Type 2 Diabetes

Your child will be diagnosed with diabetes if her:

• blood glucose is 126 mg/dL or higher first thing in the morning before eating or drinking (fast for at least eight hours)
  -or-
• blood glucose is 200 mg/dL or higher at any time if symptoms of high blood sugar are also present
  -or-
• blood glucose is 200 mg/dl or higher at two hours during a standard oral glucose tolerance test
  -or-
• hemoglobin (A1C) test is 6.5 percent or higher 

Successfully managing your child’s type 2 diabetes involves developing a careful balance of her diet, exercise level and insulin (if needed). At Children’s Hospital Boston, our diabetes team will help you to determine and balance your child’s insulin, food and exercise to keep her blood glucose levels in a safe and healthy range—and point her on the way to a lifestyle that promotes good general health.
 

Treating your child’s type 2 diabetes

Treating type 2 diabetes is an ongoing process of management and education that involves not only the child with diabetes, but also family members, and often the condition can be controlled through losing weight, improved nutrition and increased exercise and activity levels.

Through education, dietary consultation and behavior modification therapy, our team can empower you and your child to successfully manage your child’s diabetes. Our registered nutritionists and dietitians will work with you to develop a meal plan based on your child’s specific needs. And our diabetes nurse-educators will work with you and your family to increase your knowledge and confidence, so you can best care for your child.

After stabilizing your child, the goal of treating her for type 2 diabetes will be to keep blood-sugar levels as close to normal as possible. Your child’s diabetes team will help you control her blood sugar (glucose) through:

• meal planning
  • healthful food choices
  • portion control
  • meals at regular intervals
  • reduced snacking
     
• increased and regular physical activity, which improves the body’s insulin acceptance
   
• weight management
   
• routine health care, including frequent monitoring of blood-sugar levels

But sometimes even these steps these aren’t enough—and your child’s doctor will need to prescribe oral medications and/or insulin. (See What is insulin? in the In-depth tab.)
 

Complications and emergencies

People with type 2 diabetes can also be at risk for:

• polycystic ovary syndrome (PCOS)
• high blood pressure
• high cholesterol and triglycerides (metabolic syndrome)
• eventual damage to heart, vessels, nerves, feet skin, eyes, kidneys, gums         

Although type 2 diabetes can cause many different problems, there are several key complications that if uncontrolled, can cause emergencies.

• (only for patients on insulin) hypoglycemia (low blood sugar)
  • occurs when blood sugar drops too low—so the body doesn’t have the source of energy it needs to function properly
  • if unchecked, can result in a low blood glucose medical emergency with loss of consciousness or seizure
  • can result from:
    • too high an insulin dose
    • a missed meal or snack
    • more physical activity than usual
    • sickness with vomiting and/or diarrhea
• common signs and symptoms include shakiness, sweating, weakness, blurry vision, rapid heartbeat
• If your child has signs or symptoms of hypoglycemia, measure her blood glucose level (if possible) and give her 15 grams of a fast-acting carbohydrate such as fruit juice, hard candy or raisins. If the child has lost consciousness, is having a seizure or is unable to take food or fluids by mouth, administer injectable glucagon (a hormone that raises blood sugar) as directed by your diabetes team, or call for medical assistance from your local emergency services (e.g., 911).
   
• hyperglycemia (high blood sugar):
  • can be a sign that diabetes is not well controlled
  • caused by build-up of glucose in the bloodstream; possible causes:
    • not enough insulin—glucose can’t enter the body’s cells
    • too much food, wrong kinds of food
    • less physical activity than recommended
    • sickness or stressors
       
  • excessive urination, bedwetting, weight loss, thirst, yeast infections, nausea and vomiting
     
  • If your child has signs or symptoms of hyperglycemia
    • measure her blood glucose level
    • check her urine or blood for for ketones
    • if you should administer a “booster shot” of extra insulin
       
  • Speak with your diabetes team to discuss a management plan for hyperglycemia. Untreated hyperglycemia and the presence of ketones in the urine or blood could signal and medical emergency called diabetic ketoacidosis. Ketoacidosis develops when the body doesn't have enough insulin and breaks down fats instead of sugar to use for energy. Ketones are produced as part of this process; the body cannot release all of the ketones, which then build up in the blood. Ketoacidosis can be life-threatening and needs immediate treatment. Symptoms include shortness of breath, breath that smells fuity, nausea, vomiting and dehydration.
     
• diabetic ketoacidosis (more common in type 1 diabetes, but can occur in type 2):
  • lack of sugar to the cells of the body cause the body to break down fats, releasing toxins (ketones) into the bloodstream faster than the kidneys can get rid of them
  • Diabetic ketoacidosis is a serious condition that requires immediate medical attention; children become very sick; call your doctor if your child has ketones in her blood or urine.
     

Understanding your child’s feelings and condition

Regardless of your child’s age, a diagnosis of diabetes can be devastating. Your child may resist all the lifestyle changes that must come with a diagnosis of type 2 diabetes. She may experience feelings of:

• vulnerability
• anger
• difference from peers (“Why me?”)

If your child is a teen with diabetes, the normal challenges of the teenage years can even more intense. Teens want to belong, and being different in any way from one’s peers can be emotionally stressful. She may:

• become rebellious and refuse to comply
• experience denial of the disease
• become aggressive in reaction to the stress of managing diabetes

Blood sugar control is especially hard during adolescence. Researchers believe the growth hormone produced during adolescence that stimulates bone and muscle growth may also act as an anti-insulin agent. Blood sugar levels become harder to control—resulting in blood sugar levels that swing from too low to too high. This lack of control over blood sugar levels can be very frustrating for your teen.
 

Family interdependence is the key

Although a child who’s diagnosed with type 2 diabetes needs supervised medical care, the ideal relationship between parents and child is one of interdependence—with family members working together as a team—especially with a healthful diet—to help the child live normally and happily. With your encouragement and our diabetes team’s guidance, your child will learn how to take care of her diabetes—and her increasing independence will improve her self-esteem.
 

Work together towards prevention

Your child may be able to prevent or delay type 2 diabetes by eliminating or reducing her risk factors—particularly by losing weight and increasing exercise. The Type 2 Diabetes Program at Children’s can work with you and your child to develop a plan for this. Your child’s diabetes team is committed to helping you control and manage her type 2 diabetes—so your whole family can thrive.
 

Coping and support
 

We understand that a hospital stay can be difficult. From your first visit to Children’s Hospital Boston to ongoing diabetes management, our nurses and social workers will be on hand to walk you through your child’s treatment, offer solutions and help answer the questions you may have—What does this mean for my child’s lifestyle, and our family’s? Is this a lifelong condition? What do we do next? What happens when we travel? We’ll help you coordinate and continue the care and support you received while at Children’s.

We offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family