Type 2 Diabetes in Children

Although type 1 diabetes is still more common in children, type 2 diabetes accounts for about 10 percent of childhood diabetes. The alarming rise in type 2 diabetes worldwide, and particularly in children, can be prevented or managed through good nutrition and adequate exercise.

What causes type 2 diabetes?

Type 2 diabetes results when the body loses its sensitivity to insulin and/or no longer produces enough insulin. It accounts for 90 percent of adult diabetes and was formerly known as “adult onset diabetes” because it was believed to only occur in adults. Unfortunately, type 2 diabetes is being increasingly seen in children.

Signs and symptoms

The three classic diabetes symptoms are

• polydipsia (excessive thirst)
• polyphagia (excessive hunger)
• polyuria (frequent urination)

When a patient complains of these, a little red flag goes up for a health care practitioner to screen for diabetes. Other symptoms of diabetes, particularly as time goes on, include blurred vision, slow healing, frequent infections, tingling in the fingers and/or toes, and lack of energy.

In general, severe symptoms are far more common in type 1 diabetes, and those with type 2 diabetes may show very few symptoms until the disease has been present for some time. Nonetheless, it is important to recognize that these symptoms, especially in a child, should signal a trip to a health care practitioner for further investigation.

Risk factors in children

Obesity

Ninety-five percent of children with type 2 diabetes are overweight or obese. In 2010 the Canadian government released a report on childhood obesity in Canada. In it they outlined the startling statistics on obesity among Canadian children, which they describe as a “national crisis.”

Between 1978 and 2004, the percentage of Canadian children aged two to 17 considered overweight or obese increased from 15 percent to an astonishing 26 percent—that’s more than one in every four children. In the 12 to 17 age group, the news was worse, with the number of overweight or obese children doubling during this period from 14 percent to 29 percent.

For Aboriginal Canadians living off-reserve in this age group, the overweight/obesity rates are now 41 percent. With statistics like these, it’s not surprising that over the next 15 years, the number of children worldwide with type 2 diabetes is expected to increase by at least 50 percent.

Ethnicity

Certain ethnic groups at increased risk for type 2 diabetes include Aboriginal Canadians and individuals of South Asian, Hispanic, or African heritage.

Inactivity

Lack of adequate exercise increases the risk of obesity and decreases the body’s sensitivity to insulin.

Family history

More than 90 percent of children with type 2 diabetes have a first or second degree relative with diabetes. (First degree relatives include parents and siblings. Second degree relatives include grandparents, aunts, uncles, and half-siblings.)

Certain medications

The use of some psychiatric medications, such as antipsychotics, may increase a child’s risk of type 2 diabetes.

Testing for diabetes

For children who are at increased risk of type 2 diabetes, the Canadian Diabetes Association and the Canadian Paediatric Association recommend the following guidelines for screening and testing.

When should testing begin?

For children at risk, testing should begin at 10 years of age (or younger if signs of puberty are already occurring).

How often should kids be tested?

Testing should take place every two years, if two or more of the following risk factors are present:

• obesity
• member of an ethnic group known to be at increased risk
• family history of diabetes
• signs or symptoms of insulin resistance, such as high blood pressure, high cholesterol, or fatty liver disease
• impaired glucose tolerance (as determined by blood tests)
• use of antipsychotic medications or atypical neuroleptics

Children who are considered very obese should receive an oral glucose tolerance test annually.

How is it done?

Testing children for diabetes is done the same way as it is for adults, using a fasting or random blood sugar test. Diabetes is diagnosed when a fasting blood sugar level is higher than 7.0 mmol/L or when a random blood sugar level is higher than 11.1 mmol/L.

Health risks for kids

Children with type 2 diabetes have the same health risks as adults but can develop complications more quickly. Because of this, a child who has been diagnosed with type 2 diabetes is monitored on an annual basis for complications, including:

• blood sugar levels
• high cholesterol levels
• high blood pressure
• retinopathy (damage to the retina of the eye)
• neuropathy (nerve damage, which may include symptoms such as pain, numbness, or tingling, especially in the fingers or toes)
• liver disease
• kidney disease

Type 2 diabetes is on the rise in children, but by knowing the risk factors and knowing how to reduce them (see sidebar page 49), we can reverse the tide.

Did you know?

• 45 percent of children diagnosed with type 2 diabetes also had high cholesterol.
• 28 percent of children diagnosed with type 2 diabetes also had high blood pressure.
• Blood pressure of diabetic children should be checked at each visit to a health care practitioner.

6 Ways to Prevent Type 2 Diabetes In Children

The single most important factor in the prevention of type 2 diabetes at any age is prevention of obesity. Therefore, the majority of recommendations for preventing this disease in children are aimed at encouraging diet and lifestyle habits that reduce the risk of obesity.

1. Turn off the tube

Limit children’s TV and computer time. Increased TV viewing time decreases physical activity and increases children’s exposure to advertising for high-fat and sugary foods, a major part of the obesity problem.

2. Make exercise a priority and make it fun

Canadian guidelines recommend that children five to 17 years of age should be getting at least one hour of moderate to vigorous exercise every day. Activities such as cycling, dancing, hiking, and walking are activities that the whole family can enjoy together.

3. Join the team!

Team sports allow children important opportunities to be active while meeting new friends and building lifelong fitness habits.

4. Get outside

Not only is getting outside a great way to increase physical activity, but it also increases our chances of getting enough vitamin D. This vitamin is crucial for the proper functioning of most of our body’s cells, and our main vitamin D resource is sunshine. This may be especially important in obese children and those with, or at risk of, type 2 diabetes.

In one interesting study of 106 obese children and adolescents, 62 percent of these children were found to have deficient vitamin D levels. Those with vitamin D deficiency were found to have greater insulin resistance, a major step on their way to developing type 2 diabetes.

5. Encourage healthy eating

Get the whole family on board. Everyone benefits from eating fresh, nutritious whole foods. Children exposed to healthy eating at home are more likely to make healthy food choices outside the home as well.

6. Breast is best

Children can be given a head start by breastfeeding. Evidence suggests that exclusive breastfeeding for at least the first six months of life decreases the chances of overfeeding and reduces the risk of early childhood obesity.