If diet and exercise alone are not enough to control your child’s diabetes or if your child is very ill at diagnosis, your health-care team will probably add insulin, an oral diabetes medicine, or both to your child’s regimen.
Insulin and drugs. Children newly diagnosed with Type 2 diabetes after a bout of ketoacidosis or hyperglycemic hyperosmolar syndrome are initially treated with insulin. In children who do not have serious symptoms at diagnosis, diet and exercise may be sufficient initially to control blood glucose levels. Over time, however, a child’s treatment may change. Some children may be given an oral medicine or insulin, some may need an oral medicine in addition to insulin, and some may be able to switch from medicines to diet and exercise alone. Changes in diabetes care may occur as a result of changes in blood glucose control, hormone levels during puberty, or weight, or they may be related to the progressive course of diabetes.
Metformin (brand name Glucophage) is currently the only oral diabetes medicine approved by the Food and Drug Administration for use in children. Metformin works by decreasing the amount of glucose released by the liver and by causing the liver and muscle cells to be more sensitive to the effects of insulin.
Metformin can cause gastrointestinal side effects, including nausea, vomiting, a sense of fullness, constipation, and heartburn. Its use is also associated with weight loss (or at least no weight gain), which may be a welcome result for overweight adults but may not be desirable in a growing child. Parents of children experiencing bothersome side effects when taking metformin should tell the child’s doctor. In some cases, drug side effects diminish over time as the body gets used to the drug.
Although other oral diabetes medicines have not been studied as intensively in children, some physicians are comfortable prescribing them for children with Type 2 diabetes in certain cases.
Blood glucose monitoring. Regular blood glucose monitoring is important to evaluate the effectiveness of a child’s diabetes treatment regimen. Children who use insulin are usually advised to check their blood glucose levels at least before each meal and at bedtime. Children who use insulin (along with their parents and caregivers such as a school nurse) should also learn to recognize and treat the symptoms of low blood glucose (hypoglycemia) and know to check their blood glucose level if they develop symptoms of hypoglycemia. Children who do not use insulin should receive individualized recommendations from their health-care team on when to check their blood glucose levels.
HbA1c test. Another important blood test for every person with diabetes is the glycosylated hemoglobin (HbA1c) test, which gives an indication of longer-term blood glucose control. Some doctors order this lab test every three months, and some less often, especially if a person’s diabetes is in good control. While the American Diabetes Association (ADA) recommends an HbA1c goal below 7% for most people with diabetes, children are often given higher goals to prevent hypoglycemia. In any event, each child should have an individualized HbA1c goal.
Blood pressure control. Blood pressure goals for children and adolescents are different from those for adults. Children are considered to have high blood pressure (hypertension) when their systolic (the upper number) and/or diastolic (the lower number) blood pressures are above the 95th percentile for children of that sex, age, and height on several occasions.
If your child has high blood pressure along with Type 2 diabetes, it is important to treat his blood pressure through dietary changes, exercise, and possibly through medicines. Angiotensin-converting enzyme (ACE) inhibitors are often a good choice for people with diabetes because, in addition to lowering blood pressure, they also act to prevent diabetic nephropathy (kidney disease). Other medicines may include alpha-blockers, calcium antagonists, and diuretics (“water pills”). Beta-blockers, while useful, are sometimes not used in children with diabetes because of reports they may worsen hypoglycemia or conceal symptoms of hypoglycemia.