Type 2 Diabetes—No Longer an Adult-onset Problem

Jun 1, 2000

Traditionally referred to as "adult-onset" diabetes, type 2 diabetes was previously rare in children. With the American population gaining more weight and following a higher-fat and carbohydrate diet, however, health professionals are seeing more kids develop type 2 diabetes.

What Defines Overweight?

Excessive weight is one of the risk factors in childhood type 2 diabetes. Overweight is defined as weighing more than 20 percent of the ideal weight for one's height.

An American Diabetes Association (ADA) panel recommends that all overweight children, ages 10 and older, be tested for diabetes every two years at the onset of puberty. Minority groups are at particular risk and the risk escalates if the child has a family history of type 2, or shows signs of insulin resistance, high blood pressure and high cholesterol levels.

Treating Type 2 Diabetes in Kids

According to recommendations published by the ADA and the American Academy of Pediatrics in the March issues of Diabetes Care and Pediatrics, treatment and management of kids with type 2 diabetes is the same as it is for type 2 adults. Maintaining normal weight, eating a healthy diet and getting regular exercise are all staples of proper prevention. Unless they are ill at the time of their diagnosis, type 2 children should be initially treated with diet and exercise.

The ADA recommends that if a child's condition calls for medication, oral medications are usually preferable to insulin shots because most children do not like needles.

Type 2 children should also be screened regularly for diabetes-related complications such as retinopathy, high blood pressure and kidney problems.

A Family Affair

Having a child with diabetes means that the whole family should change some of its dietary and lifestyle habits.

"Encouraging healthy eating habits by the entire family is important," stresses the ADA panel.

Dietitians are charged to be sensitive to a family's resources and give culturally appropriate dietary recommendations.

Ring Around the Collar-Another Telltale Sign of Type 2

Medical authorities want to alert parents and pediatricians to watch out for acanthosis nigricans (AN) in kids. These are dark patches of skin that indicate insulin resistance, which usually leads to type 2 diabetes.

The discoloration most commonly occurs on the back of the neck-sometimes showing up as a ring around the neck. However, it has also been found on armpits, knuckles, elbows and knees.

Although AN can occur in adults, it is usually found in Hispanic, Native American and African American children, age 10 to 12. It is seen less often in Caucasians. In these minority populations, AN is often overlooked by doctors because it is so commonplace and because type 2 diabetes in kids is a fairly recent phenomenon. Parents often mistake the dark patches for dirt, and some have even resorted to scrubbing their children's necks with bleach in an attempt to remove the marks.

According to a November 11, 1999 article in the San Antonio Express-News, thousands of children in south Texas have AN. Such numbers alarmed Texas authorities, enough to fund a pilot project to screen school children in nine counties for AN. Children who were identified through the project were taught how to make lifestyle changes in diet, exercise and weight loss aimed at reducing their insulin resistance.

The skin discoloration can fade with weight loss and intervention.

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