Type 2 diabetes is also known as non-insulin-dependent diabetes or adult-onset diabetes. In this condition, the body cells resist the effects of insulin for glucose metabolism. This chronic disease could result in long-term or short-term complications in the absence of appropriate management.
Although considered an adult-onset disease, pediatric-onset of type 2 diabetes is prevalent. It can be due to an increase in prediabetic conditions such as obesity and physical inactivity. Seek medical care if you notice any signs and symptoms of diabetes in your child to prevent severe complications (1).
Causes Of Type 2 Diabetes In Children
The exact cause of diabetes type 2 is yet to be discovered. However, genetics and lifestyle factors, such as physical inactivity and being overweight or obese, may increase the risk of developing type 2 diabetes (2).
Children with type 2 diabetes have insulin resistance, so their body can’t use insulin to metabolize glucose. This may cause the accumulation of sugar in the bloodstream and result in signs and symptoms of high blood sugar levels.
Risk Factors For Type 2 Diabetes In Children
The following factors may increase the risk of developing type 2 diabetes (3).
- Being overweight or obese could increase insulin resistance. Fat around the abdominal area is known to be a strong risk factor for type 2 diabetes.
- Physical inactivity makes cells less responsive to insulin. Thus, glucose builds up in blood since it cannot enter the cells for energy production.
- Positive family history with an affected parent or sibling may increase the risk of diabetes type 2.
- Presence of certain genes in some ethnic groups may increase the risk of type 2 diabetes.
- Maternal diabetes during pregnancy (gestational diabetes) may increase the risk of diabetes in children.
Although children of any age can be affected by diabetes type 2, teens are most affected by it. Adolescent girls have a higher risk of diabetes than boys (3).
Symptoms And Signs Of Type 2 Diabetes In Children
Many children may not have any noticeable symptoms of type 2 diabetes, and it is often diagnosed during routine medical care. However, some may have a gradual onset of signs and symptoms, including (4):
- Increased thirst
- Frequent urination
- Blurred vision
- Darkening of skin areas such as the armpit or neck
- Weight loss
- Recurrent infections
- Delay in wound healing
- Numbness or tingling of extremities
These signs and symptoms are due to excess glucose in the bloodstream. Weight loss in children is more common in type 1 diabetes than type 2 diabetes.
Complications Of Type 2 Diabetes In Children
Children with diabetes may often experience short-term complications due to fluctuating blood sugar levels based on diet, medications, and physical activity. These complications are short-term yet require emergency care since they can be fatal. Complications may include (5):
- Hypoglycemia (low blood sugar)
- Hyperglycemia (high blood sugar)
- Diabetic ketoacidosis (ketones built up in the body with high blood sugar)
Regular or continuous monitoring of glucose, planned diet, exercise, and medications as per the recommended requirements could help prevent these complications.
Poorly managed type 2 diabetes may gradually affect and severely disable organ functions, thus increasing the risk of life-threatening complications, which may include (6):
- Hypertension (high blood pressure)
- Increased cholesterol levels
- Cardiovascular diseases
- Liver disease
- Kidney disease
- Visual impairment and blindness
- Non-healing sores or ulcers, especially on the limbs
The risk of developing these complications can be reduced by maintaining appropriate sugar levels. Therefore, it is essential to seek early medical care to avoid severe complications.
When To See A Doctor
Seek medical care if you are concerned about the signs and symptoms of diabetes in your child. Although similar symptoms can be seen in other conditions, confirming the blood sugar levels can be useful to diagnose and begin early management for diabetes type 2.
Diagnosis Of Type 2 Diabetes In Children
Any of the following screening tests can be ordered if the doctor suspects diabetes in your child (7) (5).
- Random blood glucose test analyzes blood samples during the visit, and blood sugar levels of more than 200mg/dL or 11.1 mmol/L suggest diabetes.
- Fasting blood glucose test is done after an overnight fast or a fast for a minimum of eight hours, and the sugar level higher than 126mg/dL or 7 mmol/L indicates diabetes.
- Hb A1C test or A1C test (glycated or glycosylated hemoglobin test) gives the average glucose levels for the past three months, and more than 6.5 % on two tests suggest the diagnosis of diabetes.
- OGTT (oral glucose tolerance test) is where the child’s blood sugar level is analyzed two hours after consuming a special sugar drink.
The diagnosis of diabetes is made only after obtaining two abnormal results on different days. Pediatricians order additional tests to differentiate type 1 diabetes from type 2 diabetes and to assess organ functions.
Treatment For Type 2 Diabetes In Children
Type 2 diabetes requires lifelong management. Your child’s treatment plans may vary as they grow to maintain the optimal sugar levels. Complications can be prevented by keeping blood sugar at normal levels as possible.
The diabetes management plan may include (5):
- Blood sugar monitoring: You may have to measure your child’s blood glucose levels using glucometers to decide the dose of insulin, diet, and physical activity to maintain healthy blood sugar levels.
- Healthy diet: Low fat and low calorie (low carbohydrate) diets are recommended to maintain blood sugar levels. Replacing high-calorie soft drinks, refined sugars, and carbohydrate-rich foods with proteins and low-calorie vegetables and fruits and reducing portion size are useful to maintain glucose levels.
- Regular exercise: An hour of aerobic physical activity a day is recommended. Regular exercise can help keep sugar levels low.
- Medications: Metformin (Glumetza) pill, insulin injection, and liraglutide injection are the three medications approved to treat diabetes type 2 in children. Metformin increases insulin use by body cells by limiting glucose release by the liver between meals, whereas liraglutide enhances the release of insulin from the pancreas after meals. Insulin, usually long-acting insulin (glargine), is used for controlling high blood sugar levels. Insulin is delivered by injection or insulin pump, depending on the requirement.
- Weight loss surgery: Teenagers who are obese with a BMI of more than 35 may require weight loss surgery to control type 2 diabetes if there are no other ways to reduce weight.
Insulin treatment can be stopped if the blood sugar can be managed with other treatment options. You may encourage your child to be physically active and follow a healthy diet to have normal sugar levels without much use of medications.
Although some alternative approaches and herbal treatments are said to be effective in curing diabetes, they lack scientific evidence. Some may interact with medications or cause harmful effects. Always ensure the safety of any therapies with your child’s doctor to avoid complications.
How To Help Your Child To Deal With Diabetes?
Consistent commitment from parents or caregivers is essential for following diabetic treatment plans. You may try the following to help your child tackle the challenges caused by the disease.
- Explain about the illness and the ways to control it.
- Encourage regular physical activity.
- Teach them to choose healthy food.
- Help your child to understand the calculations of insulin dose depending on activities, diet, and glucose levels.
- Teach them to use glucometers and insulin injections.
- Encourage your child to have a friendly relationship with the diabetes treatment
- Explain to them the warning signs of hypoglycemia, hyperglycemia, or diabetic ketoacidosis and how to call emergency help for it.
You may also tell your child’s teachers and school nurse about diabetes to ensure immediate help if the child develops low or high sugar levels during school hours.
Prevention Of Type 2 Diabetes In Children
A healthy diet and regular exercise may help prevent type 2 diabetes in children (8).
Low- calorie, and low-fat foods, including fruits, vegetables, and whole grains, are good food choices. Physical activities, such as sports training and dance, can be useful. If all the family members follow a healthy lifestyle, it can encourage the child to observe healthy eating habits and exercise regularly.
Living with diabetes can be challenging, but the right amount of support and encouragement can make the process easier. Some children may feel stressed due to the condition and its management. Stay alert to any signs, such as depression, inadequate sleep, and poor academic performance. Consult your doctor or psychologist for a prompt resolution.
Joining local or online diabetic support groups can also help the child and the family manage the condition smoothly.