 2 and younger: To help your child's brain
develop, it's best to talk, play, sing, or read together instead of letting him
or her watch TV.
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:
Let the coach know that your child has
diabetes. If your child does not take insulin, he or she may not be at risk for
low blood sugar episodes, but giving the coach a copy of the
symptoms of low blood sugar may still be a good
idea.
Take your child's
home blood sugar meter to sports practice sessions and
games. Check his or her blood sugar level before and after each activity if
needed.
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 the safest blood sugar 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
normal or near-normal 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 oral 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. See:
How to recognize and treat low blood sugar. Your child is not
likely to have a sudden drop in blood sugar level unless he or she is taking
sulfonylurea or meglitinide medicines for diabetes or insulin injections and is
unable to eat regular meals.
Wearing
medical identification at all times. In an emergency, medical identification
lets people know that your child has diabetes so they can care for your child
appropriately.
Where to get support. Many areas of the country have
support groups for children and teens with diabetes and for family members.
These groups provide encouragement and suggestions that may help you and your
child deal with the daily issues of diabetes care. Talk with your doctor about
groups in your area.
How to care for the feet. Your child needs to
wear shoes that fit properly. He or she should not go barefoot, even in the
house. It's a good idea to begin the habit of inspecting your child's feet at
the end of each day. Look for signs of injury or infection. If you notice a
foot problem, even a minor one, talk with your doctor before treating
it.
What to do for illness. Some general
sick-day guidelines may be helpful. These include
checking your child's blood sugar every 4 hours during the illness and
encouraging your child to drink fluids to prevent dehydration. Do not give your
child any
nonprescription medicines without talking with a
doctor or pharmacist. Some of these medicines can affect blood sugar
levels.
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 also may deny their diabetes, 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.
Children in elementary school can cooperate
in all tasks required for their care. By age 8, children can test their own
blood sugar with supervision.
Children in middle school or junior
high school should be able to test their own blood sugar, but they may need
help during low blood sugar episodes. By age 10, some children can give insulin
injections with supervision.
Teens should be able to handle their
care with appropriate supervision. If the teen needs to take insulin, he or she
may choose to use an
insulin pump instead of injections. If your teen
chooses to use a pump, be sure to supervise.
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 oral 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.
Medication Choices
Medicines that decrease insulin resistance:
Biguanides, such as metformin
(Glucophage or Glucophage XR) or the combination medicine metformin and
glyburide, a sulfonylurea (Glucovance)
Thiazolidinediones, such as pioglitazone (Actos) and
rosiglitazone (Avandia)
Medicines that increase insulin production:
Sulfonylureas, such as glipizide
(Glucotrol), glyburide (for example, DiaBeta, Glynase, or Micronase),
glimepiride (Amaryl), the combination medicine glyburide and metformin
(Glucovance), or the combination of glipizide and metformin HCL
(Metaglip)
Meglitinides, such as repaglinide
(Prandin) and nateglinide (Starlix)
Statins may be used if a healthy diet and physical
activity do not lower cholesterol. Sexually active teens should be warned
against becoming pregnant while taking these medicines.
What To Think About
Metformin is the only oral
medicine that has been adequately studied in children and approved by the U.S.
Food and Drug Administration (FDA) for use in children. Other oral medicines
are safe for adults, and some doctors also use them to treat children.
Exenatide, which is injectable, has not been studied in children but is used in
adults with type 2 diabetes.
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
oral diabetes medicines.
Surgery
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.
Other Treatment
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. See the
Interactive Tool: What Is Your Child's BMI?
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 the following or other complementary therapies for your child.
Herbal medicines and natural substances, such as antioxidants, vanadium, magnesium, and
chromium. Studies have indicated that chromium picolinate, vitamin C, biotin,
soluble fiber, and vanadium may help people with type 2 diabetes keep blood
sugar levels within a target range.12
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
Centers for Disease Control and Prevention
(CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone:
1-800-CDC-INFO (1-800-232-4636)
TDD:
1-888-232-6348
E-mail:
cdcinfo@cdc.gov
Web Address:
www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health-by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.
National Diabetes Education Program
(NDEP)
1 Diabetes Way
Bethesda, MD 20814-9692
Phone:
1-800-438-5383 to order materials (301) 496-3583
E-mail:
ndep@mail.nih.gov
Web Address:
http://ndep.nih.gov
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
(www.cdc.gov/team-ndep).
National Diabetes Information Clearinghouse
(NDIC)
1 Information Way
Bethesda, MD 20892-3560
Phone:
1-800-860-8747
Fax:
(703) 738-4929
TDD:
1-866-569-1162 toll-free
E-mail:
ndic@info.niddk.nih.gov
Web Address:
http://diabetes.niddk.nih.gov
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK)
Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone:
(301) 496-3583
Web Address:
www.niddk.nih.gov
The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) provides information and conducts research on a wide
variety of diseases as well as issues such as weight control and
nutrition.
Weight-Control Information Network
(WIN)
1 WIN Way
Bethesda, MD 20892-3665
Phone:
1-877-946-4627 toll-free
Fax:
(202) 828-1028
E-mail:
win@info.niddk.nih.gov
Web Address:
http://win.niddk.nih.gov/index.htm
The Weight-control Information Network (WIN) is a
service of the National Institute of Diabetes and Digestive and Kidney
Diseases, part of the National Institutes of Health. WIN supplies information
on weight control, obesity, and nutritional disorders for the public and for
health professionals.
Curtis J, et al. (2001). Diagnosis and short-term
clinical consequences of diabetes in children and adolescents. In HC Gerstein,
RB Haynes, eds., Evidence-Based Diabetes Care, pp.
107-123. Hamilton, ON: BC Decker.
American Diabetes Association (2000). Type 2 diabetes
in children and adolescents (Consensus Statement, 2000). Diabetes Care, 23(3): 381-389.
Fagot-Campagna A (2000). Emergence of type 2 diabetes
mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6):
S1395-S1402.
Orr DP (2008). Diabetes mellitus. In LS Neinstein,
ed., Adolescent Health Care: A Practical Guide, 5th ed.,
pp. 170-178. Philadelphia: Lippincott Williams and Wilkins.
American Diabetes Association (2008). Standards of
medical care in diabetes. Diabetes Care, 31(Suppl 1):
S12-S54.
American Diabetes Association (2004). Preventive foot
care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63-S64.
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/pdf/paguide.pdf.
Sinha R, et al. (2002). Prevalence of impaired glucose
tolerance among children and adolescents with marked obesity. New England Journal of Medicine, 346(11):
802-810.
Diabetes Prevention Program Research Group (2002).
Reduction in the incidence of type 2 diabetes with lifestyle intervention or
metformin. New England Journal of Medicine, 346(6):
393-403.
Savoye M, et al. (2007). Effects of a weight
management program on body composition and metabolic parameters in overweight
children: A randomized controlled trial. JAMA, 297(24):
2697-2704.
Bennett PH, et al. (2003). Other risk factors section
of Epidemiology of diabetes mellitus. In D Porte Jr et al., eds.,
Ellenberg and Rifkin's Diabetes Mellitus, 6th ed., p.
290. New York: McGraw-Hill.
Goguen JM, Leiter LA (2001). Alternative therapy: The
role of selected minerals, vitamins, fiber, and herbs in treating
hyperglycemia. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 295-322. Hamilton, ON: BC Decker.
Other Works Consulted
Arslanian SA (2000). Type 2 diabetes mellitus in
children: Pathophysiology and risk factors. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6):
1385-1394.
Chase HP, Eisenbarth GS (2007). Diabetes mellitus. In
WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 978-985. New York: McGraw-Hill.
Committee on Nutrition, American Academy of Pediatrics
(2003). Policy statement: Prevention of pediatric overweight and obesity.
Pediatrics, 112(2): 424-430.
Laffel L, et al (2005). Treatment of the child and
adolescent with diabetes. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 711-736. Philadelphia: Lippincott
Williams and Wilkins.
Riddle MC, Genuth S (2007). Type 2 diabetes mellitus.
In DC Dale, DD Federman, eds., ACP Medicine, section 9,
chap. 2. New York: WebMD.
Silverstein JH, Rosenbloom AL (2000). Treatment of
type 2 diabetes mellitus in children and adolescents. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6):
1403-1409.
Credits
Author
Caroline Rea, RN, BS, MS
Editor
Susan Van Houten, RN, BSN, MBA
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer
Stephen LaFranchi, MD - Pediatrics and Pediatric Endocrinology
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Curtis J, et al. (2001). Diagnosis and short-term
clinical consequences of diabetes in children and adolescents. In HC Gerstein,
RB Haynes, eds., Evidence-Based Diabetes Care, pp.
107-123. Hamilton, ON: BC Decker.
American Diabetes Association (2000). Type 2 diabetes
in children and adolescents (Consensus Statement, 2000). Diabetes Care, 23(3): 381-389.
Fagot-Campagna A (2000). Emergence of type 2 diabetes
mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6):
S1395-S1402.
Orr DP (2008). Diabetes mellitus. In LS Neinstein,
ed., Adolescent Health Care: A Practical Guide, 5th ed.,
pp. 170-178. Philadelphia: Lippincott Williams and Wilkins.
American Diabetes Association (2008). Standards of
medical care in diabetes. Diabetes Care, 31(Suppl 1):
S12-S54.
American Diabetes Association (2004). Preventive foot
care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63-S64.
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/pdf/paguide.pdf.
Sinha R, et al. (2002). Prevalence of impaired glucose
tolerance among children and adolescents with marked obesity. New England Journal of Medicine, 346(11):
802-810.
Diabetes Prevention Program Research Group (2002).
Reduction in the incidence of type 2 diabetes with lifestyle intervention or
metformin. New England Journal of Medicine, 346(6):
393-403.
Savoye M, et al. (2007). Effects of a weight
management program on body composition and metabolic parameters in overweight
children: A randomized controlled trial. JAMA, 297(24):
2697-2704.
Bennett PH, et al. (2003). Other risk factors section
of Epidemiology of diabetes mellitus. In D Porte Jr et al., eds.,
Ellenberg and Rifkin's Diabetes Mellitus, 6th ed., p.
290. New York: McGraw-Hill.
Goguen JM, Leiter LA (2001). Alternative therapy: The
role of selected minerals, vitamins, fiber, and herbs in treating
hyperglycemia. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 295-322. Hamilton, ON: BC Decker.
