The diagnosis of type 2 diabetes is becoming increasingly common in U.S. kids and teens, especially in those who are overweight. Some studies report that between 8% and 45% of children who've been newly diagnosed with diabetes have the form known as type 2, depending on geographic location and racial/ethnic group.

Diabetes is a chronic condition that needs close attention, but with some practical knowledge, you can become your child's most important ally in learning to live with the disease.

What Is Diabetes?

Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood. Glucose comes from the foods we eat and is the major source of energy needed to fuel the body's functions.

After you eat a meal, your body breaks down the foods you eat into glucose and other nutrients, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can't make or respond to insulin properly.

Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can't get into the cells (the doors are "locked" and there is no key) and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of symptoms and health problems.

What Is Type 2 Diabetes?

There are two major types of diabetes: type 1 and type 2. Both type 1 and type 2 diabetes cause blood sugar levels to become higher than normal. However, they cause high blood sugar levels to occur in different ways.

Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) occurs when the person's own immune system attacks and destroys the cells of the pancreas that produce insulin. Children with type 1 diabetes need insulin to help keep their blood sugar levels within a normal range.

Type 2 diabetes (formerly called non-insulin-dependent diabetes) is different. In contrast to someone with type 1 diabetes, someone with type 2 diabetes still produces insulin. But the body doesn't respond to the insulin normally. Glucose is less able to enter the cells and do its job of supplying energy (doctors call this insulin resistance). This causes the blood sugar level to rise, making the pancreas produce even more insulin. Eventually, the pancreas can wear out from working overtime to produce extra insulin. Then, the pancreas may no longer be able to produce enough insulin to keep a person's blood sugar levels within a normal range.

People with insulin resistance may or may not develop type 2 diabetes — it all depends on whether the pancreas can produce enough insulin to keep blood sugar levels normal. Repeatedly high blood sugar levels are a sign that a person has developed diabetes.

Children and teens with type 2 diabetes use diet, exercise, and medicines that improve the body's response to insulin to control their blood sugar levels. Sometimes kids and teens with type 2 diabetes may need to take insulin shots or use an insulin pump, too.

Who Gets Type 2 Diabetes?

Although no one knows for certain what causes type 2 diabetes, there seems to be a genetic component to developing it. In fact, it's estimated that 45% to 80% of children with type 2 diabetes have at least one parent with diabetes and may have a significant family history of the disease. In some cases, a parent may be diagnosed with type 2 diabetes at the same time as his or her child.

Most children and adults who develop type 2 diabetes are overweight. Excess fat makes it harder for the cells to respond to insulin. And being inactive further reduces the body's ability to respond to insulin. In the past, doctors called this type of diabetes adult-onset diabetes because it almost exclusively affected overweight adults. Today, that description is no longer accurate. More kids and teens are being diagnosed with type 2 diabetes, probably because more kids and teens are overweight.

Certain ethnic groups also tend to be more prone to developing type 2 diabetes, including people of Native American, African American, Hispanic/Latino, or Asian/Pacific Island descent. Also, children who have reached puberty are more likely to develop the disease than younger children, probably because of normal rises in the levels of hormones that can cause insulin resistance during this stage of rapid growth and physical development.

Signs and Symptoms of Type 2 Diabetes

The symptoms of type 2 diabetes aren't always obvious and they can take a long time to develop. Sometimes, there are no symptoms. It's important to remember that not everyone with insulin resistance or type 2 diabetes develops these warning signs, and not everyone who has these symptoms necessarily has type 2 diabetes.

But a child or teen who develops type 2 diabetes may:

• urinate frequently. The kidneys respond to high levels of glucose in the blood by flushing out the extra glucose in urine. A child with a high blood sugar level needs to urinate more frequently and in larger volumes.
• drink a lot of liquids. Because the child is peeing so frequently and losing so much fluid, he or she can become very thirsty. He or she drinks a lot in an attempt to keep the levels of body water normal.
• feel tired often because the body can't use glucose for energy properly.

Sometimes, children and teens with type 2 diabetes, insulin resistance, or obesity may also develop thick, dark, velvet-like skin around the neck, armpits, groin, between fingers and toes, or on elbows and knees — a cosmetic skin condition called acanthosis nigricans.

Polycystic ovary syndrome (PCOS) in girls is also often associated with insulin resistance. PCOS is a hormone problem that can cause the ovaries to become enlarged and develop fluid-filled sacs called cysts. Girls with this condition often have irregular periods or may stop having periods altogether, and they are more likely to get excess facial and body hair growth. PCOS can also result in fertility problems.

Children and teens with insulin resistance or type 2 diabetes are also more likely to develop hypertension (high blood pressure) or abnormal levels of blood fats (cholesterol and triglycerides). When these problems cluster together in a person, doctors call this metabolic syndrome. People with metabolic syndrome have a greater risk of developing heart disease, stroke, and other health problems.

Diabetes can also cause long-term complications in some people, including heart disease, stroke, vision impairment, and kidney damage. Diabetes can also cause other problems in the blood vessels, nerves, and gums. These problems don't usually show up in kids or teens with type 2 diabetes who have had the disease for only a few years. However, they can occur in adulthood in some people with diabetes, particularly if their diabetes hasn't been well controlled.

Doctors can determine if a person has diabetes by testing blood samples for glucose. Even if a child or teen doesn't have any symptoms of type 2 diabetes, doctors may order blood tests to check for it in kids who are more likely to get it — like those who are overweight.

If you think your child has symptoms of diabetes, talk to your child's doctor, who may refer you to a pediatric endocrinologist, a doctor who specializes in the diagnosis and treatment of children with diseases of the endocrine system, such as diabetes and growth disorders.

Living With Type 2 Diabetes

A child or teen with type 2 diabetes may need to:

• eat a healthy diet to help achieve a normal body weight while getting the nutrients needed to grow and develop. Doctors may recommend a low-salt or low-fat diet, especially if the child has conditions such as high blood pressure or abnormal blood fat levels.
• participate in physical activity regularly. Exercise helps increase the body's response to insulin, and it helps the body burn more calories, which can promote the loss of excess body fat.
• get to and maintain a normal body weight.
• monitor blood sugar levels regularly.
• take insulin or other medications which help the body respond to insulin more effectively.
• work closely with their doctors and diabetes health care team to help achieve the best possible control of their diabetes and be monitored for signs of diabetes complications and other health problems that occur more frequently in children with type 2 diabetes.

Living with diabetes is a challenge, no matter what a child's age, but young children and teens often have special issues to deal with. Young children may not understand why the blood testing and medications are necessary. They may be scared, angry, and uncooperative.

Teens may feel different from their peers and may want to live a more spontaneous lifestyle than their diabetes allows. Even when they faithfully follow their treatment schedule, teens with diabetes may feel frustrated when the natural adolescent body changes during puberty may make their diabetes somewhat harder to control.

Having a child with diabetes may seem overwhelming at times, but you're not alone. Your child's diabetes care team is not only a great resource for dealing with medical issues, but also for supporting and helping you and your child cope and live with diabetes.

What's New in the Treatment of Type 2 Diabetes?

Doctors and researchers are developing new equipment and treatments to help children cope with the special problems of growing up with diabetes.

Some kids and teens are already using new devices that make blood glucose testing and insulin injections easier and more effective. One of these devices is the insulin pump, a mechanical device that can be programmed to deliver insulin more like the pancreas does.

Researchers are also testing ways to stop diabetes before it starts. For example, scientists are studying whether diabetes can be prevented in those who may have inherited an increased risk for the disease.

Until scientists have perfected ways to better treat and possibly even prevent or cure diabetes, parents can help their children lead happier, healthier lives by giving constant encouragement, arming themselves with knowledge about the disease, and making sure their children eat properly, exercise, and stay on top of glucose levels every day. Doing so will enable kids to do all the things that other children do while helping them grow up to be healthy, well-adjusted, productive adults.

Reviewed by: Steven Dowshen, MD
Date reviewed: April 2007