Type 2 Diabetes

Type 2 diabetes is a metabolic disorder that develops when the body cannot properly use or produce enough insulin. It is a chronic disease with no known cure. Type 2 diabetes may be managed with healthy eating, exercise, and oral medication (medicine taken by mouth). In some cases, people with type 2 diabetes also need insulin.

Type 2 diabetes, formerly known as adult-onset diabetes, accounts for the majority of cases of diabetes in adults. Type 1 diabetes is more common among children, however, a growing number of children and adolescents are being diagnosed with type 2 diabetes. This may stem from the increase in childhood obesity. Type 2 diabetes is more common among children who are American Indian, African American, Hispanic/Latino American or Asian/Pacific Islander.

According to the Centers for Disease Control, more than 30 million Americans have diabetes and 90 percent to 95 percent have type 2 diabetes. An estimated 193,000 children younger than 20 years old have been diagnosed type 1 or type 2 diabetes.

What is insulin?

Insulin helps glucose (a form of sugar) enter the cells of the body. When glucose enters the cells, it can be used to produce energy, or it can be stored in the liver and muscles as glycogen for later use. Without insulin, glucose builds up in the bloodstream. This starves the body’s cells of energy and can cause long-term damage to many organs, including the eyes, kidneys, heart, and nerves.

Before developing type 2 diabetes, a child may become insulin resistant. This happens when their muscles, liver, and fat cells stop responding fully to insulin. At first, their insulin levels will be high, but eventually, their blood sugar levels will rise as well, leading to the onset of diabetes. Some people with type 2 diabetes have to take insulin injections and monitor their blood sugar to prevent complications. Insulin cannot be taken by mouth because the digestive system would destroy it.

Over time, high blood sugar can damage nerves and major organs. Managing diabetes through diet, exercise and medications to keep blood sugar at a normal level can greatly reduce the risk of the following conditions later in life:

• Heart disease and stroke
• Merve damage that can occur in the toes and fingers and may spread to other parts of the body
• Kidney damage
• Eye damage, possibly leading to blindness
• Infections that can lead to amputations

What is prediabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. Having pre-diabetes is a significant risk factor for development of diabetes.

If your child is diagnosed with prediabetes, losing weight and becoming more physically active may help delay or prevent the onset of type 2 diabetes.

The symptoms of type 2 diabetes may develop slowly and go unnoticed for a long time. Because of this, it is important to know what the risk factors are. If your child is at risk for type 2 diabetes, they should be tested periodically, whether or not they show signs or symptoms.

Risk factors for type 2 diabetes include:

• Being overweight or obese
• Having a parent, sibling or other close family member with type 2 diabetes
• Lack of regular exercise
• Abnormal cholesterol or high blood pressure

In addition, type 2 diabetes affects some ethnic groups more than others. Children and adolescents who are African-American, Hispanic, and Native American, Asian, or Pacific Islander are at increased risk for the condition.

If your child has symptoms, they may include:

• Constant thirst or hunger
• Frequent need to urinate
• Lost weight without any change in diet
• Blurry vision
• Exhaustion
• Numb or tingling hands or feet
• Sores that heal slowly
• Frequent infections

Type 2 diabetes is a metabolic disorder that occurs when the body is unable to produce enough insulin or use the insulin that the pancreas produces. Insulin is needed in order for glucose (a form of sugar) to enter the cells of the body. When glucose can’t get into the cells, it starts to build up in the blood instead. Not only are cells not getting the essential source of energy they need, but the high levels of sugar in the blood are damaging to the body.

Genetics play a role in type 2 diabetes. If a child’s parent has type 2 diabetes, they are at risk of developing the condition as well.

Food and exercise also play a role. Eating a diet high in fat and processed sugar increases the likelihood of developing type 2 diabetes, as does being overweight. Regular exercise and a healthy diet that includes a variety of fruits, vegetables, healthy proteins, and whole-grain foods can reduce the risk of type 2 diabetes. Your dietician can work with you to develop a healthy food plan.

If your child has the symptoms of type 2 diabetes or is at risk, their doctor may order blood and urine tests, including:

• Hemoglobin (A1C) test: indicates average blood sugar level for the past two to three months
• Random blood sugar test
• Fasting blood sugar test: taken after an overnight fast
• Oral glucose tolerance test: a two-hour test that includes checking blood sugar before and after your child drinks a prescribed sugar drink
• Checking the blood for autoantibodies, which are found in type 1 diabetes
• Checking for the presence of ketones (byproducts from the breakdown of fat in children with low levels of insulin) in the urine or blood

Your child may need to have blood drawn more than once so the test results can be confirmed with a second test on a different day. Distinguishing between type 1 and type 2 diabetes in children can sometimes be difficult. Your child's doctor may need to do additional testing or monitor your child for some time before the type of diabetes can be confirmed.

Because type 2 diabetes is a chronic condition, treatment is an ongoing process. Your child will need routine health care and frequent blood-sugar checks. After stabilizing your child’s condition, the goal of treatment will be to keep their blood sugar level as close to normal as possible.

Control of type 2 diabetes can be improved through healthy eating habits, losing weight, and becoming more physically active. Your child will have a diabetes team to help with the following:

• Choosing healthy foods, controlling portions, and reducing unhealthy snacks
• Managing their weight
• Adding more physical activity to their daily routine

Your child’s doctor may also prescribe oral or injectable medications.

The role of food in diabetes management

It is important to understand how food impacts blood glucose for children with diabetes.

Food causes blood glucose to go up. Insulin causes blood glucose to go down. Too much food with not enough insulin can cause blood glucose to go too high. Not enough food with too much insulin can cause blood glucose to go too low. Further, the type and amount of food will affect how much and how quickly the blood glucose goes up. Balancing food and insulin together can help keep blood glucose in a normal range.

Carbohydrates, also known as carbs, are an important source of energy. They are also the main nutrient the body turns into blood glucose, also known as blood sugar. Everyone needs to eat some carbohydrates to stay healthy. Common carbohydrate foods include: bread, crackers, cereal, pasta, rice, fruit, and milk.

• Carbohydrates that are high in fiber such as whole grains, fruits, and vegetables slow digestion and contribute to a feeling of fullness. High-fiber food can also reduce spikes in blood glucose after eating.
• Processed carbohydrates that are low in fiber can raise blood sugars too high. Eating fewer process carbohydrates helps manage type 2 diabetes.

A dietitian can help determine the right amount of carbohydrates and types for your child. 

Proteins and fats help kids feel full and have less impact on blood glucose levels than carbohydrates. Because of this, children with diabetes are encouraged to include protein and healthy fats at meals and snacks. Examples of healthy proteins include poultry, fish, beef, pork, peanut butter, cheese and eggs. Healthy fats include avocados, olive oil, eggs, nuts and cheese. While these foods can be a part of a healthy diet, appropriate portion sizes are important.

A healthy diet can mean different things to different people. A dietitian is very important to help with meal planning and understanding the right balance of foods for your child.

Even with careful management, type 2 diabetes can put your child at risk of some serious complications that require prompt medical attention. These include hypoglycemia, hyperglycemia and diabetic ketoacidosis.

Hypoglycemia, also known as low blood sugar, is a risk if your child is on insulin. Hypoglycemia can result from too high an insulin dose, a missed meal or snack, more physical activity than usual, or illness that causes vomiting and/or diarrhea.

• Symptoms of hypoglycemia include shakiness, sweating, weakness, blurry vision and rapid heartbeat.
• If left unchecked, hypoglycemia can result in a medical emergency. Your child could lose consciousness or have a seizure.
• If your child has any of these symptoms, measure their blood glucose level (if possible) and give them a fast-acting carbohydrate, such as fruit juice, hard candy or raisins if they are awake and able to swallow food safely. If not, call 911 and administer glucagon if your child has been prescribed this medication. Seek medical attention right away.

Hyperglycemia, also known as high blood sugar, happens when blood sugar is too high and builds up in the blood stream. It can be caused by not having enough insulin, eating too much food or the wrong kinds of food, too little physical activity, or illness.

• Symptoms of hyperglycemia can include: excessive urination, bedwetting, weight loss, thirst, yeast infections, nausea and vomiting.
• If your child has signs or symptoms of hyperglycemia, measure their blood sugar and check their urine for ketones. If ketones are elevated, call your diabetes team for further guidance.

Diabetic ketoacidosis is a life-threatening condition that can result from low insulin and high blood sugar. It is more common in children with type 1 diabetes but can occur with type 2 diabetes.

Without insulin, the body is deprived of glucose for energy and starts breaking down fat for fuel. This releases toxins into the blood faster than the kidneys can get rid of them. Diabetic ketoacidosis can cause fluid to build up in the brain, lead to a loss of consciousness, cardiac arrest or kidney failure.

Your child should receive medical attention right away if they have any of these symptoms:

• Confusion or trouble paying attention
• Sweet or fruity-smelling breath
• Trouble breathing
• Nausea or vomiting

The Diabetes Program at Boston Children’s Hospital is one of the largest pediatric diabetes centers in North America. We provide comprehensive services for infants, children, adolescents, and young adults with all types of diabetes. Our integrated team brings together pediatric endocrinologists, diabetes nurse educators, registered dietitians, and behavioral specialists who work with you and your child to develop an appropriate diabetes treatment or prevention plan.

We are one of the few centers that offers a multidisciplinary program focused on the prevention and treatment of type 2 diabetes. This includes our Optimal Wellness for Life (OWL) Program, a multidisciplinary clinic dedicated to providing state-of-the-art care and developing innovative treatments for pediatric obesity and type 2 diabetes.

Our services include:

• Diagnostic evaluation
• Management of the acute complications of diabetes
• Long-term management and follow-up care, including nutritional support, exercise programming, and behavioral support