Diabetes Self-Management Articles

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Treating Type 2 Diabetes in Children

by Jill A. Goldfarb, MD

Physicians do not test all children for diabetes. Unless symptoms are present, physicians usually only choose to screen children at high risk for diabetes. Testing in high-risk children is usually done every two years starting at age 10 or when puberty starts (whichever is sooner). To be considered at high risk, a child must be overweight and have at least two of the following characteristics: family history of Type 2 diabetes; Hispanic, African-American, Native American, Pacific Islander, or Asian American background; or signs of insulin resistance.

One sign of insulin resistance is acanthosis nigricans, areas of darkened skin and velvety thickening that may be seen on a child’s neck, armpits, groin, or other areas where there are skin folds. Acanthosis nigricans is found in up to 90% of children with Type 2 diabetes. Its presence varies with race: It is seen most often in African-American children, then Hispanics, and, although present, is least obvious in Caucasian children.

As mentioned earlier, there are certain genetic risk factors that may place your child at a higher risk for Type 2 diabetes, such as having a relative who has Type 2 diabetes or being of a certain ethnicity. In addition, children of mothers who have had diabetes during a pregnancy are also considered to have a greater risk for developing Type 2 diabetes.

Although a person cannot change his genetic makeup, there are also certain risk factors that can be changed such as high-fat, low-fiber diets; sedentary lifestyles; and overweight or obesity. Other risk factors for Type 2 diabetes include high blood pressure and blood lipid (cholesterol and triglyceride) disorders.

Treatment How a child with Type 2 diabetes is treated depends on his diabetes control, any changes in that control, and the results of regular blood glucose monitoring at home and regular checkups by his physician.

Diet and exercise. A healthful diet and exercise are the cornerstones of any diabetes care regimen. A healthful meal plan for a person with diabetes is one that takes into account all his needs. One of the first changes that may need to be made to a child’s eating habits is some form of monitoring or modification of carbohydrate intake to ensure a more even intake of carbohydrate throughout the day. Carbohydrate is the type of nutrient that affects blood glucose levels most. Your child’s diabetes care team may teach you and your child how to do carbohydrate counting or how to use exchange lists to control carbohydrate intake. Carbohydrate counting involves calculating the total grams of carbohydrate in the foods consumed in a meal or snack. The exchange lists system has people calculate and regulate the number of “exchanges” of foods they eat; for example, one exchange serving of a starchy food (such as bread, potatoes, or beans) is the amount of that food that contains 15 grams of carbohydrate (and also 80 calories, 3 grams of protein, and 0 to 1 gram of fat).

However, carbohydrate is not the only part of your child’s diet that may need to be modified. Children also have specific needs for protein, fats, vitamins, and minerals for proper growth and development. An overweight child, though, may also require a certain amount of calorie restriction, while a child with high levels of low-density lipoprotein (LDL or “bad”) cholesterol may require a meal plan lower in saturated fats.

Because of the many factors that can influence a child’s nutrient needs, if possible, include a registered dietitian who is also a certified diabetes educator in your health-care team to help you design an individualized meal plan for your child.

Exercise helps make muscles more sensitive to insulin, lowering insulin resistance. To combat problems like diabetes and overweight, the Surgeon General recommends that children engage in an hour of moderate physical activity most days of the week.

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