Recognizing and Treating Type 2 Diabetes in Children

By Alan L. Rubin

Around age 10, some children are found to have type 2 diabetes. In 1990, less than 4 percent of children diagnosed with diabetes had type 2. In 2003, the figure had risen to more than 30 percent. In 2007, almost one of every two children with diabetes had type 2 diabetes.

Important differences exist in the way type 1 and type 2 are recognized and treated. A number of clues point to a child having type 2 diabetes rather than type 1:

  • The child is overweight rather than underweight at diagnosis.

  • Symptoms, such as thirst and increased urination, are mild or not present at all; if they are present, they have been going on for a long time (often months).

  • The child has a strong family history of type 2 diabetes.

  • The child’s glucose level at diagnosis is usually lower than the glucose of a patient with type 1.

  • The child belongs to an ethnic group at increased risk for type 2, such as African American, Hispanic, Asian, or Native American.

  • The child has acanathosis nigricans, dark or thickened patches on the skin between the fingers and toes, on the back of the neck, and on the underarms. These patches are present in 90 percent of type 2 patients.

  • An older girl may have irregular menses caused by polycystic ovarian syndrome.

Despite these clues pointing to type 2, the two types of diabetes can be confused for several reasons. Type 1 diabetic children may be overweight. Type 2 children may have ketones in their urine, just as type 1 patients do. The glucose level at diagnosis in some type 1 children is not very elevated. And the overall occurrence of type 2 is still low enough that the doctor may not think of the possibility.

Some children actually have “double diabetes.” These children have type 1 diabetes but were overweight or obese at the time the diagnosis was made. In these children, lifestyle modification plays an important role in the treatment. Weight loss and exercise will help to bring the glucose under control, even though insulin is the primary treatment.

An important thing to remember is that type 2 diabetes responds to treatment with insulin much more rapidly than type 1, and the child may not need insulin at all after a proper diet and exercise are established. No child with type 1 diabetes can live without insulin except possibly.

If you have an overweight child — one who is more than 120 percent of his or her ideal weight for height — you should request that your doctor screen him or her for diabetes every two years by using a fasting blood glucose test.

The treatment of type 2 diabetes, both in children and adults, starts with lifestyle change. You, the parent, must make the commitment to exercise with your child every day. You should meet with a dietitian and discuss a diet for the whole family that provides sufficient nutrition for the growing child while allowing for weight loss. If these two things are accomplished, no more steps will be necessary. That means limiting TV and computer time so the child is active rather than passive. You might consider getting a pedometer for your child and encouraging him or her to build up the number of steps taken each day, with prizes for reaching goals.

If diet and exercise do not return the blood glucose to normal, oral hypoglycemic agents are used. Currently, metformin is the only oral drug approved by the FDA for children. If oral agents fail, insulin is given.