Type 2 Diabetes in Children

Topic Overview

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This topic provides information about type 2 diabetes in children. If you are looking for information about type 1 diabetes, see the topic Type 1 Diabetes: Children Living With the Disease.

What is type 2 diabetes?

Type 2 diabetes is a lifelong disease that develops when the pancreas cannot make enough insulin or when the body's tissues cannot use insulin properly. Insulin is a hormone that helps the body’s cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.

Without insulin, the sugar cannot get into the cells to do its work. It stays in the blood instead. This can cause high blood sugar levels. A person has diabetes when the blood sugar stays too high too much of the time.

Over time, high blood sugar can cause problems with the eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes a person more likely to get serious illnesses or infections.

In the past, doctors believed that type 2 diabetes was an adult disease and that type 1 diabetes was a children’s disease. Now, more and more children are getting type 2 diabetes.

Finding out that your child has diabetes can be scary. But your child can live a long, healthy life by learning to manage the disease.

What causes type 2 diabetes?

Doctors do not know exactly what causes diabetes. Experts believe the main risks for children getting type 2 diabetes are being overweight, not being physically active, and having a family history of the disease.

Also, the hormones released during the early teen years make it harder than usual for the body to use insulin correctly. This problem is called insulin resistance. It can lead to diabetes.

What are the symptoms?

Most children with type 2 diabetes do not have symptoms when the disease is first found. If there are symptoms, they usually are mild and may include:

  • Having to urinate more often.
  • Feeling a little more thirsty than normal.
  • Losing a little weight for no clear reason.

How is type 2 diabetes diagnosed?

A simple blood test is usually all that is needed to diagnose diabetes. Your child’s doctor may do other blood tests if it is not clear whether your child has type 1 or type 2 diabetes.

A doctor may test your child for diabetes if he or she is overweight, gets little physical activity, or has other risk factors for the disease. A risk factor is anything that increases your chances of having a disease. Some children are diagnosed with type 2 diabetes when they have a blood or urine test for some other reason.

How is it treated?

The key to treating diabetes is to keep your child’s blood sugar levels within a target range. To do this:

  • Keep track of your child’s blood sugar levels. This will help you and your child learn how different foods and activities affect his or her blood sugar. Your doctor can teach you and your child how to do this.
  • Teach your child to make healthy food choices.
    • Help your child to eat about the same amount of carbohydrate at each meal. This helps keep your child’s blood sugar steady. Carbohydrate affects blood sugar more than other nutrients. It is found in sugar and sweets, grains, fruit, starchy vegetables, and milk and yogurt.
    • Talk to your doctor, a diabetes educator, or a dietitian about an eating plan that will work for your child. There are many ways to manage how much and when your child eats.
  • Help your child stay active. Your child does not have to start a strict exercise program, but being more active can help control blood sugar. For example, your child could play outside with friends, take walks with family members, or take part in sports.
  • Set a good example. It will be easier for your child if the rest of the family also eats well and gets regular exercise. This may also reduce the risk that other family members will get the disease.
  • If your child needs medicine for diabetes, make sure that he or she takes it as prescribed.

You play a major role in helping your child take charge of his or her diabetes care. Let your child do as much of the care as possible. At the same time, give your child the support and guidance he or she needs.

The longer a person has diabetes, the more likely he or she is to have problems, such as diseases of the eye, heart, blood vessel, nerve, and kidney. But if your child can control his or her blood sugar levels every day, it may help to delay the start of or prevent some of these problems later on.

Even when you are careful and do all the right things, your child can have problems with high or low blood sugar. It is important to know what signs to look for and what to do if this happens.

Can type 2 diabetes be prevented?

Helping your child stay at a healthy weight and get regular exercise can help prevent type 2 diabetes.

Frequently Asked Questions

Learning about type 2 diabetes in children:

Being diagnosed:

Preventing the disease:

Getting treatment:

Ongoing concerns:

Living with a child who has type 2 diabetes:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Diabetes: Should I get an insulin pump?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Diabetes in children: Checking blood sugar in a child
  Diabetes in children: Counting carbs
  Diabetes in children: Dealing with low blood sugar
  Diabetes in children: Giving insulin shots to a child
  Diabetes in children: Preparing a care plan for school
  Diabetes in children: Preventing high blood sugar
  Diabetes in children: Preventing low blood sugar
  Healthy eating: Helping your child learn healthy eating habits

Interactive tools help people determine health risks, ideal weight, target heart rate, and more. Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
  Interactive Tool: What Is Your Child's BMI?

Cause

The exact cause of type 2 diabetes is not known. But experts believe the disease develops in children the same way it does in adults: the body does not produce enough of the hormone insulin, or it cannot correctly use the insulin available (insulin resistance). Either or both of these conditions lead to excess sugar (glucose) in the blood.

Insulin resistance

Insulin resistance occurs when the body's cells do not correctly use insulin, which helps control the amount of glucose in the blood. The body then needs more insulin to control blood sugar levels. The pancreas produces more insulin to try to keep blood sugar levels normal. If it cannot produce enough insulin, blood sugar rises, and diabetes may develop.

Factors that affect the body's resistance to insulin in childhood include:

  • Developmental stage. Insulin resistance normally increases about 30% during puberty, probably because of the effects of growth hormone.1
  • Being female. Girls seem to develop more resistance to insulin than boys.
  • Race. The body's resistance to insulin is about 30% higher in African-American teens than in white teens.2
  • Body composition. Insulin resistance increases as the amount of fat around the waist increases.
  • Activity. Exercise may improve how the body's cells use insulin and get the sugar they need.

Too little insulin

Normally, the pancreas produces more insulin than usual during puberty to support the rapid growth of the child. If the body cannot produce enough insulin to meet its needs, diabetes develops. Over time, the pancreas may produce less and less insulin, making the diabetes worse.

More Information:

Symptoms

Children often have no symptoms of type 2 diabetes before they are diagnosed because their blood sugar level has been rising so slowly. As a result, a child may have diabetes for several months or years before being diagnosed.

When children do have symptoms, the most common include:

  • Slight increase in the frequency of urination. If your child has already learned to use the toilet, he or she may have started wetting the bed during naps or at night.
  • Slight increase in thirst.

Other possible symptoms include:

  • Increased tiredness.
  • Nausea.
  • Blurred vision.
  • Frequent infections and slow-healing wounds or sores.
  • Weight loss.

What Happens

Type 2 diabetes usually develops in adulthood, but the number of children being diagnosed with the disease is rising. Children with type 2 diabetes are usually diagnosed during the early teen years. During this time, their bodies are growing and developing rapidly, placing a demand on the pancreas to produce additional insulin.

The hormones released during puberty make it more difficult than usual for the body to use insulin correctly (insulin resistance). Also, children with type 2 diabetes are usually overweight, which also contributes to insulin resistance. If the pancreas cannot produce enough insulin to overcome the resistance, diabetes can develop.

Very little is known about the way type 2 diabetes becomes worse over time in children because, until recently, few children had the disease. Diabetes experts believe the disease progresses as it does in adults, causing damage to the eyes, kidneys, heart, blood vessels, and nerves. The main risk factors for complications are the length of time a person has diabetes and the degree of blood sugar control. A child who develops type 2 diabetes may have an increased risk of complications because he or she will have the disease for a long time. Complications can lead to serious disabilities, such as blindness, and early death.

Studies show that when children develop diabetes, complications begin to develop in young adulthood. Delayed diagnosis and failure to keep blood sugar levels in a target range can lead to early development of complications. The longer a child has diabetes, the more likely it is that complications will develop in young adulthood.3

  • Children and teens may develop eye disease (diabetic retinopathy) and kidney disease (diabetic nephropathy).4
  • Children and teens rarely have symptoms of nerve disease (diabetic neuropathy).4
  • Children often have high blood pressure or high cholesterol, which increases their risk of heart and blood vessel disease later in life.

If a child's blood sugar levels remain high for a long time, he or she may grow at an abnormal rate—faster than normal for a while, then slower than normal later. If blood sugar levels stay high during puberty, normal changes and the beginning of menstruation may be delayed.

The way to prevent complications is to always keep blood sugar levels at a target level. This requires that your child follow his or her treatment plan daily and monitor blood sugar levels often. Your child also will need ongoing diabetes education and regular checkups. Other medical conditions, such as high blood pressure and high cholesterol, need adequate medical care as well because they raise the risk for diabetes complications.

Children with type 2 diabetes have to modify their lifestyles. Your child will be more successful if your whole family is involved. These lifestyle changes benefit everyone by reducing the risk for developing diabetes and heart disease.

What Increases Your Risk

The major risk factors for type 2 diabetes in children include:

  • Being overweight.
  • Getting little or no physical activity.
  • Family history. At least 75% of children with type 2 diabetes have a parent, sister, or brother with the disease.2

Other factors that increase risk include:

  • Race. African-American, Hispanic, Native American, Asian-American, and Pacific Islander children are at greater risk for developing type 2 diabetes than white American children.
  • Being female. Girls are more likely to develop the disease than boys.
  • The child's mother having diabetes that developed during pregnancy (gestational diabetes).
  • The child being small for gestational age at birth.

Medical conditions that contribute to the risk of complications in adolescence and beyond include:

Teens who have diabetes and smoke have a higher risk of complications from diabetes than do those who do not smoke.

When To Call a Doctor

Call 911 or other emergency services immediately if your child is:

Call a doctor immediately if your child is vomiting and cannot keep down liquids and has a blood sugar of 250 mg/dL or higher.

Call a doctor if your child:

  • Is sick for more than 2 days (unless it is a mild illness, such as a cold), and your child:
    • Has been vomiting or had diarrhea for more than 6 hours.
    • Has followed his or her doctor's advice but it has not worked. Learn what to do when you are sick and have diabetes.
    • Has blood sugar levels that are often above 250 mg/dL and urine tests for ketones show more than 2+ or moderate or higher ketones.
  • Has a blood sugar level that stays below the target range after eating some quick-sugar food.
  • Has a blood sugar level that stays high after taking a missed dose of insulin or oral diabetes medicines or after taking an extra dose of insulin (if prescribed by the doctor).
  • Has frequent problems with high or low blood sugar levels. The insulin dose or schedule may need to be changed.
  • Is having difficulty knowing when his or her blood sugar is low (hypoglycemia unawareness).
  • Is having problems following the meal plan or getting physical activity, and you want help.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your child's symptoms or condition without using medical treatment. Watchful waiting is not appropriate if:

  • You think your child may have symptoms of type 2 diabetes. A simple blood test is all that is needed to determine whether your child has the disease.
  • Your child is overweight and gets little or no exercise. He or she is at risk for developing diabetes. Early detection and treatment for type 2 diabetes can prevent or delay complications from the disease.
  • You have been told that your child has prediabetes. This condition can lead to type 2 diabetes. If your child eats a healthy diet and exercises regularly, he or she may not develop diabetes.

Who To See

Most doctors can diagnose diabetes. After your child has been diagnosed, your doctor will work with you to develop a treatment plan that fits your child's needs. Health professionals who may be involved in the treatment of children with type 2 diabetes include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Many children have had no symptoms before they are diagnosed with type 2 diabetes. Usually, the illness is discovered when a blood or urine test taken for another reason shows diabetes.

A doctor may want to assess your child for type 2 diabetes if he or she has a body mass index (BMI) or weight above the 85th percentile for his or her age and gender or weighs more than 120% of ideal and has any two of these risk factors:5

  • Family history of type 2 diabetes
  • Being a Native American, African-American, Latino, Asian-American, or Pacific Islander
  • Signs of not being able to use insulin properly (insulin resistance) or conditions associated with it, such as:

Some children have very high blood sugar levels at the time of diagnosis. A child with very high blood sugar can become confused, sleepy, or unconscious, and may develop diabetic ketoacidosis (DKA), which is an emergency. DKA is most common in people with type 1 diabetes and in some African-American people who have type 2 diabetes.

If a doctor suspects that your child may have type 2 diabetes, he or she will do a medical history, physical examination, and blood glucose testing. If the results of these tests meet the criteria for diagnosing diabetes established by the American Diabetes Association (ADA), your child has diabetes.

If a child has no diabetes symptoms, two blood tests done on separate days are needed to confirm the diagnosis. Tests used to diagnose diabetes are:

  • A hemoglobin A1c test. This test estimates blood sugar for the past 2 to 3 months.
  • A blood glucose test. A fasting blood sugar test (done after not eating or drinking for 8 hours) is preferred.
  • A glucose tolerance test. The child has a fasting blood sugar test and then drinks a sweet liquid with a certain amount of glucose in it. The child's blood sugar is tested two hours later.

Other possible tests

If it is hard to tell whether your child has type 2 or type 1 diabetes, your doctor may do a C-peptide test or an autoantibodies test. (Autoantibodies are produced when the body's immune system does not work right.) These tests may not be able to distinguish the type of diabetes your child has. Getting a definite diagnosis may take months or years. In either case, your child's sugar levels will need to be controlled right away.

Sometimes a doctor will do a quick home blood sugar test or a urine test for sugar to see whether a child may have diabetes. Although these tests are simple and can indicate possible diabetes, additional testing is needed to make sure your child actually has the disease.

Monitoring tests if diagnosed with diabetes

Because your child is at risk for diabetes complications (eye, heart, kidney, nerve, liver, and blood vessel problems), he or she needs to see a doctor regularly throughout life.5

Kinds and frequency of tests and examinations for type 2 diabetes 5

Frequency

Exams and tests

Every 3–6 months

  • Have a medical checkup to review blood sugar levels since the last checkup and evaluate whether your child's treatment plan needs to be changed. Bring your child's home blood sugar records to this appointment. Keep a record with notes of special issues such as changes in diet, in activity, and when your child has low blood sugar problems. Bring this record to the appointment too. During each visit, the doctor will check your child's blood pressure.
  • Have a hemoglobin A1c or similar blood test (glycosylated hemoglobin or glycohemoglobin) to estimate your child's average blood sugar level over the previous 2 to 3 months. This test may be done every 3 to 6 months.
  • Your child may need to have a blood sugar test (blood glucose test). If so, you may want to run a home blood sugar test when your doctor draws blood for the test. This is a good way to check the accuracy of your home meter.
Every 6 months
  • Have a dental exam to check for gum problems.
Every year
  • See an eye specialist (ophthalmologist) for an exam, including ophthalmoscopy. If your child is at low risk for vision problems, your doctor may consider follow-up exams every 2 years.
  • Have a screening test for kidney function. Urine tests look for the amount of protein in the urine (proteinuria), an indicator of kidney damage. Usually, you give a single urine sample, to test for an albumin-to-creatinine ratio. Some doctors do a urine test for protein that estimates protein but does not provide a ratio. Another way to test kidney function is to do a 24-hour urine collection. This may be better because protein levels can be different at different times of the day. Home urine collection kits are available.
  • Your child may need a thorough medical examination of his or her feet at least once a year. Yearly foot exams are recommended for all people with diabetes, and it may help your child understand the importance of proper foot care.6
  • At the time of diagnosis and as needed
  • After blood sugar levels are under control
  • Every year if the child has blood sugar levels above a target range and high LDL cholesterol
  • Every 5 years if the child has low risk and does not have a family history of the disease
  • Have a cholesterol and triglyceride level test to see whether diabetes may be raising the cholesterol level in your child's bloodstream.
  • Have liver enzymes tested to see whether diabetes and obesity may be harming liver function.

 

Early Detection

Starting at age 10 or at the beginning of puberty, a child who has a body mass index (BMI) in the 85th percentile or higher for his or her age or whose weight is more than 120% of ideal and has two of the following risk factors needs to be tested for diabetes every 3 years:7

  • Family history of type 2 diabetes
  • Being a Native American, African American, Latino, Asian-American, or Pacific Islander
  • Signs of not being able to use insulin properly (insulin resistance) or conditions associated with it, such as:

If the results of a glucose test show that your child's blood sugar is higher than normal but not yet at the level of diabetes (prediabetes), the test should be repeated 3 months later to see whether your child has developed diabetes.4 If your child eats a healthy diet and gets regular exercise, he or she may not develop diabetes.

Treatment Overview

Treatment of type 2 diabetes in children focuses on keeping blood sugar levels within a target range. Children may need higher blood sugar goals than adults because their bodies are still developing. Also, they may not be able to recognize symptoms of low blood sugar. To reach his or her target blood sugar, your child needs to eat healthy meals of appropriate portion size and get daily exercise. Treatment also may include medicine.

Healthy eating

A healthy diet with the right amount of calories will help your child achieve target blood sugar levels and maintain a healthy weight. The meal plan designed for your child will spread carbohydrate (starches and sugary foods) throughout the day. This helps prevent high blood sugar after meals as well as weight gain. A registered dietitian can design a meal plan that fits your child's needs. For more information, see the topic Healthy Eating for Children.

Being physically active

Physical activity is extremely important. It helps the body use insulin correctly and helps control weight. Your child does not have to start a rigorous exercise program, but being more active can help control blood sugar. For example, your child could play outside with friends, take brisk walks with family members, and participate in individual or team sports.

Experts recommend that teens and children (starting at age 6) do moderate to vigorous activity at least 1 hour every day.8 And 3 or more days a week, what they choose to do should:

  • Make them breathe harder and make the heart beat much faster.
  • Make their muscles stronger. For example, they could play on playground equipment, play tug-of-war, lift weights, or use resistance bands.
  • Make their bones stronger. For example, they could run, do hopscotch, jump rope, or play basketball or tennis.

It’s okay for them to be active in smaller blocks of time that add up to 1 hour or more each day.

For children older than age 2: The American Academy of Pediatrics advises parents to limit TV time to 2 hours a day or less. For children age 2 and younger: To help your child's brain develop, it's best to talk, play, sing, or read together instead of letting him or her watch TV.

Medicines

Your child may need medicines if 3 months of eating healthy meals and getting regular physical activity have not lowered your child's blood sugar to his or her target level.

  • Oral medicines for diabetes help the body produce more insulin, decrease the body's resistance to insulin, or slow the absorption of carbohydrate from the intestine. Your child may need one medicine at some times and more than one at other times.
  • Some children need daily insulin shots—alone or with oral medicines. Even if your doctor does not prescribe daily insulin, your child may need to take insulin temporarily when first diagnosed or during illness or surgery. If the progression of diabetes cannot be stopped, your child eventually may need to take insulin daily.

Checking blood sugar, blood pressure, and cholesterol

Your child's blood sugar level needs to be checked regularly. Your child will probably have to test before breakfast and 2 hours after meals.

If your child has high blood pressure or high cholesterol, those conditions need to be treated.

  • High blood pressure is usually treated with angiotensin-converting enzyme (ACE) inhibitors because these medicines also protect the circulatory system and the kidneys from damage caused by diabetes. Sexually active teens should be warned that ACE inhibitors should not be taken during pregnancy.
  • Weight loss and well-controlled blood sugar can help lower your child's cholesterol. Your child's doctor may recommend medicine if these lifestyle changes do not lower cholesterol. Sexually active teens should be warned against becoming pregnant while taking these medicines.

What To Think About

Some children have very high blood sugar levels when they are diagnosed with type 2 diabetes. A child with a very high blood sugar level may develop the serious chemical imbalance diabetic ketoacidosis and need to be treated with insulin in a hospital. After blood sugar returns to a target level, the child usually no longer needs insulin. His or her own body may start making enough insulin again.

Treating diabetes with insulin or some oral medicines (or both) increases the risk for low blood sugar episodes. Your doctor will determine the range for your child's blood sugar that will prevent damage from diabetes while causing as few low blood sugar episodes as possible.

The lifestyle changes necessary to control diabetes can be especially difficult for a child or teen. Your child will have a better chance of being successful if the whole family is involved. Eating a healthy diet and getting regular exercise may help other family members avoid developing diabetes.

Click here to view an Actionset. Healthy eating: Helping your child learn healthy eating habits

Teens who have depression or an eating disorder may have difficulty keeping their blood sugar at a healthy level. In addition, teens who smoke or use alcohol or other drugs have problems with blood sugar control. Support groups may help teens deal with diabetes management issues, which can improve the teens' perception of diabetes care and blood sugar control.

Prevention

Healthy meals, physical activity, and weight control can help prevent diabetes or can prevent or delay complications if your child has diabetes. A registered dietitian can help you build a healthy meal plan for your child. Your doctor, exercise specialist, or certified diabetes educator also can help your child find ways to become more physically active.

Weight loss is appropriate if your child is overweight and he or she has reached adult height. In some severe cases, weight loss before your child reaches his or her full adult height may be needed. See the Interactive Tool: What Is Your Child's BMI?

Having a blood sugar level that is higher than normal but not yet at the level of diabetes (prediabetes) increases a child's risk for type 2 diabetes. One study found that 25% of children between the ages of 4 and 10 and 21% between the ages of 11 and 18 who were very overweight had prediabetes.9 If your child has prediabetes, eating a healthy diet and increasing physical exercise may make his or her blood sugar return to a normal range and possibly prevent type 2 diabetes. Your child will still need to see a doctor regularly to check for signs of the disease.

Studies have shown that lifestyle changes can prevent or delay type 2 diabetes in adults.10 But experts are not sure whether lifestyle changes will have the same effect in children. Studies on preventing type 2 diabetes in children and teens are ongoing. Some clinical trials show that a program of physical activity and healthy eating can decrease insulin resistance and control blood glucose.11

Click here to view an Actionset. Healthy eating: Helping your child learn healthy eating habits

Diabetes prevention may begin in infancy: some evidence shows that breast-feeding lowers a child's risk of developing diabetes.12

Home Treatment

Healthy eating

Your child needs to eat healthy meals with appropriate portions to support growth and prevent weight gain. The meal plan for your child will also spread carbohydrate throughout the day to prevent high blood sugar after meals. For information on healthy eating and weight management, see the topic Healthy Eating for Children.

For help learning about carbohydrate counting, see:

Click here to view an Actionset. Diabetes in children: Counting carbs.

More Information:

Physical activity

Encourage your child (age 6 to 17) to do moderate to vigorous activity at least 1 hour every day. If your child enjoys watching TV or playing computer and video games, limit the time spent in these activities. Guidelines for child and teen fitness may be helpful in encouraging your child to play sports and take vigorous walks or go bicycling with family members.

For children older than age 2: The American Academy of Pediatrics advises parents to limit TV time to 2 hours a day or less. For children age 2 and younger: To help your child's brain develop, it's best to talk, play, sing, or read together instead of letting him or her watch TV.

Work with your child's teachers and school to make a plan to handle your child's special needs, including testing blood sugar and eating snacks when needed.

For more information, see:

Click here to view an Actionset. Diabetes in children: Preparing a care plan for school.

Your child can take part in the same activities as other children. For safety:

  • Let the coach know that your child has diabetes. If your child does not take insulin, he or she may not be at risk for low blood sugar episodes, but giving the coach a copy of the symptoms of low blood sugar may still be a good idea.
  • Take your child's home blood sugar meter to sports practice sessions and games. Check his or her blood sugar level before and after each activity if needed.
  • Take a snack that contains carbohydrate to all practice sessions and games in case of a low blood sugar episode.

Home blood sugar monitoring

You and your child will need to monitor his or her blood sugar frequently to know how well it is under control. Talk with your doctor about the safest blood sugar range for your child. Young children may need a higher blood sugar goal than adults because of growth needs and to prevent very low blood sugar (hypoglycemia). As your child grows older, the goal can be lowered so that it is closer to the recommended normal or near-normal range.

Click here to view an Actionset. Diabetes in children: Checking blood sugar in a child

Insulin injections

Your child may not need to take insulin if his or her blood sugar levels are staying within a target range with meal planning, exercise, and possibly oral medicine. But at some point your child may need to take insulin because the pancreas may produce less and less insulin.

If your child takes insulin, you and your child need to know how to prepare and give a shot. See:

Click here to view an Actionset. Diabetes in children: Giving insulin shots to a child.

Other issues

Other important issues include:

  • How to recognize and treat high blood sugar. Blood sugar levels that suddenly rise above a target range can lead to an emergency.
    Click here to view an Actionset.Diabetes in children: Preventing high blood sugar
  • How to recognize and treat low blood sugar. Your child is not likely to have a sudden drop in blood sugar level unless he or she is taking sulfonylurea or meglitinide medicines for diabetes or insulin injections and is unable to eat regular meals.
    Click here to view an Actionset.Diabetes in children: Dealing with low blood sugar
    Click here to view an Actionset.Diabetes in children: Preventing low blood sugar
  • Wearing medical identification at all times. In an emergency, medical identification lets people know that your child has diabetes so they can care for your child appropriately.
  • Where to get support. Many areas of the country have support groups for children and teens with diabetes and for family members. These groups provide encouragement and suggestions that may help you and your child deal with the daily issues of diabetes care. Talk with your doctor about groups in your area.
  • How to care for the feet. Your child needs to wear shoes that fit properly. He or she should not go barefoot, even in the house. It's a good idea to begin the habit of inspecting your child's feet at the end of each day. Look for signs of injury or infection. If you notice a foot problem, even a minor one, talk with your doctor before treating it.
  • What to do for illness. Some general sick-day guidelines may be helpful. These include checking your child's blood sugar every 4 hours during the illness and encouraging your child to drink fluids to prevent dehydration. Do not give your child any nonprescription medicines without talking with a doctor or pharmacist. Some of these medicines can affect blood sugar levels.

What to think about

Childhood and the teen years are a difficult time to be diagnosed with diabetes. Normal developmental changes may interfere with your child following his or her treatment. Teens also may deny their diabetes, rebel against treatment, or participate in risky behavior, such as using drugs or drinking alcohol.

You play a major role in helping your child become independent in his or her diabetes care. Allow your child to do as much of the care as possible, but give your child the support and guidance he or she needs.

  • Children in elementary school can cooperate in all tasks required for their care. By age 8, children can test their own blood sugar with supervision.
  • Children in middle school or junior high school should be able to test their own blood sugar, but they may need help during low blood sugar episodes. By age 10, some children can give insulin injections with supervision.
  • Teens should be able to handle their care with appropriate supervision. If the teen needs to take insulin, he or she may choose to use an insulin pump instead of injections. If your teen chooses to use a pump, be sure to supervise.
    Click here to view a Decision Point.Diabetes: Should I get an insulin pump?

More Information:

Medications

The same medicines are used to treat adults and children with type 2 diabetes. These medicines increase insulin production, make the body better able to use insulin (decrease insulin resistance), or slow the intestinal absorption of carbohydrate.

Sometimes a child needs more than one medicine to adequately control diabetes. Two or more medicines taken together may work more effectively than a single medicine. Taking two medicines together also may reduce possible side effects by allowing lower doses of each. But in some cases taking two medicines can increase the risk of certain side effects, such as low blood sugar (hypoglycemia).

Some children need daily insulin shots—alone or with oral medicines. Even if your doctor does not prescribe daily insulin, your child may need to take insulin temporarily when first diagnosed or during illness or surgery. At some point in adulthood, he or she will likely need insulin because, over time, the pancreas does not produce enough insulin. Insulin also may be needed during pregnancy and breast-feeding.

If your child has high cholesterol or high blood pressure, medicine for those conditions may be needed. Even blood pressure slightly above normal increases the risk for eye and kidney damage from diabetes.

Medication Choices

Medicines that decrease insulin resistance:

  • Biguanides, such as metformin (Glucophage or Glucophage XR) or the combination medicine metformin and glyburide, a sulfonylurea (Glucovance)
  • Thiazolidinediones, such as pioglitazone (Actos) and rosiglitazone (Avandia)

Medicines that increase insulin production:

  • Sulfonylureas, such as glipizide (Glucotrol), glyburide (for example, DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the combination medicine glyburide and metformin (Glucovance), or the combination of glipizide and metformin HCL (Metaglip)
  • Meglitinides, such as repaglinide (Prandin) and nateglinide (Starlix)
  • Incretin mimetics, such as exenatide (Byetta)

Medicines that slow intestinal absorption of carbohydrate:

Some doctors treat children with insulin injections.

Medicines to control blood pressure and cholesterol

Some children may need medicines to lower their blood pressure and cholesterol to reduce the risk for later complications.

What To Think About

Metformin is the only oral medicine that has been adequately studied in children and approved by the U.S. Food and Drug Administration (FDA) for use in children. Other oral medicines are safe for adults, and some doctors also use them to treat children. Exenatide, which is injectable, has not been studied in children but is used in adults with type 2 diabetes.

Metformin is the medicine of choice for children with type 2 diabetes. It usually keeps blood sugar levels within a target range without increasing the likelihood that the child will gain weight. If after 3 to 6 months of treatment with metformin the child's blood sugar levels are not consistently within a target range, other medicine usually is added.

Insulin may be given as a single nighttime dose, as several smaller doses throughout the day, or both. Insulin doses for children with type 2 diabetes are usually high—to overcome the body's resistance to insulin—which may increase the risk for weight gain.

Although alpha-glucosidase inhibitors are safe for children, they may cause abdominal gas, making them less acceptable to teens than other oral diabetes medicines.

Surgery

When obesity is severe in older adolescents with type 2 diabetes, gastric bypass or other similar surgery may be considered as a last resort. For more information, see the topic Obesity.

Other Treatment

Children who have type 2 diabetes should not try to lose weight by following a fad diet or by enrolling in a quick-fix weight loss program. Most doctors recommend that overweight children eat a healthy diet that provides appropriate calories to prevent further weight gain.

Weight loss is appropriate if your child is overweight and he or she has reached adult height. In some severe cases, weight loss before your child reaches his or her full adult height may be needed. See the Interactive Tool: What Is Your Child's BMI?

Other types of treatment for diabetes are provided by therapists or others who do not operate within mainstream medical practice. None of these complementary therapies have been proved to be effective in treating diabetes. But your child may benefit from safe, nontraditional therapies that complement conventional medical treatment for the disease. Talk with your doctor before seeking the following or other complementary therapies for your child.

Other Places To Get Help

Organizations

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, VA  22311
Phone: 1-800-DIABETES (1-800-342-2383)
E-mail: AskADA@diabetes.org
Web Address: www.diabetes.org
 

The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.


Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA  30333
Phone: 1-800-CDC-INFO (1-800-232-4636)
TDD: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web Address: www.cdc.gov
 

The Centers for Disease Control and Prevention (CDC) is an agency of the U.S. Department of Health and Human Services. The CDC works with state and local health officials and the public to achieve better health for all people. The CDC creates the expertise, information, and tools that people and communities need to protect their health—by promoting health, preventing disease, injury, and disability, and being prepared for new health threats.


National Diabetes Education Program (NDEP)
1 Diabetes Way
Bethesda, MD  20814-9692
Phone: 1-800-438-5383 to order materials
(301) 496-3583
E-mail: ndep@mail.nih.gov
Web Address: http://ndep.nih.gov
 

The National Diabetes Education Program (NDEP) is sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC). The program's goal is to improve the treatment of people who have diabetes, to promote early diagnosis, and to prevent the development of diabetes. Information about the program can be found on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC (www.cdc.gov/team-ndep).


National Diabetes Information Clearinghouse (NDIC)
1 Information Way
Bethesda, MD  20892-3560
Phone: 1-800-860-8747
Fax: (703) 738-4929
TDD: 1-866-569-1162 toll-free
E-mail: ndic@info.niddk.nih.gov
Web Address: http://diabetes.niddk.nih.gov
 

This clearinghouse provides information about research and clinical trials supported by the U.S. National Institutes of Health. This service is provided by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).


National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD  20892-2560
Phone: (301) 496-3583
Web Address: www.niddk.nih.gov
 

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides information and conducts research on a wide variety of diseases as well as issues such as weight control and nutrition.


Weight-Control Information Network (WIN)
1 WIN Way
Bethesda, MD  20892-3665
Phone: 1-877-946-4627 toll-free
Fax: (202) 828-1028
E-mail: win@info.niddk.nih.gov
Web Address: http://win.niddk.nih.gov/index.htm
 

The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. WIN supplies information on weight control, obesity, and nutritional disorders for the public and for health professionals.


References

Citations

  1. Curtis J, et al. (2001). Diagnosis and short-term clinical consequences of diabetes in children and adolescents. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 107–123. Hamilton, ON: BC Decker.
  2. American Diabetes Association (2000). Type 2 diabetes in children and adolescents (Consensus Statement, 2000). Diabetes Care, 23(3): 381–389.
  3. Fagot-Campagna A (2000). Emergence of type 2 diabetes mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6): S1395–S1402.
  4. Orr DP (2008). Diabetes mellitus. In LS Neinstein, ed., Adolescent Health Care: A Practical Guide, 5th ed., pp. 170–178. Philadelphia: Lippincott Williams and Wilkins.
  5. American Diabetes Association (2008). Standards of medical care in diabetes. Diabetes Care, 31(Suppl 1): S12–S54.
  6. American Diabetes Association (2004). Preventive foot care in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S63–S64.
  7. American Diabetes Association (2009). Standards of medical care in diabetes. Clinical Practice Recommendations 2009. Diabetes Care, 32(Suppl 1): S13–S61.
  8. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
  9. Sinha R, et al. (2002). Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. New England Journal of Medicine, 346(11): 802–810.
  10. Diabetes Prevention Program Research Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6): 393–403.
  11. Savoye M, et al. (2007). Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized controlled trial. JAMA, 297(24): 2697–2704.
  12. Bennett PH, et al. (2003). Other risk factors section of Epidemiology of diabetes mellitus. In D Porte Jr et al., eds., Ellenberg and Rifkin's Diabetes Mellitus, 6th ed., p. 290. New York: McGraw-Hill.
  13. Goguen JM, Leiter LA (2001). Alternative therapy: The role of selected minerals, vitamins, fiber, and herbs in treating hyperglycemia. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 295–322. Hamilton, ON: BC Decker.

Other Works Consulted

  • Arslanian SA (2000). Type 2 diabetes mellitus in children: Pathophysiology and risk factors. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6): 1385–1394.
  • Chase HP, Eisenbarth GS (2007). Diabetes mellitus. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 978–985. New York: McGraw-Hill.
  • Committee on Nutrition, American Academy of Pediatrics (2003, reaffirmed 2007). Policy statement: Prevention of pediatric overweight and obesity. Pediatrics, 112(2): 424–430.
  • Laffel L, et al (2005). Treatment of the child and adolescent with diabetes. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 711–736. Philadelphia: Lippincott Williams and Wilkins.
  • Riddle MC, Genuth S (2007). Type 2 diabetes mellitus. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 2. New York: WebMD.
  • Silverstein JH, Rosenbloom AL (2000). Treatment of type 2 diabetes mellitus in children and adolescents. Journal of Pediatric Endocrinology and Metabolism, 13(Suppl 6): 1403–1409.

Credits

Author Caroline Rea, RN, BS, MS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer Stephen LaFranchi, MD - Pediatrics and Pediatric Endocrinology
Last Updated July 28, 2008

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