Coaching Kids for Health: Managing Type 2 Diabetes in Children
By Dr. Caron Goode

AA “Lifestyle” Disease

Have you read this headline: “6 Deaths Reported From Diabetes Drug Byetta”?

If you are the parent of a child with Type 2 Diabetic children, then read on! You must learn as much as possible about the condition. To coach your child to better health, you need a solid plan, which relies less on pharmaceuticals and more on lifestyle choices. Have you heard that Diabetes 2 is called a “lifestyle disease?” While parents of Type 2 Diabetic children spend thousands of dollars on vitamin supplements, mineral supplements and liquid vitamins, nothing replaces appropriate lifestyle choices.

Alarming Children’s Diabetes Rates

Children are diagnosed with diabetes each day and that number is increasing. Type 1 Diabetes, otherwise known as childhood diabetes, is typically diagnosed in childhood and usually represents only 5% of all diabetes cases. Type 2 Diabetes, or adult-onset diabetes, is more common and was once thought to be a disease that only afflicted adults over 30 years of age.

However, recent figures show that Type 2 Diabetes is becoming increasingly common in children and teens. The prevalence has been rising at a startling rate over the last 10 years. The National Association of School Nurses reports that approximately 1 out of every 500 children and teenagers has Type 2 Diabetes. Furthermore, an article published in the New England Journal of Medicine by Dr. William Dietz, reports that almost half of diabetes cases in children and adolescents are type 2. A 50% rate of Type 2 Diabetes was unheard of 20 years ago. Most physicians believe this increase in Type 2 Diabetes rates is due to increasing obesity, poor food choices and the progressively more sedentary lifestyle experienced by children today.
Insulin Is Key

With type 1 diabetes, the pancreas does not produce insulin. Insulin acts to keep blood glucose levels from rising too high. That’s why type 1 diabetics have to take insulin on a daily basis. However, with Type 2 Diabetes, the pancreas still produces insulin. The problem is that either the amount of insulin produced in not enough to control blood glucose levels, or the body becomes resistant to the blood sugar lowering effects of insulin. Unfortunately, parents and children alike mistakenly believe that a prescription medication for Type 2 Diabetes will solve the problem. Prescription drugs, in theory, provide a quick fix to illnesses and diseases and are reasonably safe when taken as directed. Insulin and the oral drug Metformin are the only FDA approved prescription drugs for treatment of type 2 diabetes in children. However, these drugs are not as safe as the FDA may want you to believe.

  • Daily insulin injections are associated with a plethora of side effects, which can range from weight gain to dangerously low blood glucose levels.
  • This, in turn, may cause fatigue, dizziness and fainting.
  • The safety profile of Metformin is not much better. For example, a study led by Dr Kenneth Jones reported that in 42 children treated with Metformin, 14% dropped out of the study within 4 months, 10% required rescue medication and a startling 70% experienced at least one adverse event (most common side effects were abdominal pain, diarrhea, nausea, vomiting and headache).
  • Given the evidence, Metformin can hardly be considered a safe drug. This reveals that just because FDA approved the drug doesn’t necessarily mean that it is risk free. Clearly, parents need better alternatives to prescription medications to help treat Type 2 Diabetes in children.

Screen Children for Diabetes

The American Diabetes Association recommends that children aged 10 years or older with the following characteristics need to be screened for Type 2 Diabetes:

  • Body mass index (a number calculated from height and body weight) is in the 85th percentile or higher, or if body weight is greater than 120% of normal for their height and any 2 of the following
  • Family history of Type 2 Diabetes in a first or second degree relative such as a mother, brother or first cousin.
  • Ethnic background is African-American, Hispanic, American Indian, Asian or Pacific Islander. People of these ethnic origins have higher rates of Type 2 Diabetes than people of other backgrounds.
  • Signs of insulin resistance such as polycystic ovary syndrome, hypertension or high triglyceride levels.

It is difficult to detect Type 2 Diabetes, especially in children. Symptoms are usually nonexistent or mild in the early stages of the disease, which may be overlooked for long periods of time. Some telltale signs of possible Type 2 Diabetes include:

  • Constant thirst,
  • Frequent urination or bed-wetting,
  • Fatigue,
  • Blurred vision and
  • Darkened skin around the neck or underarms.
  • The darkened skin is called Acanthosis nigricans or AN for short and is caused by insulin resistance. In this state the body produces insulin, but it is simply not being used. Hence, a build-up in the body, which results in AN. About 75% of young people with type 2 diabetes experience the AN side effect.

Children who have Type 2 diabetes can learn to manage their lifestyle so they remain healthy for the rest of their lives.

How Do Children Get Diabetes?

A definite diagnosis of Type 2 Diabetes is made through blood tests. Blood glucose levels are measured, which offers an indication of blood sugar control. Another common test is to measure “glycosylated hemoglobin,” which calculates the average blood sugar levels over the last 2-3 months.

You may be wondering how children develop the disease in the first place and how to treat this condition so your child can experience a relatively normal life. The answer is not being dependent on so called “safe and effective” drugs that may cause unwanted or even serious side effects. The answer is to seek natural sources like natural liquid vitamins and to develop nutritious diets and exercise programs.

This disease is entirely manageable by making simple lifestyle changes. The main reason for the recent Type 2 Diabetes epidemic in young people today and the answer to treating this adverse condition is, in its entirety, lifestyle.

Coaching for a Healthy Lifestyle

We are living in an age where convenience is king. There’s a fast food restaurant on every corner where fat and sugar-laden meals are just a few bucks. Because of television sets, computers and cell phones, kids are spending more time sitting in front of a screen each day than most adults work in a single shift. The thousands of junk food commercials that children watch each year do nothing but reinforce the idea of fast foods and video games, all counterproductive to staying fit and reducing diabetes risk. More so than ever before, children are slammed with messages of junk foods to include sugary cereals, high fat snacks and sugary fruit juices peddled on the pretext that they are sources of natural liquid vitamins.

The first step is to promote an active lifestyle for your child. The good news is that this does not need to be a boring regimented exercise program that probably wouldn’t be maintained for very long anyway. Physical exercise can include any activity where your child is moving such as playing baseball, doing chores or even walking the dog. The key to success is to encourage your children to get regular activity without making them feel as if they are being scolded or forced into something they don’t want to do. Keep it fun and light. Better yet, regular exercise can become a family affair. Riding bikes together, throwing and catching a football or taking a hike together are all great ways to get exercise and increase quality family time all in one smooth swoop. Exercise speeds up calorie expenditure promoting weight loss and also increases insulin sensitivity and receptivity in the cells. Regular exercise has a dramatic rate on the amount of insulin the body will require.

The second step is to encourage changes in eating habits and moving to nutrition, not just food that fills the mouth. The American Diabetes Association has recently backed away from encouraging a rigid meal plan for children and adolescents and instead has adopted a better approach. Their new recommendation encourages children to follow principles.

  • The first principle is that eating an equal amount of sugar or starch will raise blood sugar the same amount.
  • The second is that carbohydrates affect blood glucose, with protein and fat having little effect.
  • Consuming protein and healthy fats with small amounts of carbohydrates can reduce the spike seen in blood sugar after meals.
  • What’s the take home message from this recommendation?
  • Reducing and ideally eliminating starch and sugar in the diet will help control blood sugar fluctuations.
  • Encourage your children to eat foods high in protein and moderate portions of fat. Foods that are high in protein include clean meats, eggs, cheese and nuts.
  • Foods that are high in fat should be eaten in moderation because they can cause weight gain and increase the risk for chronic diseases in adulthood such as heart disease and cancer.
  • Fruits and vegetables are healthful food choices, abundant with health promoting plant chemicals called phytonutrients. While fruits and vegetables are absolutely power packed with essential nutrition, keep in mind that fruit sugar (called fructose) may induce high blood sugar spikes. In many cases no different from a candy bar.
  • While fruit is an excellent component of the daily diet for a Type 2 Diabetic child, an emphasis should be placed on large amounts of phytonutrients rich leafy greens.

The third step is to educate your children early about the benefits of proper food choices and regular activity and continuing to encourage them throughout their teenage years. Habits developed during childhood often remain intact through adulthood. Children with Type 2 Diabetes and their families should participate in education programs that teach them how to self manage their disease. Parents and siblings influence children, so the entire family can become informed about the condition and encourage each other to engage in healthy behaviors. Physicians, nurses and exercise physiologists host diabetes education programs. These professionals cover topics such as meal planning, exercise programs and the self monitoring of glucose levels, just to name a few of the many benefits.

If your children have these consistent positive influences, they will develop the habits and motivation needed to defeat Type 2 Diabetes for good.

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REFERENCES

1. American Diabetes Association. “Diabetes Symptoms”, accessed OCT 2008
2. University of Maryland Medical Center. “Diabetes – Type 2”, accessed OCT 2008
3. WebMd Health News, “6 Deaths Reported From Diabetes Drug Byetta”, OCT 17 2008
4. University, op cit.
5. BBN, American Family Physician, “Treatment of Diabetes with Metformin and Insulin”, FEB 2007
6. CBS News, “Old Diabetes Drug Has Advantages”, JULY 2007
7. American Diabetes Association, Diabetes Care, “Dancing with Many Different Ghosts: Treatment of Youth with Type 2 Diabetes”, Heather J. Dean, MD, FRCPC, 2002
8. American Osteopathic College of Dermatology, “Acanthosis Nigricans”, accessed OCT 2008
9. New York Times, “Type 2 Diabetes: Risk Factors”, OCT 17 2008
10 NDIC, “Diagnosis of Diabetes”, JAN 2005

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