Type 2 diabetes is on the rise in kids, but it’s preventable
Diabetes isn't just for adults anymore
If you knew you could prevent high blood pressure, heart disease, vision loss, kidney disease, and nerve damage that might lead to your child needing an amputation, would you? Of course you would.
But if your child or teen is overweight, and especially if the child is obese, they could already be well on their way to experiencing a chronic illness that is dangerous, can be disabling, and may even be life-threatening.
Type 2 Diabetes used to be called adult-onset
diabetes but now, due primarily due to the high-fat, high-carbohydrate American diet and sedentary lifestyle it’s become much more common in children.
Signs to look for
Your pediatrician or primary care physician may become concerned and call for blood tests at a regular checkup if your child is overweight. Symptoms of type 2 diabetes in children include increased thirst and frequent urination, blurred vision, and unusual tiredness. Another sign of diabetes is blackish skin in the armpits and back of the neck.
Having a family history may be a factor, and if your child is diagnosed with diabetes, it affects the entire family.
“Diabetes is a family affair,” said Emily Frydman, MD, a pediatric endocrinologist at Dartmouth-Hitchcock in Manchester. “In many cases it’s a problem that a parent or family member may already be dealing with.”
Blood tests screen for A1C, an indicator of blood sugar levels over time. If this is high, then a fasting blood sugar test is called for. The average age of diagnosis is 14 to 16, Frydman said, but children as young as 10 or 11 who are very overweight may already have type 2 diabetes and should be checked.
If A1C is high, treatment is insulin only. There are not a lot of oral medications approved by FDA for children, Frydman said.
Then the family has to get involved. “They have to be willing to change, with healthy eating and exercise. This is a very difficult population to help — no one wants to be told what they need to eat, and to exercise.”
Frydman manages a team at Dartmouth-Hitchcock that includes an exercise physiologist, a nutritionist and a social worker. They hold a clinic once a month for youth age 12 to 18 with type 2 diabetes, most of whom are referred through a doctor who specializes in obesity.
Kids think they’re invincible, Frydman said, but with youth the complications of diabetes start much sooner, including their eyes, kidneys and feet.
“Everything an adult can get a kid can get too, and complications happen faster,” making getting diabetes under control an urgent matter.
Hope Damon is a registered dietitian practicing at the Nutrition Counseling Center in New London. She said the whole family needs to be involved, but having your child diagnosed with a chronic illness is a real blow.
“Name an emotion that is stress-producing, and parents probably have had it or have it, including anxiety, worry, self-blame, because their child is overweight. The parent may be overweight as well.
“They say, ‘I should have tried harder to manage their weight,’ or if the parent has diabetes, ‘He got it from me, it’s my fault.’ We have to help them move beyond that, because it’s not helpful. Taking care of the disease is far more important,” Damon said.
To prevent diabetes
“If we help children live an active lifestyle and eat much like we want everyone to eat in terms of general wellness, there would be less type 2 diabetes in children,” Damon said.
“Run around with your kids, talk a walk, shoot hoops, go swimming, ride bikes, snowshoe. Having an active lifestyle from the get-go can prevent obesity and diabetes.” Limit screen time to a couple of hours a day.
Incorporate healthy eating and exercise — and make it fun — early on.
Avoid “empty” calories (i.e., sugar and carbs with no nutritional value) by drinking water frequently and soda, sports drinks, coffee drinks and fruit juice occasionally or rarely.
According to Damon, it would be ideal if children did not grow up drinking diet or regular soda.
“Regular soda doesn’t work at all because it’s a beeline of sugar into bloodstream that raises blood sugar to an alarming level. It’s totally contraindicated for someone with type 2 diabetes,” she said.
“Diet soda doesn’t have sugar or calories or carbs in it, which makes it a better choice than regular soda. However, the news isn’t very reassuring about diet soda.” Research shows that consuming noncaloric sweeteners can cause an increased craving for carbs, said Damon.
Fruit juice can also be problematic, she said, because juice is concentrated liquid carbohydrates. A 16-ounce drink or smoothie can contain the same amount of carbs as three to five pieces of fruit, the dietitian said, and “Who eats three to five apples, oranges, or bananas at a time?”
It’s important for everyone to eat more fruits and vegetables for nutrition, fiber, and they fill you up. Frozen or canned fruit (in natural juice) and vegetables are fine when fresh isn’t available or is too pricey.
It’s unrealistic to think you’ll never hit the drive-thru again, but more healthful choices include grilled or broiled meats, bypassing the fries, and selecting salads with dressing on the side. A kids’ meal offers smaller portions. Options such as whole-grain buns, pasta or bread, and brown rice have fiber and fill you up longer, staving off blood sugar spikes.
Teens and autonomy
For teenagers with diabetes, dealing with food is hardest, said Damon, even though there isn’t anything they can’t eat. But there is a loss of spontaneity, which is an important part of our culture.
“We want to eat what we want to eat when we want to eat it,” she said. Having diabetes means being disciplined about what to choose, and the amount you eat. This is especially hard for teens, who want to be socially normal and go out for pizza with their peers.
Pizza is a challenging food for diabetics. With a white flour crust and carbs in the sauce, “Pizza has a considerable effect on blood sugar.”
“Teens want to be a little different with their hair or tattoos,” Damon said, “but not ‘my body doesn’t work normally’ different.” Also, having type 2 diabetes means your parents are weighing in on what you’re eating at a later age than your peers.
Let’s make a deal
Caring for a child with type 2 diabetes isn’t that different from other challenges in parenting, Damon said, when it comes to power struggles. You have to find middle ground and choose your battles.
Parenting toddlers and teens can seem like an endless game of “Let’s Make a Deal,” giving choices and negotiating terms. That’s why Damon doesn’t tell her clients “you can’t have that.”
“It pushes people into a corner,” she said. So she’ll negotiate with the teenager who loves chocolate chip cookies, asking, how much are you eating now, would you be willing to limit the amount to less than that, “and then I suggest what to eat instead to reduce cookie intake.”
Type 2 diabetes can be brought under control even if the child or teen remains overweight, Damon said.
“Weight loss is very valuable, any amount, and you don’t have to become thin. But while you’re doing the very best you can with weight control, you need to look at activity, how food is distributed through the day, types of carbohydrates and quantity. You want to get your carbs from plant foods that aren’t highly refined, lentils and legumes, lots of vegetables, whole fruits.”
A child diagnosed at 10 is still growing and developing. They get taller, hormones change and their activities vary, all of which changes their needs and the ability to maintain control of diabetes, said Damon. Going away to school is another major challenge.
‘I can do this!’
The good news? Children and teens can help control their blood sugar through medication, by losing even a small amount of weight, and physical activity. Seeing that they can lose weight and control their blood sugar levels can empower obese teens to continue weight loss and commit to a healthier lifestyle.
Parents need to support them, saying, “I know this is really hard for you, I’m so sorry you have to deal with this,” said Damon.
Because they need to monitor blood sugar levels throughout the day, a person with diabetes needs to check after lunch, for example. Teens usually need to go to the nurse’s office, and “they’re not elated about doing that.”
Damon noted, if we understood diabetes better as a culture, it would be easier for people to cope. To that end, she suggests teens consider presenting on their disease as a school project, as a good learning experience for all involved.
“Compliance is an ongoing part of the work to help people make good decisions for themselves,” the dietitian said.
When you get a family working together, she said, a good outcome is that we get to the point that parents say “It’s not the worst thing that could happen, and we’re a happy, healthier family than before.”
Mary Ellen Hettinger, APR is an award-winning reporter, editor and writer and accredited public relations professional. She won a bronze award in 2017 from the Parenting Media Association for her news feature on perfluorochemicals in NH’s water supply.