Treatment Of Type 2 Diabetes Mellitus In Children And Adolescents
The American Academy of Pediatrics has, very recently, published management guidelines how to treat children and adolescents with type 2 diabetes mellitus. The ideal goal of treatment is normalization of blood glucose values and HbA1c. Successful control of the associated comorbidities, such as hypertension and dyslipidemia, is also important. The ultimate goal of treatment is to decrease the risk of acute and chronic complications associated with diabetes mellitus.
Most of the recommended guidelines for treatment in children with type 2 diabetes mellitus are extrapolated from experience gained in adults. Despite of severe manifestation, initial management of obese children and adolescents with type 2 diabetes mellitus should consist of behaviour modification strategies for lifestyle change such as decreasing high-caloric high-fat food choice and sedentary behaviour, while increasing physical activity. Weight control is essential for reaching treatment goals and are effective to treat type 2 diabetes mellitus in adolescents. However, lifestyle changes cannot be imposed and self-motivation is necessary. Referral to a dietician with knowledge and experience in nutritional management of children with diabetes mellitus is necessary. Dietary recommendations should be culturally appropriate, sensitive to the family resources, and provided to all caregivers. Encouraging healthy eating habits by the entire family is important .
What Causes Type 2 Diabetes At A Young Age
Historically known as adult-onset diabetes because it typically begins in middle age, type 2 diabetes is a disease caused by insulin resistance, which develops when the body cant use insulin properly and blood sugar levels are too high, according to the National Institute of Diabetes and Digestive and Kidney Diseases . Elevated blood sugar that does not rise to the level of diabetes is known as prediabetes, and is a risk factor for the later development of type 2 diabetes.
Insulin resistance usually starts during puberty, explains Perez-Colon. Typically the range is 1019 years of age. The body becomes less sensitive to insulin during this time of metabolic change, but the reasons why are not well understood, according to research published July 2016 in Current Diabetes Reports.
One way to measure blood sugar is through a hemoglobin A1C test, which gives a two- to three-month average measurement of how much glucose attaches to the hemoglobin in red blood cells. A normal A1C level is below 5.7 percent, according to the NIDDK. Between 5.7 and 6.4 percent indicates prediabetes, and a level of 6.5 percent or above means a person has diabetes.
Home Blood Sugar Monitoring
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 a target 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 . As your child grows older, the goal can be lowered so that it is closer to the recommended target range.
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Speaking To Your Child About Diabetes
Here are some recommended tips for discussing diabetes with your child:
- discuss how foods fit into a healthy lifestyle
- describe blood sugar levels as in target, high, or low
- talk to your child about other important things that are happening in their life such as school, sports and social events
- remember that diabetes is only one part of your childs life
Try;not;to describe food as bad or junk and avoid describing blood sugar levels as good or bad,.
Can Children Develop Type 2 Diabetes
While Type 2 diabetes is more common in older adults, an increasing number of children have been diagnosed with the disease. Childhood obesity is on the rise and is a major factor in this increase.
Type 2 diabetes is a chronic disease affecting the way the body processes glucose. It develops over a long period of time because there is too much sugar, or glucose, circulating in the blood stream. With Type 2 diabetes, a child’s pancreas produces insulin, but the child’s cells do not respond to insulin and the uptake of glucose from the bloodstream. This also is referred to as insulin resistance and causes elevated blood sugar levels. This differs from Type 1 diabetes in which the pancreas produces little or no insulin.
Diabetes risk factors
Researchers don’t fully understand why some children develop diabetes and others do not, even if they have similar risk factors.
However, some known risk factors that increase incidence among children include:
- Obesity Being overweight is the primary risk for developing Type 2 diabetes. Fat tissue contributes to insulin resistance.
- Type 2 diabetes is more likely to present in a childs early teens.
- Family history A risk of Type 2 diabetes increases if a child has a parent or sibling with diabetes or a mother who had gestational diabetes while pregnant.
- Inactivity Physical activity helps children control their weight and helps cells be more responsive to insulin.
Preventing diabetes in children
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Child Risk Factors For Type 2 Diabetes
Once referred to as adult-onset diabetes, type 2 diabetes has become a more common diagnosis in children. This is because of rising levels of childhood obesity over the past twenty years. Most cases of childhood diabetes are diagnosed in puberty, though children can get it as young as 8 years old. There has also been an increase in mothers who are diagnosed with gestational diabetes during pregnancy. Gestational diabetes increases the risk for developing diabetes later in life in both the mother and her baby.
Children, most often girls, are also at an increased risk for developing type 2 diabetes if they have a family history for either diabetes or obesity. If your child is of African American, Hispanic, Asian American, Pacific Islander, or Native American descent, he/she also has a higher chance of developing type 2 diabetes as a child.
Obesity is linked with insulin resistance, the leading cause of type 2 diabetes. Childhood obesity affects around 12.7 million children and teenagers in the United States. As the childhood obesity epidemic grows, so do the number of children who become insulin resistant and go on to be diagnosed with type 2 diabetes.
Which Youth Are Most At Risk Of Developing Type 2 Diabetes
A child wouldnt be screened for prediabetes or type 2 diabetes until age 10 or the start of puberty , according to American Diabetes Association guidelines. But the CDC describes risk factors that may set a child on a path to those conditions years before that, including:
- Mother had gestational diabetes
Obesity is among the modifiable risk factors. Between 1971 and 2000 the rate of obesity more than tripled in youth ages 6 to 11 and more than doubled in those ages 12 to 19, from 4 to 15.3 percent for both age ranges, according to the National Academy of Sciences. The CDC reports that obesity in youth ages 2 to 19 stood at 18.5 percent in 2016, affecting about 13.7 million children and adolescents. Hispanic and non-Hispanic Black children had higher obesity rates than non-Hispanic white children .
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Clinical Presentation Of Type 2 Diabetes Mellitus In Children And Adolescents
Obesity is the hallmark of type 2 diabetes mellitus. Most children with type 2 diabetes mellitus are obese or extremely obese at diagnosis and present with glucosuria without ketonuria, absent or mild polyuria and polydipsia, and little or no weight loss. Currently, children with type 2 diabetes mellitus are usually diagnosed over the age of 10 years and are in middle to late puberty.
In the type 2 diabetes mellitus mildest form, the diagnosis is made in an asymptomatic child during a routine medical check-up by detection of hyperglycaemia or glycosuria. One third of patients are diagnosed by urinanalysis during routine physical examination. In its severest form, the child presents with polyuria, polydipsia, and weight loss. Up to 33% in particular ethnic groups have ketonuria at diagnosis and 5%-25% ketoacidosis at presentation .1). Vary rare, type 2 diabetes mellitus manifest with a hyperglycaemic hyperosmolare coma. With these clinical pictures, often the distinction from type 1 diabetes mellitus is not possible until months later, when insulin requirements decline and a non-insulin-dependent course develops without dependence on insulin for survival.
What Causes Type 1 Diabetes
Type 1 diabetes occurs when your immune system, the bodys system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease.
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What Kind Of Exercise Should Children With Diabetes Do
Exercise is the second major factor in controlling type 2 diabetes, and it is incredibly important for all children suffering from diabetes. Recommendations stand that children with diabetes should try to exercise every day. However, parents should be aware that physical activity lowers blood sugar levels.
It may be necessary for your child to reduce their dose of insulin, as in conjunction with exercise it can significantly lower blood sugar levels and result in hypos. When carrying out physical exercise your child should be near sugar.
Physical activity also governs how much your child can eat.
If Your Child Gets Diabetes
Type 2 diabetes treatment has three goals:
Get blood glucose levels as close to normal as you can.
Get A1C levels as close to normal as you can. A1C reflects long-term bloodglucose control.
Prevent damage to the eyes, kidney, nerves, and heart.
Being overweight makes it harder to control diabetes. For this reason,striving for a healthy weight may also be part of type 2 diabetestreatment.
A child or teen who gets type 2 diabetes needs expert advice on diet andexercise. A dietitian can help both the child and the family learn to eat in ahealthy way. A pediatric exercise counselor can help the child and familystart an exercise program. In all cases, it’s a good idea for the whole familyto change its habits.
Type 2 diabetes tends to get worse over time. After a while, people withtype 2 diabetes may need drugs to keep their blood glucose levels undercontrol, even if they’ve taken good care of themselves. Drugs include insulinand many types of diabetes medicines.
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What Problems Can Happen With Type 2 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. This skin darkening can lighten over time with improvement in insulin resistance.
Polycystic ovary syndrome in girls is also often associated with insulin resistance. This hormone problem can make the ovaries become enlarged and develop cysts . Girls with PCOS might have irregular periods, might stop having periods, and may have excess facial and body hair growth. It also can cause fertility problems.
People with insulin resistance or type 2 diabetes are also more likely to develop hypertension or abnormal levels of blood fats . When these problems cluster together, it’s called metabolic syndrome. People with metabolic syndrome are at risk for heart disease, stroke, and other health problems.
Diabetes also can cause heart disease and stroke, as well as other long-term complications, including 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 if their diabetes isn’t well controlled.
Signs And Symptoms Of Type
The signs and symptoms of type-2 diabetes tend to develop over several weeks or months.
Signs and symptoms of type-2 diabetes include:
- increased urination over a period of weeks
- increased thirst and drinking over a period of weeks
When theres high sugar in the blood, the kidneys try to flush it out in urine. This is why children with type-2 diabetes might urinate more. And because the body is making a lot of urine to try to get rid of the sugar, its also using and losing a lot of water. This is why children can get dehydrated.
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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.
Type 2 Diabetes In A Four
A four-year-old First Nations boy was referred by his family physician for evaluation of new-onset diabetes at a diabetes centre for children and adolescents in Winnipeg, Manitoba. Because of the high rates of type 2 diabetes in Manitoba First Nations children, the family physician had screened the boy for diabetes. At the time of screening, both the parents and child said that he had no symptoms, but on direct questioning, it became clear that he had been experiencing polyuria, polydipsia and nocturia for two months.
Our patient had been in the 97th percentile for weight at birth and was delivered vaginally following induction for polyhydramnios. His mother had had pregestational type 2 diabetes treated with insulin, and he had experienced persistent newborn hypoglycemia that required hospital admission. He was formula fed. His parents reported that he had minimal physical activity, a high intake of sugar-containing beverages, and poor sleep habits. Several of his family members had been given a diagnosis of type 2 diabetes: his mother , his maternal grandparents, paternal grandfather, two aunts and two uncles. Our patient had two healthy siblings and there was no family history of type 1 diabetes or other autoimmune diseases.
Timeline in weeks and months depicting clinical care of a boy diagnosed with type 2 diabetes at the age of four years. He was initially screened and given the diagnosis at week 0. HbA1c = glycated hemoglobin.
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Effective Treatments For Type 2 Diabetes
- make adjustments to lifestyle – healthy eating, an increase in physical activity and weight loss may prevent the need for medical treatment
- most young people will need;medical treatment at some stage, including tablets that help the body to use insulin more effectively, insulin injections or a combination of both
- medicines do not cure diabetes and most people will have to take medicines for the rest of their lives
- a child or young person living with diabetes needs a lot of care and assistance;with;establishing healthy habits to help and support them in living with diabetes
Why Diabetes Develops
The causes of type 1 diabetes are not known, although it does run in families. There is nothing you can do to prevent your child from developing type 1 diabetes.
Type 2 diabetes is linked to being overweight and having a poor diet. Even though type 2 diabetes is very rare in young children, people are more likely to develop the condition later if they are overweight or obese as children. Making sure your child eats a healthy diet, exercises regularly and does not become overweight will help protect them against diabetes in the future.;
If you had diabetes when you were pregnant , your baby is at increased risk of developing type 2 diabetes later in life. Most type 2 diabetes can be prevented by maintaining a healthy weight, being physically active and following a healthy eating plan.
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How Is It Treated
The key to treating diabetes is to keep your child’s blood sugar levels within a target range. 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.