Type 2 Diabetes in Kids and Adolescents

By A. Jay Cohen, MD, FACE

We need two basic substances to get into every cell in our body, oxygen and fuel (mostly in the form of glucose). While oxygen can easily zip into our cells from the blood stream without any extra work, getting glucose (fuel) into the cell is more complex. Cells require a key (insulin) to open the doors (receptors) and allow glucose into the cell. These doors have hinges, door handles and key holes. In our everyday life, if you have a small amount of insulin (keys), it’s easy to open the doors and our cells easily obtain food (mostly glucose or sugar) from the bloodstream.

Type 1 diabetes is a disease in which the body does not make enough insulin because, usually, there is an (autoimmune) attack on the beta cells of the pancreas, which gradually destroy the ability to make insulin; therefore, with no “keys,” the doors of the cells cannot open, resulting in the cells starving within a sea (bloodstream) of extra food (glucose, etc.).

In type 2 diabetes, many problems develop as the person usually becomes more overweight (with less exercise and eating more calories). Initially, the door hinges, door handles and keyholes get progressively stuck or “gunky” or “rusty” resulting in resistance to the usual number of keys (insulin resistance). In order to open the doors (receptors) to get food into the cells, our cells call out for additional insulin (hyperinsulinemia) and food. At first, this can work, but gradually the pancreas wears out; it cannot continue to make massive amounts of insulin and it starts to decrease the insulin secretion. Our usual storage sites for food in the body (liver and fat cells) may actually produce extra glucose and fat to attempt to supply the rest of the body with food,because the peripheral cells (mostly muscle cells) do not know there already is enough food in the blood stream. This results in elevated glucose levels in the blood stream. Whew!!!

Type 2 diabetes has become much more common in kids and teens in the United States over the last 10 years, especially in those who are overweight. Between 10 and 50 percent of children with a new diagnosis of diabetes may have the form known as type 2 diabetes. This disease was almost unheard of 20 years ago. It is especially common in Hispanic youth, African Americans, Asian/Pacific Islanders and American Indian youth, but can occur in anybody. The rapid rise in obesity, not being physically active and consumption of excessive calories seems to have led to the epidemic of children with type 2 diabetes. About 50 to 90 percent of kids and adolescents with type 2 diabetes have a parent or close relative that also has type 2 diabetes.

Associated problems can include obesity, high blood pressure (hypertension), elevated cholesterol and fat levels in the blood stream (hyperlipidemia), irregular menses and potential risks of infertility (polycystic ovarian syndrome), and a darkened, rough skin condition in the creases of the skin (acanthosis nigricans). When these problems cluster together, they may be called metabolic syndrome. Children with type 2 diabetes are at an accelerated risk for the long-term complications of diabetes, including heart disease, stroke, kidney disease and nerve damage.

How do you treat type 2 diabetes?

First, we want to prevent the disease. Daily exercise for 60 minutes, decreasing obesity, eating healthy foods with the right portion size is a good first step. Treatment of type 2 diabetes takes multiple steps working together:

  • Develop a total treatment plan with your endocrinologist.
  • Educate the child/adolescent and the entire family.
  • Involve your school, faith-based organizations, neighbors and community.
  • Learn healthy food choices, proper portion sizes and develop an eating plan.
  • Exercise every day; we breathe and eat every day, so it’s time to exercise every day.
  • Check blood glucose levels, write them down and discuss with your doctor.
  • Set a good example as a parent. You have to also perform all of these tasks daily.
  • Take medication as prescribed, if needed. Compliance is important.
  • Aggressive management of possible associated problems is a key, including elevated blood pressure, cholesterol and fat levels.
  • Continue daily working on overall health goals.

Thanks and good luck!

Work as a team with your endocrinologist.

A. Jay Cohen, MD, FACE, is the Medical Director at The Endocrine Clinic, P.C. He is also Clinical Assistant Professor in the Department of Family Medicine at the University of Tennessee and Clinical Associate Professor in the Department of Pharmacology at the University of Tennessee; Director of the Diabetes Advisory Panel at St. Francis Hospital; and a consultant in endocrinology at St. Jude Children’s Research Hospital. He is actively engaged in numerous phase 2 and 3 endocrine clinical research studies in areas such as inhaled insulins, new type 1 and 2 diabetes agents, novel osteoporosis agents, new androgen therapies, and long acting growth hormones. He is a primary investigator into humanized anti-CD3 monoclonal antibodies to potentially cure type 1 diabetes.