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Diabetes: Type 2

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KEY POINTS

  • Type 2 diabetes means that there is too much glucose (sugar) in your child’s blood. Your child’s body makes insulin but cannot use it well to get glucose from the blood into the cells.
  • Uncontrolled diabetes can damage small blood vessels and nerves, causing problems in the eyes, heart, brain, liver, kidneys, skin, and feet.
  • Your healthcare provider will help you learn to manage your child’s diabetes by providing a variety of healthy foods, helping your child stay physically active, losing weight if your child is overweight or has obesity, helping your child take all medicines as prescribed, and checking your child’s blood glucose levels.

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What is type 2 diabetes?

Having diabetes means that there is too much glucose (sugar) in your child’s blood. Your child’s body breaks down some of the foods your child eats into glucose. The blood carries the glucose to the cells of the body. Your child needs some glucose in the cells for energy, but too much or too little glucose in the blood causes symptoms and is not good for your child’s health.

What is the cause?

Diabetes is a problem with the way the body makes or uses insulin. Insulin is a hormone made by the pancreas, which is an organ in the upper belly. Your child’s body uses insulin to help move glucose from the blood into the cells. When your child’s body does not make enough insulin or has trouble using the insulin the body makes, glucose cannot get into the cells and builds up in your child’s blood. Uncontrolled diabetes can damage small blood vessels and nerves, causing problems in the eyes, heart, brain, liver, kidneys, skin, and feet.

The exact cause of type 2 diabetes is not known. Your child has a higher risk of having type 2 diabetes if your child is of African American, Alaska Native, American Indian, Hispanic/Latino, Asian American, or Pacific Islander descent. The risk is also increased if your child has a family history of type 2 diabetes, doesn't get enough physical activity, has a high-calorie diet, smokes, or is overweight or has obesity.

If you had gestational diabetes when you were pregnant, your child has a higher risk of type 2 diabetes.

This type of diabetes usually starts in adulthood. However, more children and teenagers are developing type 2 diabetes.

What are the symptoms?

Diabetes can be silent and may not cause any symptoms for months or years. Have your child’s blood glucose levels as often as advised by your child’s healthcare provider.

Not everyone has the same symptoms. Symptoms may include:

  • Urinating a lot
  • Increased thirst
  • Increased hunger
  • Blurry vision
  • Dry mouth
  • Tiredness
  • Unexpected weight gain or loss
  • Fruity-smelling breath
  • Dry, itchy skin
  • Frequent infections such as of the skin, gums, bladder, or vagina
  • Infections that heal slowly
  • Infections of the foreskin in uncircumcised males
  • Thickened, darkened skin on the neck or in body folds such as under the arms

If diabetes is not diagnosed and treated, your child’s blood glucose levels could get so high that it causes your child to go into a coma and die.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child’s provider will also ask about your child’s personal and family medical history. Your provider will check the level of glucose in your child’s blood. For most people, 2 abnormal test results are used to confirm the diagnosis. The tests may be done on different days. If your child is having severe symptoms of high or low blood glucose, a single random blood glucose test may be used to confirm your child’s diagnosis.

Your child will have tests to measure the level of glucose in the blood. Tests may include:

  • Fasting blood glucose test (FBG). For this test, your child’s blood glucose is checked in the morning after not eating any food or drinking anything except water for at least 8 hours.
  • A 2-hour oral glucose tolerance test (OGTT). Your child’s blood glucose is checked when your child has fasted. Then your child drinks a special sugar drink and your child’s blood is checked again 2 hours later to see how well your child’s body has processed the sugar.
  • Hemoglobin A1C. This blood test is used to check your child’s average blood glucose over the past 3 months. Hemoglobin A1C is also known as HbA1C and A1C.
  • Random blood glucose test (RBG) at a time when your child has been eating normally.

Your child may have other blood tests to see what type of diabetes your child has.

How is it treated?

The goal of treatment is to control the level of glucose in your child’s blood and keep it in a target range. Controlling your child’s blood glucose can prevent or delay serious problems caused by diabetes.

When your child has type 2 diabetes, high blood glucose can often be controlled by eating healthy foods, staying physically active, and losing weight if your child is overweight or has obesity. You need to check your child’s blood glucose levels to make sure your child’s meal plan and physical activity are working well. If your child’s meal plan and physical activity are not controlling your child’s blood glucose levels, then your child will need to take medicine to help keep glucose levels within the target range. It is also important to learn about diabetes, including recognizing and treating symptoms of high and low blood glucose levels.

Meal Planning

  • Your child’s healthcare provider will give you guidelines about which foods your child should eat and how many carbohydrates (carbs) and calories to eat each day. Your child’s meal plan will include fruits, vegetables, complex carbohydrates (carbs) such as whole grain pastas, breads, and cereals, lean protein, and high-fiber grains. Include healthy fats such as small servings of nuts, seeds, avocado, olive oil, and fish oil. Your child may be able to have an occasional snack with sugar, but the meal plan should not regularly include sugary food such as soft drinks, candy, and desserts. You will also learn how to space your child’s meals so your child eats as often as needed.
  • Your provider may refer your child to a dietitian or certified diabetes educator for help with meal planning. Choosing healthy foods for your child’s meal plan may help with weight loss if needed and improve overall health. Sometimes losing just a few pounds can lower your child’s blood glucose enough to keep your child from needing to take medicine to treat the diabetes.

Physical activity

  • Physical activity is very important. Physical activity improves blood flow, uses up more of the glucose in the blood, and helps your child’s body use insulin better. Getting enough physical activity is all some children need to control their blood glucose. A good activity plan can help control your child’s blood glucose level. It also helps keep your child healthy and avoid some of the problems caused by diabetes. Talk to your healthcare provider about the right activity plan for your child.

Medicine

  • If your child’s blood glucose can’t be controlled with meal planning and physical activity, your healthcare provider may prescribe an oral medicine to lower it. Your child may also need more than 1 type of medicine to keep the blood glucose levels in your child’s target range. Your child may need shots of insulin if meal planning, physical activity, and oral medicines are not keeping blood glucose levels in the target range. Your child can learn to give the shots of insulin between the ages of 10 or 11 years.
  • When your child takes medicine for diabetes, including insulin if it’s needed, you must carefully follow your provider's directions for checking your child’s blood glucose levels. This will help keep your child’s blood glucose from getting too high or too low. Blood glucose that is too low can make your child sick and cause headaches, nausea, cold sweats, and seizures. It can even be life-threatening if it gets too low.

Blood glucose checks

  • You and your child will learn how to check your child’s blood glucose level with a small machine called a blood glucose meter. Check blood glucose levels as often as advised by your child’s healthcare provider. When your child is 7 to 10 years old, your child can learn how to check blood glucose levels.
  • You will need to keep a record of your child’s blood glucose measurements. Your provider will check the record at appointments to see if any changes need to be made to your child’s medicine.
  • A continuous glucose monitor (CGM) is a device worn on the skin that reads blood glucose levels at set times. Talk to your child’s healthcare provider about the best device for your child’s needs.
  • Your child may have an A1C test every 3 to 6 months to check overall control of blood glucose levels. The A1C test is a way of measuring average blood glucose over a 3-month period. It’s a good way to see if your child’s diabetes is under control. However, it does not replace daily blood glucose measurements. Daily checks of your child’s blood glucose levels show whether your child’s treatment is working throughout the day.

Education

  • When a child is diagnosed with diabetes, there is a lot to learn about the disease. This education is usually done at a diabetes clinic. This education is very important. Ask your healthcare provider about your choices.
  • Healthcare providers, including certified diabetes educators and dietitians, will teach you what diabetes is, and how to give shots of the right amounts of insulin if needed. You and your child will learn how and when to check for glucose in the blood and for ketones in the blood or urine. You will learn how to treat high and low blood glucose and other ways to keep your child healthy.

How can I take care of my child?

You can learn to take good care of your child in a few weeks and your child can keep doing most of your child’s favorite activities. You may need to help your child do the following:

  • See your child’s healthcare provider regularly.
  • Learn new ways to add healthy foods to your child’s meal plan or continue eating a variety of healthy foods.
  • Add or continue physical activities.
  • Lose weight or maintain a healthy weight.
  • Check blood glucose levels as often as advised by your child’s healthcare provider.

Carefully controlling blood glucose and taking care of any other health problems your child has may prevent or delay serious health problems. Good control of diabetes depends on following the meal and physical activity plans as advised to keep your child’s blood glucose in the target range. If your child’s diabetes is not controlled by meal planning and physical activity, it is important for your child to take medicines as directed by your healthcare provider. Follow the full course of treatment as prescribed. In addition:

  • Try to help your child have meals, snacks, and physical activity near the same time each day when possible. Your child should carry a protein snack, such as cheese and crackers or peanuts, to make sure your child eats as often as needed.
  • Make sure your child carries glucose to take if blood glucose levels get too low. Glucose tablets or gel are good for emergencies.
  • Follow your child’s healthcare provider's instructions for checking your child’s blood and, if your child needs to take insulin, adjusting the insulin dosage according to the results of your child’s blood tests.
  • Get your child’s eyes checked as often as advised by your child’s healthcare provider.
  • Make sure that your child stays physically active as advised by your child’s provider. Help your child limit sitting time.
  • Get other medical problems treated, especially high blood pressure and high cholesterol. Your child’s healthcare provider can identify and help you manage your child’s risk factors.
  • Your child should carry a medical ID such as a card or bracelet that says he or she has diabetes.
  • Learn about diabetes and its complications so you can make the decisions needed to control your child’s blood glucose levels. There is a lot to learn. It's good for everyone in your family to learn about diabetes.
  • Following all the steps to manage your child’s diabetes may feel overwhelming. If you or your child feel stressed or depressed, talk with a counselor.

Children with diabetes are faced with the same pressures as other kids. They may be curious about smoking, drinking alcohol, or using drugs. Smoking speeds up damage to the heart and blood vessels. Alcohol and drugs can affect blood glucose and can cause nerve damage over time. Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs.

Ask your child’s provider:

  • How and when you will get your child’s test results
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of your child at home
  • What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests. Be sure to take your child’s glucose records or glucose meter to all appointments.

How can I help prevent type 2 diabetes?

Unlike type 1 diabetes, type 2 can be prevented or delayed. Even if there is a history of diabetes in your family, your child may be able to prevent or delay the disease if your child:

  • Keeps a healthy weight.
  • Stays physically active as advised by your child’s provider. Help your child limit sitting time.
  • Help your child eat a variety of healthy foods that includes fruits, vegetables, lean protein, and high-fiber grains. Include healthy fats such as small servings of nuts, seeds, avocado, olive oil, and fish oil. Limit sugars, sugary drinks, and desserts. Avoid the white foods such as white flour products, white bread, biscuits, pancakes, white potatoes, and white rice. Help your child choose more whole grains such as whole wheat flour, bran, oatmeal, quinoa, brown rice. You may want to work with a dietitian to set up a meal plan that meets your child’s needs.

If your child has a family history of diabetes or is overweight or has obesity, have blood glucose levels checked as often as advised by your child’s healthcare provider.

For more information, contact:

Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2022-03-15
Last reviewed: 2022-02-05
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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