Type 2 Diabetes

15 year-old Brittany didn’t feel sick. But two years ago,
she tested positive for type 2 diabetes during a routine trip to
the doctor.

Brittany says, “At first, I was asking, am I going to die?
And I was like, I don’t want to die, I’m young to die.”

Doctors say almost all teens with type 2, or adult-onset diabetes
are overweight. Dr. Byron Cotton, a primary care physician with
Children’s Healthcare of Atlanta says, “It’s
become so commonplace that 12 year-olds who are 200 pounds don’t
see themselves as being abnormal or overweight.”

Of the kids who are heavy, doctors say those who get diabetes,
likely have it in their genes. Dr. Cotton says, “You’ll
find diabetes in all populations, but you tend to find it more
in people of color: African-Americans, Hispanics, Native Americans.”

Over time, diabetes can lead to blindness, kidney failure, even
amputation. Brittany says, “A lot of bad stuff can happen.
You can get a lot of stuff cut off, like your legs and stuff cut
off. And I don’t want that to happen because I’m young,
and I want to have a teenage life, grown up life, and then when
I’m old I want to still be living.”

Complications typically show up fifteen years after diabetes
sets in. That means teens with the disease may deal with the effects years earlier…at
25 or 30…instead of age 60, or 70. Dr. Cotton says, “It
greatly shortens your life span. So if you have a family history
of diabetes, or I would even say if you are a person of color and
you are overweight, I think you should be aggressive and ask your
physician to check your child to see if he is either diabetic or
at risk of becoming diabetic.”

Brittany knows losing even a little weight can greatly improve
her health. Brittany says, “If I get down three different
pants sizes, smaller pants sizes, I’d be happy.” Her
mom Janelle Brown says, “Something really bad can happen
to her, and I don’t want that to happen to my baby. So that’s
why I have to stay focused and stay on her, even though she gets
mad, I have to stay on her about the food and exercise.”

Dr. Cotton says, “Diabetes is not a death sentence. You
have control over what happens to you. If you change behavior,
if you exercise, eat right, you can live a happy healthy life.”

Doctors say, at first, most kids who develop type two diabetes will
not have symptoms. That’s why it’s important to ask your
pediatrician for an evaluation if your child is overweight.

Diabetes mellitus is a group of diseases characterized by high
levels of blood glucose resulting from defects in insulin secretion,
insulin action or both. According to experts at the Centers for Disease
Control and Prevention, there are four types of diabetes:

• Type 1 diabetes was previously called insulin-dependent diabetes
  mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account
  for 5 to 10 percent of all diagnosed cases of diabetes. Risk factors
  are less well defined for type 1 diabetes than for type 2 diabetes,
  but autoimmune, genetic and environmental factors are involved in
  the development of this type of diabetes.
• Type 2 diabetes was previously called non-insulin dependent diabetes
  mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account
  for about 90 to 95 percent of all diagnosed cases of diabetes. Risk
  factors for type 2 diabetes include older age, obesity, family history
  of diabetes, prior history of gestational diabetes, impaired glucose
  tolerance, physical inactivity, and race/ethnicity. African-Americans,
  Hispanic/Latino Americans, American Indians, and some Asian Americans
  and Pacific Islanders are at particularly high risks for type 2 diabetes.
• Gestational diabetes develops in 2 to 5 percent of all pregnancies
  but disappears when a pregnancy is over. Gestational diabetes occurs
  more frequently in African-Americans, Hispanic/Latino Americans,
  American Indians and persons with a family history of diabetes. Obesity
  is also associated with higher risk. Women who have had gestational
  diabetes are at increased risk for later developing type 2 diabetes.
  In some studies, nearly 40 percent of women with a history of gestational
  diabetes developed diabetes in the future.
• “Other specific types” of diabetes result from specific
  genetic syndromes, surgery, drugs, malnutrition, infections and other
  illnesses. Such types of diabetes may account for 1 to 2 percent
  of all diagnosed cases of diabetes.

Diabetes may not be considered by many to be a serious disease, but
statistics from the Juvenile Diabetes Research Foundation suggest otherwise.
Consider the following:

• Diabetes kills one American every three minutes.
• Sixteen million Americans have the disease; of those, 5.4 million
  are undiagnosed.
• Diabetes afflicts 120 million people worldwide, and the World
  Health Organization (WHO) estimates that number will skyrocket to
  300 million by 2025.
• A new case of diabetes is diagnosed every 40 seconds.
• Diabetes is the leading cause of kidney failure, adult blindness
  and non-traumatic amputations. It is a leading cause of nerve damage.
• People with diabetes are two to four times more likely to have
  a heart attack or stroke than someone without the disease.
• Life expectancy of people with diabetes averages 15 years less
  than people without the disease.
• Diabetes accounts for more than $105 billion of annual U.S. healthcare
  costs.
• One of every four Medicare dollar goes to pay for the health care
  of people with diabetes.

Type 2 diabetes is a serious and costly
disease affecting more than 15 million adult Americans. The chronic
complications of diabetes include accelerated development of cardiovascular
disease, end-stage renal disease, loss of visual acuity, and limb amputations.
All of these complications contribute to the excess morbidity and mortality
in individuals with diabetes. Moreover, the prevalence of type 2 diabetes
in adults is increasing. Superimposed on this disturbing picture in
adults are the recent reports of the emerging problem of type 2 diabetes
in children and adolescents.

Currently, children with type 2 diabetes are usually diagnosed
over the age of 10 and are in middle to late puberty. As the childhood
population becomes increasingly overweight, type 2 diabetes may be
expected to occur in younger pre-pubertal children. There is evidence
suggesting that type 2 diabetes is increasing in children and adolescents
in the United States. One possible explanation for its emergence
in children is the increase in obesity and decrease in physical activity
in children.

Obesity is now reaching epidemic proportions all over the world,
and specifically in the United States. It is a very common finding
in children with type 2 diabetes. According to the American Diabetes
Association (ADA), other risk factors include the following:

• Family history of diabetes – The frequency of a history
  of type 2 diabetes in a first- or second-degree relative has ranged
  from 74 to 100 percent.
• Sex and puberty – In the adult U.S. population, the prevalence
  of diagnosed type 2 diabetes is slightly higher in women than in
  men. Most of the studies in children, including those that are
  population-based, indicate a higher frequency in females. Reported
  cases of type 2 diabetes in children show a peak age of diagnosis
  during the usual pubertal age period, although there have been
  individuals described who were diagnosed pre-pubertally. The mean
  age of diagnosis was between 12 and 16.

There are a number of pharmacological treatment combinations for
the treatment of diabetes, most of which include some level of insulin
utilization. However, there are a number of lifestyle-oriented modifications
that can also have a significant impact on the health and wellbeing
of individuals dealing with diabetes. According to the ADA, the goal
of lifestyle-oriented treatment is to lower your blood sugar and
improve your body’s use of insulin. Components of this goal
include:

• Meal planning – When an individual eats, his/her body
  changes food into blood sugar, making his/her blood sugar go up.
  A good meal plan slows this rise. A dietitian can help your child
  create a meal plan just for him/her, but make sure the following
  hold true:
  • It is low in fat.
  • It has moderate amounts of protein.
  • It contains starches, like those in beans, vegetables and
    grains (such as breads, cereals, noodles and rice).
• Exercise – Being active helps the cells in your child’s
  body take in blood sugar, so exercise plays a major role in the
  treatment plan. Tell your child’s doctor about the kinds
  of exercise he/she does now. His/her healthcare provider will help
  your child fit them to his/her new lifestyle. If your child doesn’t
  exercise, you may want to encourage him/her to become more active.
  It would be great if he/she could be active on most days of the
  week for a total of 30 minutes, which can be broken down into short
  sessions. If your child isn’t used to exercising, encourage
  him/her to start slow. Even a five-minute walk can help.
• Weight loss – Losing weight is another big part of diabetes
  treatment. It will help your child’s body use insulin better.
  The best way to lose weight is to exercise and follow a healthy
  meal plan. With a healthy meal plan, your child will consume fewer
  calories because he/she will fill up on low-fat foods, not fatty
  foods. Your child’s healthcare provider can help determine
  how much weight (if any) your child should lose. Sometimes, just
  10 or 20 pounds is enough to bring diabetes under control. Your
  child should then decide how much to lose per week, keeping in
  mind that one pound per week should be the maximum. Slow weight
  loss is healthier and easier.
• Blood sugar checks – Once your child understands that
  eating healthy, losing weight and keeping fit help keep blood sugar
  levels normal, he/she can check his/her blood sugar levels at home
  to keep track of how he/she is doing.