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Parents, youths must take special precautions to ward off type 2 diabetes

Miami Herald (FL)


Nov. 10--When Dana Edwards noticed how "out of it" her daughter Patrianna Bartley had been acting, she immediately thought she had been drugged and rushed her to the hospital.

But it wasn't drugs. It was Bartley's blood-sugar level, which was so abnormally high, she was headed into a diabetic coma.

That's when the diagnosis came: type 2 diabetes.

"I was devastated because I never had a close family member diagnosed with it," Edwards said. "It was a totally new learning process that I had to try and grasp in order to make sure I provided her with the proper care.''

Type 2 diabetes -- a result of the body developing a resistance to insulin -- has been dramatically increasing in adolescence primarily due to the obesity epidemic. Insulin is the main driver of glucose -- also known as sugar -- and the main source of the body's energy.

According to the Centers for Disease Control and Prevention, type 2 diabetes is a chronic disease usually diagnosed in adults over age 40. But for the past 20 years, the diagnosis of children and adolescents between 10 and 19 has become more common.

If current trends continue, the CDC is predicting that 1 in 3 American adults will have diabetes by 2050, and that one in three babies will develop diabetes in their lifetime. Currently, about 26 million children and adults in the U.S. are living with diabetes, and 7 million of those people don't know they have it.

Bartley, who was diagnosed in March 2009, is now a 15-year-old freshman at South Dade Senior High School and has been able to manage her diabetes by exercising and changing her eating habits. To date, she has lost more than 70 pounds and says she has regained her self-esteem.

"I feel better now that I've been following my treatment plan, because before I didn't really feel like I had to," she said. "I stay on top of what I have to do and make sure to count the carbs."

But her life is different from most teenagers her age. Every day, she has to see the nurse at school to check her blood sugar and make sure everything is OK. If it's too high, the nurse has to call her mom. She also gets pulled out during physical education at school to hydrate herself and have a snack.

Increased risk

Although the condition can be asymptomatic, children who begin to develop insulin resistance may have a dark pigmentation under their arms or around the belly button, have excessive thirst and need to urinate, and develop an increased appetite. Other symptoms include weight gain, fatigue, blurred vision, and cuts and sores that take longer to heal than usual.

Factors for developing type 2 diabetes during childhood and adolescence include being overweight or obese, having a strong family history of the disease, getting it passed on from mother to child during pregnancy, an inactive lifestyle, and race and ethnicity.

Luis Gonzalez-Mendoza, the director of the division of pediatric endocrinology at Miami Children's Hospital, says that children who are diagnosed with diabetes have a very high risk for developing serious complications such as vision loss, kidney failure, nerve damage and fatty liver.

"If you develop diabetes at the age of 10, by the age of 30 or 40, you are going to be a wreck," he said. "That is the issue we are having, and that is why we are trying to let the population know. Once you have diabetes, you have diabetes. It doesn't go away."

Although a variety of treatments are available for adults with type 2 diabetes, options for youths are limited. Metformin is currently the only approved prescription drug available for children and adolescents with type 2 diabetes, along with insulin and diet and exercise plans.

The National Institute of Diabetes and Kidney Diseases funded the TODAY study -- Treatment Options for type 2 Diabetes in Adolescents and Youth -- which revealed that type 2 diabetes is much more aggressive in children than it is in adults.

The study also proved that metformin is not enough to control type 2 diabetes during puberty and that most children diagnosed with the disease early on are likely to progress and not get better.

"By modifying behavior and increasing physical activity, children might be able to stay away from medication if they are at the early stages," Gonzalez-Mendoza said. "If you develop problems and then decide to take care of yourself, the problems are going to remain. The important thing is not to let yourself get to that level."

Rules to live by

The American Academy of Pediatrics recently created the first guidelines for children ages 10 to 18 who are managing type 2 diabetes. The guidelines call for 60 minutes of physical activity a day and healthy eating along with metformin. They also suggest less than two hours a day of "nonacademic screen time."

Leyanee Perez, a registered dietician who volunteers with the American Heart Association, says managing carbohydrates and controlling portion sizes is critical for children with diabetes, along with physical activity.

She recommends that diabetic and prediabetic children eat more fruits and vegetables, consume more grains and fiber, and drink milk. "Children are not little adults," she said. "They have special nutritional needs to support their growth, and they should not be playing with that."

Childhood obesity has more than doubled in children and tripled in adolescents over the past 30 years, according to the CDC. About 17 percent of all children and adolescents in the United States are obese.

Robin Nemery, a pediatric endocrinologist at Joe DiMaggio Children's Hospital in Broward County, says parents become very defensive about their children being obese, and many times make excuses for it.

She hopes parents change their attitudes about weight issues and become more proactive and open-minded about changing their lifestyle and the way they feed their kids.

"Parents who think their children are just going to get better are fooling themselves," Nemery said. "The best way to treat type 2 diabetes is to prevent it."


(c)2013 The Miami Herald

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