Type 2 Diabetes: What Is It?
The diagnosis of type 2 diabetes is becoming more common in U.S. kids and teens, especially in those who are overweight. Some studies report that between 8% and 45% of children who've been newly diagnosed with diabetes have the form known as type 2.
Diabetes is a chronic condition that needs close attention, but with some practical knowledge, you can become your child's most important partner in learning to live with the disease.
Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood.
Our bodies break down the foods we eat into glucose and other nutrients needed to fuel body functions, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can't make or can't respond to insulin properly.
Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can't get into the cells (the doors are "locked" and there is no key) and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of symptoms and health problems.
About Type 2 Diabetes
The two types of diabetes are type 1 and type 2. Both cause blood sugar levels to become higher than normal but do so in different ways.
Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) happens when the immune system attacks and destroys the cells of the pancreas that produce insulin. Kids with type 1 diabetes need insulin to help keep their blood sugar levels within a normal range.
Type 2 diabetes (formerly called non-insulin-dependent diabetes) is different. Unlike someone with type 1 diabetes, a person with type 2 diabetes still produces insulin but the body doesn't respond to it normally. Glucose is less able to enter the cells and do its job of supplying energy (this is called insulin resistance). This causes the blood sugar level to rise, making the pancreas produce even more insulin. Eventually, the pancreas can wear out from working overtime to produce extra insulin and may no longer be able to produce enough insulin to keep blood sugar levels normal.
People with insulin resistance may or may not develop type 2 diabetes — it all depends on whether the pancreas can produce enough insulin to keep blood sugar levels normal. Repeatedly high blood sugar levels are a sign that a person has developed diabetes.
Kids and teens with type 2 diabetes use diet, exercise, and medicines that improve the body's response to insulin to control their blood sugar levels. Some may need to take insulin shots or use an insulin pump, too.
Who Gets Type 2 Diabetes?
Although no one knows for sure what causes type 2 diabetes, there seems to be a genetic risk. In fact, it's estimated that 45% to 80% of affected kids have at least one parent with diabetes and may have a significant family history of the disease. In some cases, a parent may be diagnosed with type 2 diabetes at the same time as the child.
Most people who develop type 2 diabetes are overweight. Excess fat makes it harder for the cells to respond to insulin. And being inactive further reduces the body's ability to respond to insulin. In the past, doctors called this type of diabetes adult-onset diabetes because it almost exclusively affected overweight adults. Today, that description is no longer accurate. More kids and teens are being diagnosed with type 2 diabetes, probably because more kids and teens are overweight.
Certain ethnic groups also tend to be more prone to developing type 2 diabetes, including people of Native American, African American, Hispanic/Latino, or Asian/Pacific Island descent. Also, kids in puberty are more likely to develop the disease than younger kids, probably because of normal rises in hormone levels that can cause insulin resistance during this stage of rapid growth and physical development.
Signs and Symptoms
The symptoms of type 2 diabetes aren't always obvious and they can take a long time to develop. Sometimes, there are no symptoms. It's important to remember that not everyone with insulin resistance or type 2 diabetes develops these warning signs, and not everyone who has these symptoms necessarily has type 2 diabetes.
But kids or teens who develop type 2 diabetes may:
- Urinate frequently. The kidneys respond to high levels of glucose in the blood by flushing out the extra glucose in urine (pee). Kids with high blood sugar levels need to urinate more frequently and in larger volumes.
- Drink a lot of liquids. Because they're peeing so often and losing so much fluid, they can become very thirsty and drink a lot in an attempt to keep the levels of body water normal.
- Feel tired often. This is because the body can't use glucose for energy properly.
Complications of Diabetes
Sometimes, kids and teens with type 2 diabetes, insulin resistance, or obesity might develop thick, dark, velvet-like skin around the neck, armpits, groin, between fingers and toes, or on elbows and knees — a cosmetic skin condition called acanthosis nigricans.
Polycystic ovary syndrome (PCOS) in girls is also often associated with insulin resistance. PCOS is a hormone problem that can cause the ovaries to become enlarged and develop cysts (fluid-filled sacs). Girls with PCOS often have irregular periods, might stop having periods altogether, and may develop excess facial and body hair growth. PCOS also can cause fertility problems.
People with insulin resistance or type 2 diabetes are also more likely to develop hypertension (high blood pressure) or abnormal levels of blood fats (cholesterol and triglycerides). When these problems cluster together, doctors call this metabolic syndrome. People with metabolic syndrome have a greater risk of developing heart disease, stroke, and other health problems.
Diabetes also can cause long-term complications, including heart disease, stroke, eye problems, kidney disease, nerve damage, and gum disease. While these problems don't usually show up in kids or teens who've had type 2 diabetes for only a few years, they can affect them in adulthood, particularly in those whose diabetes hasn't been well controlled.
Doctors can determine if a person has diabetes by testing blood samples for glucose. Even if a child or teen doesn't have any symptoms of type 2 diabetes, doctors might do blood tests to check for it in kids who are more likely to get it — like those who are overweight.
If you think your child has symptoms of diabetes, talk to your doctor, who may refer you to a pediatric endocrinologist, a doctor who specializes in the diagnosis and treatment of diseases of the endocrine system (such as diabetes and growth disorders) in kids.
Living With Type 2 Diabetes
Kids or teens with type 2 diabetes may need to:
- Eat a healthy diet to help achieve a normal body weight while getting the nutrients needed to grow and develop. Doctors may recommend a low-salt or low-fat diet, especially if they have conditions such as high blood pressure or abnormal blood fat levels.
- Participate in physical activity regularly. Exercise helps increase the body's response to insulin, and it helps the body burn more calories, which can promote the loss of excess body fat.
- Get to and maintain a normal body weight.
- Monitor blood sugar levels regularly.
- Take insulin or other medicines that help the body respond to insulin more effectively.
- Work closely with their doctors and diabetes health care team to get the best possible diabetes control.
- Be monitored for signs of complications and other health problems that can affect people with type 2 diabetes.
Living with diabetes is a challenge for anyone, but kids and teens often have special issues to deal with. Young kids might not understand why blood testing and medicines are necessary. They might be scared, angry, and uncooperative.
Teens may feel different from their peers and want a more spontaneous lifestyle than their diabetes allows. Even when they faithfully follow their treatment schedule, they might feel frustrated if the natural body changes of puberty make their diabetes somewhat harder to control.
Having a child with diabetes may seem overwhelming at times, but you're not alone. Your child's diabetes care team is not only a great resource for dealing with medical issues, but also for supporting and helping you and your child.
What's New in the Treatment of Type 2 Diabetes?
Doctors and researchers are developing new equipment and treatments to help kids deal with the special problems of growing up with diabetes.
Some kids and teens already use new devices that make blood glucose testing and insulin injections easier and more effective. One of these is the insulin pump, a mechanical device that can be programmed to deliver insulin more like the pancreas does.
Researchers are also testing ways to stop diabetes before it starts. For example, scientists are studying whether diabetes can be prevented in those who may have inherited an increased risk for the disease.
Until scientists have perfected ways to better treat and possibly even prevent or cure diabetes, parents can help their kids lead happier, healthier lives by giving constant encouragement, learning all they can about the disease, and making sure their kids eat properly, exercise, and stay on top of glucose levels every day. This will help their kids do all the things that other kids do, while helping them grow up to be healthy, well-adjusted, productive adults.