If your teenager gets diagnosed with diabetes, there’s a 1 in 3 chance it won’t be the type you might expect.
Type 2 diabetes, once called adult-onset diabetes, increasingly is being diagnosed in adolescents and younger children.
One in three cases of newly diagnosed diabetes in U.S. children and teens are type 2, which is when the body doesn’t produce enough insulin or cells ignore insulin it does produce.
Type 1 diabetes is when the body doesn’t produce insulin. It’s the type that usually occurs in childhood although — in another reversal — it’s being diagnosed in adults more than it used to be.
Type 2 diabetes in children and teens is trickier to find, based on symptoms alone. Parents and doctors need to be aware of and specifically testing for it.
Forty percent of children with type 2 diabetes don’t have symptoms at the time they’re diagnosed, said Dr. Erjola Balliu, a Lakeland Regional Health endocrinologist who is board certified in pediatric and adult diabetes.
By the time symptoms appear in pediatric type 2 diabetes, she said, 80 percent of the function of beta cells (which synthesize and secrete insulin) often has been destroyed.
She and Dr. Mauri Carakushansky, chief of the pediatric endocrinology division of Nemours Children’s Hospital in Orlando, have observed the increase of cases in pediatric type 2 diabetes that’s being reported nationwide.
They’re passionate about encouraging primary care doctors to test for diabetes and pre-diabetes in children who are at higher risk of getting the disease.
Missed diagnoses mean delayed treatments.
“Different studies estimated that youth with type 2 diabetes may have a loss of up to 15 years of life expectancy, and increased risk of serious health complications by the time they reach their 40s, depending on their level of glycemic (blood sugar level) control,” Carakushansky said.
Type 2 diabetes that emerges in youth also is associated with substantially increased incidence of end stage kidney disease and mortality in middle age, along with higher incidence of high blood pressure and retinopathy, he added.
Up to 32 percent of teens with type 2 diabetes has hypertension when they’re diagnosed, studies have found.
Obesity is a key factor in the rising number of children and teens diagnosed with type 2 diabetes. Secondhand smoke, unhealthy eating patterns, lack of physical activity and genetic issues are other factors, said Balliu, (pronounced bal-ee-oo).
Which kids are at risk
The American Diabetes Association recommends type 2 diabetes screening begins at age 10 or the start of puberty in children who are overweight and have two additional risk factors.
Balliu listed these as risk factors:
• Type 2 diabetes mellitus in a first-or-second-degree relative
• Being Native American, African American, Latino, Asian American or Pacific Islander
• Maternal history of diabetes or the mother having had gestational diabetes during pregnancy
• Signs of insulin resistance or conditions associated with it, such as hypertension, polycystic ovary syndrome and abnormally high cholesterol. Others are birth weight that was small for a baby’s gestational age and acanthosis nigricans, a skin condition.
“The main thing is to make everybody aware it’s important to screen all these groups that have higher risk,” Balliu said.
The increasing incidence of type 2 is particularly pronounced in minority racial and ethnic groups, who are disproportionately affected.
“Blood tests can help determine early on if a child is at risk for type 2 diabetes way before blood sugars become abnormal,” said Carakushansky, who is certified through the American Board of Pediatrics.
If insulin resistance is detected before diabetes occurs, dietary changes, added physical activity and medicine like metformin can be used to delay or prevent the condition from progressing to diabetes.
Metformin helps lower blood sugar and fight the body’s resistance to insulin in patients with type 2. It got approved for pediatric use in 2000 and has several brand names.
A second drug, Victoza (liraglutide), got approval June 17 for treating type 2 diabetes in pediatric patients 10 years old or older. It’s the first non-insulin drug approved for pediatric type 2 diabetes since metformin, according to the U.S. Food and Drug Administration.
Victoza operates in a different way than metformin, stimulating the pancreas to make more insulin if needed and slowing digestion, Balliu said. The FDA approved it for adult type 2 diabetes in 2010.
Team approach, referrals and trials
Pediatricians, family doctors and others treating children need to be screening at-risk children, both doctors said, as well as pushing them more strongly toward healthy weight, exercise and healthy eating.
If a child is diagnosed with diabetes or pre-diabetes, a broader treatment team needs to be involved. Pediatric endocrinologists, of course, but also nutritionists, diabetes educators and the child’s family.
As with any other chronic disease, the diagnosis will have an impact familywide. Dietary patterns will change. More exercise is needed.
“Many of those things work better if the family as a whole is participating,” said Dr. Laura Smith, a psychologist at the University of South Florida who works with its diabetes center and pediatrics department.
With type 2 diabetes and its link to obesity, she said, there’s more likelihood of children being blamed or feeling blamed for having the condition.
“Parents go through emotional reactions to their child being diagnosed,” Smith said, such as worrying about the long-term impact on the child.
USF, Nemours and All Children’s Hospital in St. Petersburg are where Watson Clinic pediatricians refer pediatric diabetes patients, said Dr. Kendra Velez-Rodriguez, a board-certified pediatrician with the clinic.
Polk County has a shortage of pediatric endocrinologists, one that Balliu’s addition to LRH helped alleviate. Nemours this summer will base a full-time diabetes educator and a full-time pediatric endocrinologist, Dr. Soniely Lugo-Ruiz, at LRH Medical Center.
Dealing with diabetes is a lifelong process.
Patients diagnosed with type 2 may find they get their blood sugar level back to normal by losing weight and exercising, but that doesn’t mean the diabetes is cured. It does mean it’s well controlled and their risk of developing diabetes complications is much lower, Carakushansky said.
Robin Williams Adams is at [email protected]