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Type 2 diabetes in children

Overview

Type 2 diabetes in children is a chronic disease that affects the way your child's body processes sugar (glucose). It's important to manage your child's diabetes because its long-term consequences can be disabling or even life-threatening.

Type 2 diabetes is more commonly associated with adults. In fact, it used to be called adult-onset diabetes. But type 2 diabetes in children is on the rise, fueled largely by the obesity epidemic.

There's plenty you can do to help manage or prevent type 2 diabetes in children. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If diet and exercise aren't enough to control type 2 diabetes in children, oral medication or insulin treatment may be needed.

Symptoms

Type 2 diabetes in children may develop gradually. About 40 percent of children who have type 2 diabetes have no signs or symptoms and are diagnosed during routine physical exams.

Other children might experience:

  • Increased thirst and frequent urination. Excess sugar building up in your child's bloodstream pulls fluid from tissues. As a result your child might be thirsty — and drink and urinate more than usual.
  • Weight loss. Without the energy that sugar supplies, muscle tissues and fat stores simply shrink. However, weight loss is less common in children with type 2 diabetes than in children with type 1 diabetes.
  • Fatigue. Lack of sugar in your child's cells might make him or her tired and lethargic.
  • Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. Your child might be unable to focus clearly.
  • Slow-healing sores or frequent infections. Type 2 diabetes affects your child's ability to heal and resist infections.

When to see a doctor

See your child's doctor if you notice any of the signs or symptoms of type 2 diabetes. Undiagnosed, the disease can cause serious damage. Diabetes screening is recommended for all children and adolescents who are overweight and have at least two other risk factors for type 2 diabetes.

Causes

The exact cause of type 2 diabetes is unknown. But family history and genetics appear to play an important role. Inactivity and excess fat — especially abdominal fat — also seem to be important factors.

What is clear is that people with type 2 diabetes don't process glucose properly anymore. As a result, sugar accumulates in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.

Most of the glucose in people's bodies comes from the food they eat. When food is digested, sugar enters the bloodstream. Moving sugar from the bloodstream to the body's cells requires a hormone (insulin).

Insulin comes from the pancreas, a gland located behind the stomach. The pancreas secretes insulin into the bloodstream after a person eats.

As insulin circulates, it allows sugar to enter the cells — and lowers the amount of sugar in the bloodstream. As the blood sugar level drops, so does the secretion of insulin from the pancreas.

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops making enough insulin. The resulting buildup of sugar in the bloodstream can cause life-threatening complications.

Risk factors

Researchers don't fully understand why some children develop type 2 diabetes and others don't, even if they have similar risk factors. However, it's clear that certain factors increase the risk, including:

  • Weight. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue children have — especially inside and between the muscle and skin around the abdomen — the more resistant their bodies' cells become to insulin. The association between obesity and type 2 diabetes is even stronger in youth than in adults.
  • Inactivity. The less active your child is, the greater his or her risk of type 2 diabetes. Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin.
  • Family history. Children's risk of type 2 diabetes increases if they have a parent or sibling with the disease.
  • Race. Although it's unclear why, people of certain races — including African-Americans, Hispanics, Native Americans, Asian-Americans and Pacific Islanders — are more likely to develop type 2 diabetes.
  • Age and sex. Many children develop type 2 diabetes at the start of puberty. Adolescent girls are likelier to develop type 2 diabetes than are adolescent boys.
  • Birth weight and gestational diabetes. Low birth weight and being born to a mother who had gestational diabetes during the pregnancy are both associated with a higher risk of developing type 2 diabetes.

Complications

Type 2 diabetes can affect nearly every major organ in your child's body, including the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes develop gradually. But eventually, diabetes complications may be disabling or even life-threatening.

Complications of type 2 diabetes include:

  • High blood pressure
  • High cholesterol
  • Heart and blood vessel disease
  • Stroke
  • Nonalcoholic fatty liver disease
  • Kidney disease
  • Blindness
  • Amputation
  • Certain skin conditions

Keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Diagnosis

If diabetes is suspected, your child's doctor will likely recommend a screening test. A diagnosis of type 2 diabetes in children generally requires abnormal results from two tests taken on different days. There are several blood tests for diabetes.

Fasting blood sugar test

A blood sample is taken after your child fasts for at least eight hours, or overnight. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

In general:

  • A fasting blood sugar level below 100 mg/dL (5.6 mmol/L) is considered normal.
  • A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes — which indicates a high risk of developing type 2 diabetes.
  • A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes.

Glycated hemoglobin (A1C) test

Your doctor might recommend this test if your child's fasting blood sugar test results don't indicate diabetes but the doctor still suspects it.

The A1C test indicates your child's average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your child's blood sugar levels, the more hemoglobin your child will have with sugar attached.

In general:

  • An A1C level below 5.7 percent is considered normal.
  • An A1C level between 5.7 and 6.4 percent is considered prediabetes.
  • An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes.

Oral glucose tolerance test

A blood sample is taken after your child fasts for at least eight hours or overnight. Then your child drinks a sugary solution, and his or her blood sugar levels are measured periodically over the next few hours.

In general:

  • A blood sugar level less than 140 mg/dL (7.8 mmol/L) is considered normal.
  • A blood sugar level from 140 to 199 mg/dL (7.8 to 11.0 mmol/L) is considered prediabetes.
  • A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher indicates type 2 diabetes.

Random blood sugar test

A blood sample is taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.

Additional tests

Your doctor will likely recommend additional tests to confirm the type of diabetes that your child has. It's important to distinguish between type 1 diabetes and type 2 diabetes because treatment strategies differ.

After the diagnosis

Your child will need regular follow-up appointments to ensure good diabetes management and to check his or her A1C levels. Your doctor will also periodically use blood and urine tests to check your child's:

  • Cholesterol levels
  • Thyroid function
  • Kidney and liver function

In addition, your doctor will regularly assess your child's blood pressure and growth. Your child will also need regular eye examinations.

Treatment

Treatment for type 2 diabetes is lifelong and includes blood sugar monitoring, healthy eating, regular exercise, and sometimes insulin or other medications. As your child grows and changes, so will his or her diabetes treatment plan. The goal is to maintain healthy blood sugar levels, improve your child's sensitivity to insulin and prevent complications of type 2 diabetes.

If managing your child's diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your child's diabetes treatment team — doctor, certified diabetes educator and dietitian — to keep your child's blood sugar level as close to normal as possible.

Alternative medicine

Although many alternative therapies have been touted as possible ways to treat or prevent type 2 diabetes, there's no definitive evidence that any of these alternative therapies are effective.

Talk to your child's doctor about dietary supplements or other alternative therapies to treat or prevent type 2 diabetes. Some of these supplements or alternative therapies might be harmful if combined with certain prescription medications. Your child's doctor can help you weigh the pros and cons of specific alternative therapies.

Blood sugar monitoring

You will need to check and record your child's blood sugar at least daily, possibly more often. This usually requires finger sticks, although some blood glucose meters allow for testing at other sites. Testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows.

Children who need insulin therapy will need to check their blood sugar levels at least three times a day. Ask your doctor how often your child needs to test his or her blood sugar.

Healthy eating

Your child won't be restricted to a lifetime "diabetes diet" of boring, bland foods. Instead, your child needs plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories. Ideally, your child's intake of carbohydrates should be consistent.

Your child's dietitian will likely suggest that your child — and the rest of the family — consume fewer animal products and sweets. This eating plan is the best for the whole family. Sugary foods are OK once in a while, as long as they're included in your child's meal plan.

Your dietitian is also likely to recommend that you:

  • Decrease portion sizes
  • Substitute a fruit or vegetable for a carbohydrate-rich food
  • Replace high-calorie beverages, such as soft drinks or fruit juices, with water
  • Eat at home more frequently instead of eating at restaurants

Physical activity

Physical activity lowers blood sugar. Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. Encourage your child to get regular physical activity for at least an hour a day and, better yet, exercise with your child.

Medication

Your child might need a medication to help control blood sugar. Metformin (Fortamet, Glucophage, Glumetza) reduces the amount of sugar a child's liver releases into the bloodstream between meals. Metformin might also help your child lose weight.

Side effects may include nausea, upset stomach, diarrhea and headaches. Metformin isn't safe for anyone who has liver failure, kidney failure or heart failure.

Insulin

Insulin is generally recommended at the time of diagnosis for children with:

  • Blood sugar above 250 mg/dL (13.9 mmol/L)
  • A1C above 9 percent

Once your child's blood sugar levels fall to normal, your child might be weaned off insulin. Your child will need to take metformin and maintain lifestyle changes to control blood sugar.

If blood sugar isn't well-controlled with metformin and lifestyle changes, insulin will have to be given again. Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options.

Your doctor's recommendation will depend on your child's blood sugar level and the presence of any other health problems. A long-acting insulin, such as insulin glargine (Lantus), is often used for type 2 diabetes in children.

Insulin delivery options include:

  • Injections. Insulin can be injected using a fine needle and syringe or an insulin pen ¾ a device that looks like an ink pen, except the cartridge is filled with insulin.
  • Insulin pump. The pump is a device about the size of a cellphone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. A pump that is programmed to dispense specific amounts of insulin automatically might be an option.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 2 diabetes — such as low blood sugar, high blood sugar and ketoacidosis — require immediate care.

Hypoglycemia

Hypoglycemia is a blood sugar level below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin.

Teach your child the symptoms of low blood sugar. When in doubt, he or she should always do a blood sugar test. Early signs and symptoms of low blood sugar include:

  • Pale complexion
  • Sweating
  • Shakiness
  • Hunger
  • Irritability
  • Nervousness or anxiety
  • Headaches

If your child has a low blood sugar reading:

  • Give your child fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar
  • Retest the blood sugar in about 15 minutes to make sure it has gone up into the normal range
  • If the blood sugar is still low, re-treat with more sugar and then retest in another 15 minutes

Left untreated, low blood sugar will cause your child to lose consciousness. If this occurs, the child may need an emergency injection of a hormone that stimulates the release of sugar into the blood (glucagon). Make sure your child always carries a source of fast-acting sugar.

Hyperglycemia

Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating the wrong types of foods and not taking enough insulin.

Signs and symptoms of high blood sugar include:

  • Frequent urination
  • Increased thirst or dry mouth
  • Blurred vision
  • Fatigue
  • Nausea

If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is persistently above his or her target range, call your child's doctor or seek emergency care.

Diabetes ketoacidosis

Severe lack of insulin causes your child's body to produce certain toxic acids (ketones). Excess ketones build up in your child's blood and are spilled in the urine, a condition known as diabetic ketoacidosis (DKA).

DKA is more common in children with type 1 diabetes, but can sometimes occur in children with type 2 diabetes. Untreated DKA can be life-threatening.

Signs and symptoms of DKA include:

  • Thirst or very dry mouth
  • Increased urination
  • Exhaustion
  • Dry or flushed skin
  • Nausea, vomiting or abdominal pain
  • A sweet, fruity smell on your child's breath
  • Confusion

If you suspect DKA, check your child's urine for excess ketones. If the ketone levels are high, call your child's doctor or seek emergency care.

Preparing for an appointment

Your child's family doctor or pediatrician will probably make the initial diagnosis of diabetes. However, you'll likely then be referred to a doctor who specializes in metabolic disorders in children (pediatric endocrinologist).

Your child's health care team will also generally include a dietitian, a diabetes educator and a doctor who specializes in eye care (ophthalmologist).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment take these steps:

  • Be aware of any pre-appointment restrictions. If the doctor is going to test your child's blood sugar, your child might need to avoid eating or drinking anything but water for four to eight hours, depending on the type of test.
  • Write down any symptoms your child is experiencing, including any that may seem unrelated.
  • Ask a family member or friend to join you, if possible. Managing your child's diabetes well requires you to retain a lot of information, and it can sometimes be difficult to recall all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down a list of questions to ask your doctor.

Some basic questions to ask your child's doctor include:

  • How often do I need to monitor my child's blood sugar?
  • What should my child's blood sugar levels be during the day and before bedtime?
  • What changes need to be made in the family diet?
  • How much exercise should my child get each day?
  • Will my child need to take medication? If so, what kind and how much?
  • Does my child need to take insulin? What are the options for insulin delivery, and what do you recommend?
  • What signs and symptoms of complications should I look for?
  • My child has another health condition. How can we best manage them together?
  • How often does my child need to be monitored for diabetes complications? What specialists do we need to see?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may come up during the appointment.

What to expect from your doctor

Examples of questions your doctor may ask, include:

  • What's a typical day's diet?
  • Is your child exercising? If so, how often?
  • On average, how much insulin is your child using each day?
  • Has your child experienced any low blood sugars?
  • Do you feel confident about your child's treatment plan?
  • How do you feel your child is coping with diabetes and its treatment?

Contact your child's doctor or diabetes educator between appointments if your child's blood sugar isn't well-controlled, or if you're not sure what to do in a certain situation.

Lifestyle and home remedies

Type 2 diabetes is a serious disease. Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment. But your efforts are worthwhile. Careful management of type 2 diabetes can reduce your child's risk of serious — even life-threatening — complications.

As your child gets older:

  • Encourage him or her to take an increasingly active role in diabetes management
  • Stress the importance of lifelong diabetes care
  • Teach your child how to test his or her blood sugar and inject insulin if needed
  • Help your child make wise food choices
  • Encourage your child to remain physically active
  • Foster a relationship between your child and his or her diabetes treatment team

Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with type 2 diabetes.

School and diabetes

You'll need to work with your child's school nurse and teachers to make sure they know the symptoms of high and low blood sugar levels. Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children get a proper education.

Coping and support

Living with type 2 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of time and effort, especially in the beginning.

Diabetes can affect your child's emotions both directly and indirectly. Poorly controlled blood sugar can cause behavior changes, such as irritability. If you notice that your child or adolescent is persistently sad or pessimistic, or experiences dramatic changes in sleeping habits, friends or school performance, have your child assessed for depression.

Your child may find encouragement and understanding in a type 2 diabetes support group for children. Support groups for parents are also available. Websites that offer support include the American Diabetes Association (ADA).

Prevention

Healthy lifestyle choices can help prevent type 2 diabetes in children and its complications. And if your child already has type 2 diabetes, lifestyle changes can reduce the need for medications. Encourage your child to:

  • Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
  • Get more physical activity. Encourage your child to become active. Sign up for a sports team or dance lessons, or look for active things to do together.

Better yet, make it a family affair. The same lifestyle choices that can help prevent type 2 diabetes in children can do the same for adults. The best diet for a child with diabetes is also the best diet for the whole family.

Last updated: April 19th, 2017

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