The rates of obesity and Type 2 diabetes among children in the U.S. is rapidly rising. Many children with Type 2 diabetes don’t even know they have the disease. Neil White, a pediatrician at WUSM and St. Louis Children’s Hospital, outlines symptoms and risk factors for diabetes in the following St. Louis Post-Dispatch article.
Diabetes takes a toll on kids
(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Health & Fitness section on Monday, March 7, 2005)
By Dr. Neil H. White
Symptoms of diabetes
The classic symptoms of both types of diabetes are similar:
- Excessive urination.
- Excessive thirst.
- Nighttime urination.
- Excessive eating or hunger.
These symptoms tend to progress rapidly in Type 1 diabetes, and may result in vomiting, acidosis, dehydration and the life-threatening condition known as diabetic ketoacidosis.
In Type 2 diabetes, however, the onset of symptoms can be relatively slow and may go unrecognized. Many people with Type 2 diabetes do not know they have it.
Diabetes takes a toll on kids
Diabetes has been around for thousands of years, at least since ancient Egypt. Before the discovery of insulin in 1922, childhood diabetes was rapidly fatal. Since then, childhood diabetes has become a chronic disease with serious long-term complications.
Medical advances have improved the ability to control diabetes. However, diabetes in children and teenagers is increasing, threatening the health of the next generation of young adults.
What is it?
Diabetes mellitus is a group of disorders that have in common high blood sugar and the risk of damage to tissues and organs. There are two major types:
- Type 1 (also called juvenile diabetes).
- Type 2 (also called adult-onset diabetes).
In Type 1 diabetes, the cells of the pancreas that make insulin are destroyed. Often, the body’s immune system destroys these cells, sort of like friendly fire. Without insulin, blood sugar rises and complications occur. Lifelong insulin treatment is required.
In Type 2 diabetes, organs and tissues are resistant to insulin; that is, more insulin is needed to have the same effect. When the insulin-making cells can no longer keep up with the extra insulin needed, blood sugar becomes high and diabetes occurs.
The American Diabetes Association estimates that there are 19 million people with diabetes in the United States, and that about 5 million do not know they have it. Most of them have Type 2 diabetes.
There has been little increase in the incidence of Type 1 diabetes over the past few decades. But the number of people worldwide with Type 2 diabetes is increasing in epidemic proportions.
A major reason for this is the increase in obesity, which is associated with insulin resistance. A study called the Diabetes Prevention Program showed that if adults at risk for diabetes lost weight, they could reduce the likelihood of getting diabetes by 58 percent.
Diabetes and children
Obesity and diabetes are taking their toll on our children.
From 1963 to 1970, about 4.5 percent of children were overweight. From 1999 to 2002, the number had increased to 16 percent, and continues to rise.
In 1985, experts estimated that about 1 to 2 percent of children with diabetes had Type 2. By 1995, the number stood at about 17 percent. More recently, in some areas of the country, 30 to 40 percent of children with diabetes now have Type 2.
Because of that increase, the American Diabetes Association and the American Academy of Pediatrics recommend routine screening of children at higher risk for Type 2 diabetes. At-risk children include those who are obese and also:
- Have a family history of diabetes.
- Are in a high-risk population (African-American, Hispanic, American Indian, Asian-American).
- Have other conditions, such as high blood pressure or high cholesterol.
One way to determine if your child is overweight is to determine his body mass index. For more information about calculating and interpreting children’s BMI, go to www.cdc.gov/nccdphp/dnpa/bmi.
Treatment for Type 1 diabetes requires lifelong use of insulin, which can only be given by injections or through an insulin pump. Managing Type 1 diabetes involves a complex regimen of insulin, diet, exercise and glucose monitoring.
Treating Type 2 diabetes can be very different. Some people will need insulin; for others, diet, exercise and weight loss will provide adequate control of the condition. Others respond to a variety of medications that can be taken by mouth.
Physicians have a lot of experience in using these medications in adults, but less is known about using them in children. The National Institutes of Health is conducting a project to learn more about how to treat and prevent Type 2 diabetes in children. The first part of this project is under way at 12 medical centers in the United States, including St. Louis Children’s Hospital and Cardinal Glennon Children’s Hospital.
Families with children 10 to 18 years old who have had Type 2 diabetes for less than two years can find out more about the project by calling 1-877-785-2329.
Dr. Neil H. White is a professor of pediatrics and medicine at Washington University School of Medicine and is in the division of Endocrinology and Diabetes at St. Louis Children’s Hospital.
Copyright 2005 St. Louis Post-Dispatch, Inc.