Recognizing Type 2 Diabetes in Children and Adolescents

Type 2 diabetes in youth is on the rise, largely influenced by the obesity epidemic. While the majority of children and adolescents with diabetes have Type 1 diabetes — a condition in which the body makes very little to no insulin — more and more kids have been diagnosed with Type 2 in the last two decades. In Type 2 diabetes, the body produces some insulin; however, not enough to overcome the insulin resistance that occurs with the disorder. Experts estimate that about 5,000 children and adolescents in the U.S. are diagnosed with Type 2 diabetes annually. In fact, new cases of Type 2 diabetes in youth (less than 20 years old) are predicted to quadruple in the next 40 years.

Risk for Type 2 diabetes

The ratio of Type 1 versus Type 2 diabetes in kids differs among ethnic groups. While non-Hispanic white children and adolescents are usually diagnosed with Type 1, Type 2 accounts for about 55 percent of new cases of diabetes among African-American adolescents over 10 years old. If you are wondering if your child is at risk for prediabetes (a condition in which blood glucose is higher than normal but not high enough for a diagnosis of diabetes) and subsequently Type 2 diabetes, answer these questions honestly:

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1) Is my child sedentary?
2) Does my child weigh too much?
3) Do we have a family history of Type 2 diabetes (a primary or secondary family member)?
4) Is my child’s blood pressure high?
5) Does my child’s ethnicity include African-American, Hispanic-American, American Indian, or Asian-American descent?
6) Does my child have “acanthosis nigricans,” a brownish-black discoloration of the skin usually found in body folds such as the neck, armpits, or groin?
7) Does my adolescent daughter have unexplained recurrent yeast infections?

If you answer yes to any or all of these questions, have a discussion with your child’s pediatrician or family-care provider to learn more.

Symptoms

About 40 percent of youth with prediabetes or Type 2 diabetes have no symptoms, which is why it is important to be proactive about your child’s care. If symptoms do occur, your child may have a combination of the following:

• Increase in urination as the kidneys attempt to filter glucose out of the bloodstream.
• Increase in thirst due to dehydration caused by the increase in urination.
• Tiredness related to the body’s inability to use glucose from the blood for energy.
• Blurry vision with an inability to focus.
• Sores and/or skin infections that heal slowly.

At onset of Type 2 diabetes, about 6 percent of youth between 10 and 19 years old present with diabetic ketoacidosis (DKA) and diabetes-associated autoantibodies (which is a typical occurrence when Type 1 is diagnosed). DKA is a dangerous complication that occurs when the body produces high levels of ketones (blood acids) due to a lack of insulin. Therefore, it is best that children with diabetes are followed by a pediatric provider who specializes in diabetes to ensure an accurate diagnosis.

Your child’s health

If you recognize that your child is at risk for Type 2 diabetes, be sure to get any questions you have answered during visits with your child’s health-care provider. Ask for blood testing to determine if your child has prediabetes/Type 2 diabetes. Why not go ahead and start with lifestyle modification for the whole family before your child develops prediabetes/Type 2 diabetes? In the adult population, data support healthy eating, reducing total body weight by 5–10 percent in those who are overweight, and 150 minutes of physical activity per week as a method to prevent or delay Type 2 diabetes. Children should be encouraged to eat a balanced diet limited in added sugar. Avoiding an excess in caloric intake and including fresh fruits and vegetables, whole grains, and lean protein is essential. Kids aged 5–17 years should get at least 60 minutes of moderate or vigorous physical activity every day. Playing outside, engaging in sports activities, and cutting back on screen time can improve physical activity status.

Compared to Type 2 diabetes in the adult population, Type 2 diabetes is generally more aggressive in youth. Insulin is often used sooner because of this, as well as due to the fact that the only approved diabetes medications for kids with Type 2 diabetes are metformin and insulin. Furthermore, these treatments may not work as well in youth. Similar to adults with Type 2 diabetes, youth with Type 2 may also have high blood pressure and lipid (blood fat) disorders, which puts them at risk for heart attack and stroke. Similar to kids with Type 1, those with Type 2 should be screened for complications such as eye and kidney disease.

Conclusion

Prediabetes and Type 2 diabetes in youth is a real health-care issue to the medical community. Because of that, the future for youth with Type 2 diabetes is uncertain. Stay aware of the research that is being done in the area to learn more about these two conditions and how children and adolescents are affected now and as they become adults. If you have a family history of Type 2 diabetes, so do your blood relatives, which include your kids. Stay aware of your child’s health risks and ask your health-care provider questions to understand if your child is at risk for prediabetes and Type 2 diabetes. Be familiar with the genetics of the disease and reduce the risks for the whole family.

Want to learn more about kids and diabetes? Read “Diabetes at School: Finding the Best Written Care Plan for Your Child,” “Top 10 Tips for Better Blood Glucose Control,” and “Children and Type 2 Diabetes: What’s New?”

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