Updated January 11, 2006

Treating Type 2 Diabetes in Children

by Jill A. Goldfarb, M.D.

Until recently, it was thought that Type 2 diabetes was a disease of adults. During the 1990’s, however, pediatric endocrinologists began to recognize and diagnose it in children. There has been an increasing number of children diagnosed with Type 2 diabetes ever since that time, forcing more and more parents to learn about this disease and its treatments.

While many parents may find the thought of a pill a lot easier to swallow than the thought of insulin injections, treatment for Type 2 diabetes varies from child to child. Your child’s health-care team may recommend treatments ranging from a change in diet and more exercise to insulin injections to an oral medicine to a combination of insulin and an oral medicine. To understand why your child is being treated the way he is and why his treatment may change over time, it is important to understand Type 2 diabetes.

What is Type 2?
People with diabetes have difficulty regulating the level of glucose in their blood. The two major forms of diabetes are Type 1 and Type 2. A person with Type 1 diabetes does not make enough insulin because a misfiring immune system has destroyed insulin-producing beta cells in his pancreas. Insulin is a hormone that has a number of functions, including telling cells to take up glucose from the blood. In Type 2 diabetes, insulin is made initially in normal or increased amounts. The problem, however, is that the person’s cells are “insulin resistant” (not as sensitive to insulin), which means glucose is not able to enter the cells as easily. The body tries to compensate for insulin resistance by producing more insulin, but eventually this is thought to cause insulin-producing cells to “burn out.”

When glucose is not removed from the blood, it can cause a number of problems. High blood glucose (hyperglycemia) can, over time, lead to complications such as eye disease (retinopathy), kidney disease (nephropathy), and nerve damage (neuropathy). Acute hyperglycemia can also cause serious problems such as ketoacidosis (when by-products from fat breakdown build up and cause vomiting and possibly death) and hyperglycemic hyperosmolar syndrome (which can cause coma and death).

Children in the United States today, along with the rest of the population, have an increasing rate of obesity. The increasing rate of Type 2 diabetes mirrors the increasing rate of obesity. This trend is not limited to the United States; it is also seen in countries such as Japan, Libya, Bangladesh, Australia, and Canada. The link between overweight and diabetes is insulin resistance; overweight contributes to insulin resistance.

Diagnosing Type 2
Because Type 2 diabetes usually develops over a period of years, children often do not have symptoms during the early stages of the disease. If symptoms of diabetes do appear, they can take a variety of forms. Children with uncontrolled diabetes may be more tired, thirstier, or hungrier than usual. Some children may make more trips to the bathroom than usual or wet the bed at night. They may also have frequent infections, complain of blurry vision, or experience weight loss despite an increased appetite. Some children may become extremely sick because of ketoacidosis.

The standard test for diagnosing diabetes, especially in children, is a fasting plasma glucose test, which requires a person to fast for at least eight hours, then have blood drawn. However, many children diagnosed with Type 2 diabetes are given a fasting plasma glucose test only after glucose is found in their urine during a routine physical examination, alerting their doctor to perform a blood test for diabetes.

Dr. Goldfarb is a third-year general pediatrics resident at Children’s Medical Center, University of Texas Southwestern Dallas. She will be starting her fellowship in pediatric endocrinology in July 2005. This column is edited by Jean Betschart Roemer, a Pediatric Nurse Practitioner at the Children’s Hospital of Pittsburgh and the author of Type 2 Diabetes in Teens: Secrets for Success, which is available through www.Learningdiabetes.com.

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