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Type 2 Diabetes in Children

AMBULATORY CARE:

Type 2 diabetes

is a disease that affects how your child's body uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 2 diabetes develops because either the body cannot make enough insulin, or it cannot use the insulin correctly. Diabetes cannot be cured but it can be controlled.

Common symptoms include the following:

Your child may have had high blood sugar levels for a long time before symptoms appear. Your child may have no symptoms or any of the following:

  • More hunger or thirst than usual
  • Frequent urination
  • Tired feeling
  • Blurred vision
  • Tingling, numbness, or pain in hands or feet

Treatment:

Type 2 diabetes is treated with lifestyle changes, oral medicine, and insulin.

  • The goal is to help control your child's blood sugar level. Also, the goal is to decrease or delay complications of diabetes such as neuropathy and retinopathy. Type 2 diabetes can cause complications in children sooner than in adults.
  • Your child's care team will decide which treatment is right for your child. Some children can control blood sugar levels with a nutrition plan and exercise. Your child may start receiving insulin injections. Insulin is given if it is not clear if your child has type 1 or type 2 diabetes. Insulin is also given if your child's blood sugar is above 250 mg/dL or A1c above 8.5%. Instead, your child may be given an oral medicine. This medicine will help your child's body properly use insulin that is made naturally. Your child may need both insulin and the oral medicine to control his or her blood sugar levels.
  • Your child will have a diabetes care team. His or her care team may include physicians, nurse practitioners, and physician assistants. It may also include nurses, dietitians, exercise specialists, pharmacists, and a dentist. You, your child, and other family members will also be part of the team. The team will make goals and plans to manage diabetes and other health problems. The plans and goals will be specific to your child's needs.

Call you local emergency number (911 in the US) if:

  • Your child has a seizure or cannot be woken.
  • Your child's heartbeat is fast and weak.
  • Your child's breath has fruity, sweet smell.
  • Your child has a low blood sugar level and it does not improve with treatment.

Call your child's doctor or care team if:

  • Your child's blood sugar levels are high after several checks.
  • Your child's blood sugar level does not lower with extra insulin.
  • Your child often has blood sugar levels that are too low.
  • Your child has abdominal pain, diarrhea, or is vomiting.
  • Your child has numbness in his or her arms or legs.
  • Your child has warm, red patches of skin or a wound that does not heal.
  • Your child is anxious or depressed.
  • You have questions or concerns about your child's condition or care.

Diabetes education:

Diabetes education will start right away. Members of your child's team will teach you and your child the following:

  • How to check your child's blood sugar level: You and your child will learn what his or her blood sugar level should be. You will be given information on when to check your child's blood sugar level. You will learn what to do if his or her level is too high or too low. Write down the times of your checks and your child's levels. Take them to all follow-up appointments.
  • About oral and injectable diabetes medicines: You and your child will learn the best times to take the medicine. You will also learn how and where the injectable medicine should be placed. You and your child will be taught how to dispose of needles after use.
  • About insulin: You, your child, and your family members will be taught how to draw up and give insulin. You will learn how much insulin your child needs and what time to inject insulin. You will be taught when not to give insulin. You will also be taught how to dispose of needles and syringes.
  • About nutrition: A dietitian will help you make a meal plan to keep your child's blood sugar level steady. You will learn how food affects your child's blood sugar levels. You will also learn to keep track of sugar and starchy foods (carbohydrates). Do not let your child skip meals. Blood sugar levels may drop too low if your child has received insulin and does not eat.
  • Exercise and diabetes: You and your child will learn why physical activity, such as exercise, is important. A plan will be made for your child's activity. A goal of 60 minutes of moderate to intense aerobic activity every day will be in the plan. Your child can choose from brisk walking, dancing, running, or jumping rope. The provider will also recommend flexibility and resistance training, which may include yoga and lifting weights.
    Family Walking for Exercise
  • How to manage blood sugars when your child is sick: Blood sugar levels can be too high or too low when your child is sick. Your child's care team will give you information about managing your child's diabetes during sick days.

Your child's nutrition:

A dietitian will help you and your child create a meal plan. The plan will help keep your child's blood sugar level steady. Help your child make the best decisions when choosing foods. The following are tips to help you to start helping with your child's nutrition:

  • Keep track of carbohydrates (sugar and starchy foods). Your child's blood sugar level can get too high if he or she eats too many carbohydrates. His or her dietitian will help you plan meals and snacks that have the right amount of carbohydrates. Here is an example to help you plan your child's meals before meeting with a dietitian:
    Plate Method
  • Give your child low-fat and low-sodium foods. Examples of low-fat foods are lean meat, fish, skinless chicken or turkey, and low-fat milk. Limit high-sodium foods, such as potato chips and soup. Do not add salt to food you cook. Limit your child's use of table salt.

  • Give your child high-fiber foods. Foods that are a good source of fiber include vegetables, whole-grain bread, and beans.

Help your child manage type 2 diabetes:

  • Talk to your child's care team if you or your child become stressed about diabetes care. Learning about diabetes care can be stressful. The stress can cause your child not to want to help in his or her own care. The stress can also cause you to feel overwhelmed. Your child's care team can help by offering tips about self-care. The care team may suggest you and your child talk to a mental health provider. The provider can listen and offer help with self-care issues and feelings of being overwhelmed. You and your child may choose to see the provider at separate times. You and child may, instead, choose to see the provider together.
  • Make sure your child always wears medical alert jewelry or carries a card that says he or she has diabetes. Ask your child's healthcare provider where to get these items.
    Medical Alert Jewelry
  • Give instructions to your child's school and care providers. Make sure your child's teachers and care providers know he or she has diabetes. Provide written instructions about what to do if your child has symptoms of high or low blood sugar levels.
  • Do not smoke around your child. Do not let others smoke around him or her. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Cigarette smoke can worsen the problems that occur with diabetes. Ask your child's care team provider for information if you or child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your child's care team provider before you or your child use these products.
  • Bring your child in for screenings as directed. Your child will need to be screened for complications of diabetes and other conditions that may develop. Examples include kidney problems, high cholesterol, high blood pressure, blood vessel problems, eye problems, and eating disorders. Some screenings may begin right away and some may happen within the first 5 years of diagnosis. Your child will need to continue screenings through his or her lifetime. Keep your child's follow-up appointments with all providers.
  • Ask about vaccines. Your child has a higher risk for serious illness if he or she gets the flu or pneumonia. Ask your child's care team provider if your child should get a flu or pneumonia vaccine, and when to get the vaccine.

Follow up with your child's healthcare provider as directed:

Your child will need to return to have his or her A1c checked. The care team will make sure that treatment is working. Your child's treatment may need to be adjusted. Write down questions that you and your child have so you remember to ask them during his or her visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Type 2 Diabetes in Children (Ambulatory Care)

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