Diabetes in children
While the obesity epidemic and the surge of Type 2 diabetes in adults grab headlines, teens and children are taking a hit too, writes Dr Shamin Ramasamy
UNTIL recently, the common type of diabetes in children and teens was Type 1. It was called juvenile diabetes. With Type 1 diabetes, the pancreas does not make insulin. Insulin is a hormone that helps glucose, or sugar, get into your cells to give them energy. Without insulin, too much sugar stays in the blood.
Now, younger people are also getting Type 2 diabetes.
Type 2 diabetes used to be called adultonset diabetes. But now it is becoming more common in children and teens, due to obesity.
With Type 2 diabetes, the body does not make or use insulin well. Children have a higher risk of Type 2 diabetes if they are overweight or have obesity, have a family history of diabetes, or are not active.
UNDERSTANDING DIABETES
Both types of diabetes make blood sugar levels higher than normal but they do so in different ways.
Generally, a blood test is required for diagnosis. There are various components to the blood test including an oral glucose tolerance test, HbA1C, fasting levels for insulin, C-peptide and insulin antibodies to determine if it is Type 1 or Type 2 diabetes because management and treatment of diabetes may differ.
A person can have diabetes without knowing it because the symptoms aren’t always obvious and they can take a long time to develop. Type 1 diabetes may come on gradually or suddenly.
Children or teens who develop Type 1 diabetes may exhibit signs such as:
INcREASED fREqUENcy of URINATIoN
• The kidneys respond to high levels of glucose in the blood by flushing out the extra glucose in urine. Kids with high blood sugar levels urinate more often. • They may also drink a lot of liquids because they’re urinating so often and losing so much fluid so they become very thirsty and drink a lot in an attempt to keep the levels of body water normal. • Feeling tired often. This is because the body can’t use glucose for energy properly.
• Losing weight (or not gaining weight as they grow). Children and teens with Type 1 diabetes may have an increased appetite, but often lose weight because the body breaks down muscle and stored fat in an attempt to provide fuel to the hungry cells.
• In some cases, other symptoms can be the signal. Sometimes the first sign of diabetes is bedwetting in a child who has been dry at night.
• Diabetes also should be suspected if a girl who hasn’t started puberty yet gets a vaginal yeast infection.
Type 2 diabetes in adolescents might be more difficult to gauge due to the long duration of insulin resistance before they present with similar symptoms as those with Type 1 diabetes. Obesity, feeling tired or lethargic will be the earliest tell-tale sign for parents to warrant a visit to the doctor for further assessment.
MANAGING DIABETES
anyone, but children and teens often have special issues to deal with. Young children might not understand why they need blood tests and medicines. They might be scared, angry and uncooperative.
Teens may feel different from their peers and want a more carefree lifestyle than diabetes allows. Even when they faithfully follow their treatment schedule, they might feel frustrated if the natural body changes of puberty makes their diabetes harder to control.
The prevalence of Type 2 diabetes in adolescents and young adults is dramatically increasing. Similar to older-onset Type 2 diabetes, the major predisposing risk factors are obesity, family history, and a sedentary lifestyle. Onset of diabetes at a younger age (defined here as up to age 40 years) is associated with longer disease exposure and increased risk for chronic complications.
THE coNSEqUENcES
The complications of diabetes are related to the duration of the disease. The younger you are diagnosed, the longer diabetes affects your life and adds to the cost of healthcare.
An adult who develops Type 2 diabetes at age 45 might develop cardiovascular complications 10 or 15 years later, around 55 or 60 years of age. A teenager who develops type 2 diabetes at 15 may present with similar cardiovascular complications at the age of 25 or 30.
Early development of chronic diseases traditionally seen in older adults increases the financial impact of diabetes. Not surprisingly, diabetes shortens life expectancy significantly for individuals who develop the disease at a younger age.
The greatest net value of future earnings lost due to premature death from diabetes is in children and young adults.
While differences in life expectancy between individuals with diabetes and those without diabetes is shrinking thanks to improved treatment, diabetes still shortens life expectancy. The diabetes difference is more distinct in younger patients than in older ones.
The increasing incidence of Type 2 diabetes in young people appears to be associated with increases in obesity just as it is in adults. The risk of the development of Type 2 diabetes is higher if the individual has a family history of Type 2 diabetes.
Genetics sets the stage and environment pulls the trigger.
Combine high-carbohydrate diets with susceptible genetics and you have a major problem. One reason for the strong familial association may be that families tend to share eating, exercise, and other lifestyle habits associated with the development of Type 2 diabetes. As more adults become obese, they teach their own poor lifestyle habits to their children, who become obese and pass those same unhealthy lifestyle habits onto their children.
Parents can help their children lead happier, healthier lives by adopting a few simple measures.
• Eat a balanced, healthy diet and pay special attention to the amounts of sugars and starches in the food they eat. • Have them maintain a healthy weight • Be sure they are physically active
• Have them eat smaller portions of healthy
foods
• Limit time with the TV, computer, and video
Nothing makes a bigger impact than parents leading by example by demonstrating all the above themselves.