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A Newsletter For Those Who Care For
CHILDREN
Volume 17, Issue 10
TYPE 2 DIABETES IN CHILDREN
October 2011
Editor-in-Chief: Mary Myers Dunlap, MAEd, RN
BEHAVIORAL OBJECTIVES
AFTER
READING THIS NEWSLETTER THE
LEARNER WILL BE ABLE TO:
1. Compare the pathophysiology of type 1 and type 2
diabetes.
2. Describe five clinical manifestations of type 2 diabetes
in childhood, as well as two changeable risk factors.
Type 2 diabetes is an epidemic in the United States,
affecting 20 million adults and children. According to the
American Diabetes Association (ADA), of these, an
estimated 6 million Americans are undiagnosed. Type 2
diabetes was previously rare in children – it was previously
called adult-onset diabetes, but in the last couple of
decades, the most rapid increase in the incidence of this
disease is in children. For the first time in human history,
type 2 diabetes is now more common than type 1 diabetes in
children. Because of epidemic rates of obesity and inactivity
in children, type 2 diabetes mellitus is occurring at younger
and younger ages. It has been diagnosed in children as
young as 2 years of age. However, new cases of type 2
diabetes in children are typically diagnosed after age 10.
During this time, the bodies of preadolescents are growing
and developing rapidly, placing an additional demand on the
pancreas to produce additional insulin.
This newsletter will compare the
pathophysiology of type 1 versus type
2 diabetes. Pediatric risk factors for
type 2 diabetes will be described,
which are key for healthcare providers
to note during patient assessment.
GLUCOSE METABOLISM
Normally, after eating, the body’s digestive system breaks
down the sugars and starches consumed into glucose, which
then travels in the bloodstream to cells throughout the body.
Any food or drink containing glucose (or the digestible
carbohydrates which contain it, such as sucrose, fructose and
starch) causes blood glucose levels to increase significantly. In
a person with normal metabolism, the elevated blood glucose
level causes the pancreas to release insulin into the blood.
Insulin then binds with glucose in the bloodstream and to cell
receptors, particularly in tissue, muscles and the liver, opening a
portal that allows glucose to enter the cell, where it's
transformed into energy.
As a result, the blood glucose is maintained at approximately
90 mg/dL. If the body does not produce insulin, as with type 1
diabetes, or enough insulin or the cells ignore the insulin, as
with type 2, glucose builds up in the blood instead of going into
cells, resulting in hyperglycemia.
PATHOPHYSIOLOGY – TYPE 1 VS TYPE 2
In children with type 1 diabetes,
the beta cells in the Islets of
Langerhans in the pancreas are
destroyed, rendering them incapable
of producing insulin. Type 1 diabetes
occurs when the immune system
attacks and destroys the cells of the
pancreas that produce insulin.
Lifelong insulin replacement is
necessary for glucose metabolism.
Most children with type 1 diabetes are slender, while the
overwhelming majority of children with type 2, are
overweight/obese. However, in both instances, this is not
always the case. Unlike with type 1 diabetes, in type 2
diabetes, the pancreas secretes insulin, but the body is
unable to use insulin. Initially, the cells are said to be insulin
resistant, meaning additional insulin must be released to
overcome the tissue cells’ resistance and to allow glucose to
move into the cells. Eventually, the pancreas wears out from
working overtime to produce extra insulin. It gradually
becomes unable to produce enough insulin to keep blood
sugar levels normal.
The length of time before the child actually shows signs
of type 2 diabetes is unknown, but many authors agree that
insulin resistance is present for several years before type 2
diabetes is diagnosed. Insulin resistance exists when fasting
blood sugars (FBS) are > 100mg/dL. Type 2 diabetes is
diagnosed if the FBS is higher than 126 mg/dL on two
occasions. Generally, children with type 2 diabetes have
poor glycemic control (A1C = 10% - 12%). The A1C
measures a patient’s average blood glucose control for the
past 2 to 3 months. It is determined by measuring the
percentage of glycated hemoglobin, or HbA1c, in the blood.
With proper glucose metabolism, the A1C is normal,
between 4% and 6%. Children with type 2 diabetes often
present with glycosuria (glucose in the urine), as well as an
increased insulin level, hyperinsulinemia. Although beta cells
function normally with type 2 diabetes, the cycle of impaired
insulin production and elevated blood glucose is thought to
gradually contribute to their destruction, as occurs in type 1
diabetes. This is why many patients with type 2 diabetes,
nearly 50%, will require insulin to control their blood sugar
levels at some point in the course of their illness.
Copyright © 2011 Growing Up With Us, Inc. All rights reserved.
Page 1 of 4
CLINICAL MANIFESTATIONS
Type 2 diabetes usually develops gradually, often over a
period of years, whereas type 1 diabetes typically occurs
rapidly, in a matter of weeks. Some children who have type 2
diabetes have no signs or symptoms, while others will have
the following manifestations:






Polydipsia and polyuria increased thirst and urination may
occur. As excess glucose builds
up in the child's bloodstream, fluid
is pulled from the tissues. This
may cause excessive thirst,
causing the child to drink, as well as urinate, more than
usual. Often nighttime bedwetting, in a previously
trained child, is an initial sign of a problem in children, as
well as adults.
Polyphagia, increased hunger may be evident. Without
enough insulin to move glucose into the child's cells, the
child's muscles and organs become depleted of energy.
This triggers hunger.
Weight loss - Despite eating more than usual to relieve
hunger, the child may lose weight. Significant weight
loss is not a presenting symptom in most children with
type 2 diabetes\
Fatigue. When the child's cells are deprived of glucose,
he or she may become tired and irritable.
Blurred vision. With hyperglycemia, fluid may be pulled
from the lenses of the eyes, affecting the child's ability to
focus clearly.
Slow-healing cuts or frequent infections. Type 2
diabetes affects the child's ability to heal and resist
infections. Yeast infections are common.
 Areas of darkened skin. Areas of darkened skin
(acanthosis nigricans) may be a sign of insulin
resistance. These dark patches often occur in the
armpits or neck.
RISK FACTORS
Not all factors associated with an increased risk for
developing type 2 diabetes can be changed. However,
obesity and physical inactivity, which place children at
highest risk for developing type 2 diabetes, can be corrected.
ETHNICITY: Certain ethnic groups are at increased risk for
type 2 diabetes. Compared with a 6% prevalence in
Caucasians, the prevalence in African Americans and Asian
Americans is estimated to be 10%. Additionally, type 2
diabetes is more common in Hispanic/Latinos and Hawaiian
natives and other Pacific Islanders.
FAMILY HISTORY: Unlike in Type 1 diabetes, approximately
25-33% of all children with type 2 diabetes patients have
family members with type 2 diabetes. However, because
families share many lifestyle features, such as eating and
exercise habits, it’s unclear whether genetics or environment
play the major role. When clusters of diabetes appear within
families, genetic factors should be strongly suspected.
MATERNAL FACTORS: Maternal obesity during pregnancy is
a proven risk factor for offspring to develop obesity and type
2 diabetes later in life. Latest research suggests babies of
obese mothers begin to develop insulin resistance in utero.
Women with a history of gestational diabetes, as well as
their children, are also at greater risk for progressing to type
2 diabetes mellitus later in life.
OBESITY, regardless of age, is the greatest risk factor for
type 2 diabetes. Fat cells secrete chemicals that directly
sabotage the cells' ability to use insulin. Insulin resistance
and type 2 diabetes not only stimulate the pancreas to
produce excessive insulin, but also stimulate the fat cells to
absorb glucose (fat cells are not insulin resistant). The result
is an outpouring of free fatty acids (FFA) from the fat cells.
The FFA’s get quickly converted into triglycerides in the liver.
Triglycerides are simply fats that circulate in the
bloodstream. The child’s triglyceride level may also be
elevated at the time of diagnosis.
Overweight and obesity in children are significant public
health problems in the United States. According to the
Centers for Disease Control and Prevention (CDC),
childhood obesity has more than tripled in the past 30 years.
There is a direct correlation between this statistic and the
rise in type 2 diabetes in children. In our country,
approximately 17% (or 12.5 million) of children and
adolescents aged 2 - 19 years are obese. It is estimated that
one-third of children born in 2000 will develop obesity-related
diabetes.
Children's dietary habits have shifted away from healthy
foods, such as fruits, vegetables, and whole grains, to fast
foods, processed and snack foods, as well as sugary drinks.
These foods tend to be high in fat and/or calories and low in
many other nutrients. Portion sizes have increased in the
American diet. Patterns commonly associated with obesity
are eating when not hungry and eating while watching TV.
BEING PHYSICALLY INACTIVE: Physical inactivity is directly
related to weight gain, as well as the body’s ability to utilize
insulin. Exercise and weight loss go hand in hand. If a
person is inactive, calories consumed aren’t burned
effectively - each 3500 calories consumed above the body’s
needs results in one pound of weight gain. Exercise also
improves the sensitivity of the insulin receptors. It stimulates
the release of growth factors, one of which is insulin-like
growth factor 1 (IGF-1), that helps insulin attach to the
insulin receptors and that stimulate the production of even
more insulin receptors.
Many American children live sedentary lifestyles.
Children and adolescents, 8 -18 years
old, spend an average of 7.5 hours a
day using entertainment media,
including TV, computers, video games,
and cell phones. Eighty-three percent
of children from 6 months to 8 years of
age view TV or videos an average of 2
hours a day.
In type 2 diabetes, either the body does not produce enough
insulin or the cells ignore the insulin. Type 2 diabetes
predisposes the child to serious health problems, including heart
and blood vessel disease, as well as eye, nerve, and kidney
damage. An upcoming newsletter will discuss implications for
the healthcare provider related to prevention of type 2 diabetes
in children, including assessment of risk factors and teaching.
Growing Up With Us, Inc.
PO Box 481810 • Charlotte, NC • 28269
GUWU Testing Center
www.growingupwithus.com/quiztaker/
Phone: (919) 489-1238 Fax: (919) 321-0789
Editor-in-Chief: Mary M. Dunlap MAEd, RN
E-mail: [email protected]
Website: www.growingupwithus.com
Copyright © 2011 Growing Up With Us, Inc. All rights reserved.
Page 2 of 4
Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
GROW ING UP WITH US...
A Newsletter for Those Who Care for Children
October 2011
Competency:
Demonstrates Age-Specific Competency by correctly answering 9 out of
10 questions related to Type 2 Diabetes in Children.
TYPE 2 DIABETES IN CHILDREN
1. Today, type 1 diabetes is more common in children than type 2 diabetes.
a. True
b. False
2. A difference between type 1 and type 2 diabetes is that:
a.
b.
c.
d.
only type 1 involves the pancreas.
with type 2, symptoms occur abruptly.
too many beta cells are produced with type 1.
insulin resistance occurs in type 2.
3. As opposed to type 1 diabetes, with type 2 diabetes:
a.
b.
c.
d.
the beta cells in the pancreas are destroyed.
the body is unable to use insulin.
lifelong insulin replacement is necessary.
the pancreas is unable to produce glucose.
4. Which of the following does NOT contribute to type 2 diabetes in children? A/an:
a.
b.
c.
d.
immune attack destroying all pancreatic beta cells.
obesity.
increase in insulin resistance.
reduced physical activity.
5. Which of the following is least likely to be evident in a newly diagnosed 11 year old with type 2
diabetes?
a.
b.
c.
d.
Excessive thirst
Nightime bed-wetting
Fatigue
Significant weight loss
Copyright © 2011 Growing Up With Us, Inc. All rights reserved.
Page 3 of 4
Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
GROWING UP WITH US... Caring For Children
TYPE 2 DIABETES IN CHILDREN
6. A fasting glucose greater than which of the following values would suggest insulin resistance in a
child?
a.
b.
c.
d.
60 mg/dL
86 mg/dL
100 mg/dL
156 mg/dL
7. With type 2 diabetes and insulin resistance, hyperinsulemia may be present.
a. True
b. False
8. Which of the following laboratory findings is NOT consistent with a child suspected of having type
2 diabetes in children?
a.
b.
c.
d.
Glucose in the urine
A1C of 4%
FBS >126 mg/dL
Increased insulin levels
9. Which of the following maternal factors does NOT predispose a child to type 2 diabetes? His or
her mother:
a.
b.
c.
d.
had gestational diabetes while pregnant with the child.
was obese when pregnant with the child.
has type 2 diabetes.
is Caucasian.
10. Fat cells interfere with the body’s ability to use insulin.
a. True
b. False
Copyright © 2011 Growing Up With Us, Inc. All rights reserved.
Page 4 of 4