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topic provides information about
type 2 diabetes in children. If you are looking for
type 1 diabetes, see the topic
Type 1 Diabetes: Children Living With the Disease.
Type 2 diabetes is a
lifelong disease that develops when the
pancreas cannot make enough
insulin or when the body's tissues cannot use insulin
properly. Insulin is a hormone that helps the body's cells use sugar (glucose)
for energy. It also helps the body store extra energy in muscle, fat, and liver cells.
Without insulin, the sugar cannot get into the cells to do
its work. It stays in the blood instead. This can cause high blood sugar
levels. A person has diabetes when the blood sugar stays too high too much of
Over time, high blood sugar can cause problems with the
eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes a
person more likely to get serious illnesses or infections.
past, doctors believed that type 2 diabetes was an adult disease and that type
1 diabetes was a children's disease. Now, more and more children are getting
type 2 diabetes.
Finding out that your child has diabetes can be
scary. But your child can live a long, healthy life by learning to manage the
Doctors do not know
exactly what causes diabetes. Experts believe the main risks for children
getting type 2 diabetes are being overweight, not being physically active, and
having a family history of the disease.
Also, the hormones
released during the early teen years make it harder than usual for the body to
use insulin correctly. This problem is called
insulin resistance. It can lead to diabetes.
Most children with type 2
diabetes do not have symptoms when the disease is first found. If there are
symptoms, they usually are mild and may include:
A simple blood
test is usually all that is needed to diagnose diabetes. Your child's doctor
may do other blood tests if it is not clear whether your child has type 1 or
type 2 diabetes.
A doctor may test your child for diabetes if he
or she is overweight, gets little physical activity, or has other risk factors
for the disease. A risk factor is anything that increases your chances of
having a disease. Some children are diagnosed with type 2 diabetes when they
have a blood or urine test for some other reason.
The key to treating diabetes is
to keep your child's blood sugar levels within a target range. To do
You play a major role in helping your child take charge
of his or her diabetes care. Let your child do as much of the care as possible.
At the same time, give your child the support and guidance he or she needs.
The longer a person has diabetes, the more likely he or she is to
have problems, such as diseases of the eyes, heart, blood vessels, nerves, and
kidneys. But if your child can control his or her blood sugar levels every day,
it may help to delay the start of or prevent some of these problems later
Even when you are careful and do all the right things, your
child can have problems with high or low blood sugar. It is important to know
what signs to look for and what to do if this happens.
child stay at a healthy weight and get regular exercise can help prevent type 2
Learning about type 2 diabetes in children:
Preventing the disease:
Living with a child who has type 2 diabetes:
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of
type 2 diabetes is not known. But experts believe the
disease develops in children the same way it does in adults. The body does not
produce enough of the hormone
insulin, or it cannot correctly use the insulin
available (insulin resistance). Either or both of these
conditions lead to excess sugar (glucose) in the blood.
Insulin resistance occurs when
the body's cells do not correctly use insulin, which helps control the amount
of glucose in the blood. The body then needs more insulin to control blood
sugar levels. The
pancreas produces more insulin to try to keep blood
sugar levels normal. If it cannot produce enough insulin, blood sugar rises,
and diabetes may develop.
Things that affect the body's
resistance to insulin in childhood include:
Normally, the pancreas produces
more insulin than usual during puberty to support the rapid growth of the
child. If the body cannot produce enough insulin to meet its needs, diabetes
develops. Over time, the pancreas may produce less and less insulin, making the
Children often have no symptoms of
type 2 diabetes before they are diagnosed, because
their blood sugar level has been rising so slowly. As a result, a child may
have diabetes for several months or years before being diagnosed.
When children do have symptoms, the most common include:
Other possible symptoms include:
Type 2 diabetes
usually develops in adulthood, but the number of children being diagnosed with
the disease is rising. Children with type 2 diabetes are usually diagnosed
during the early teen years. During this time, their bodies are growing and
developing rapidly, placing a demand on the
pancreas to produce additional
The hormones released during
puberty can make it harder than usual for the body to use insulin correctly
(insulin resistance). Also, children with type 2
diabetes are usually overweight, which also contributes to insulin resistance.
If the pancreas cannot produce enough insulin to overcome the resistance,
diabetes can develop.
Diabetes experts believe the disease progresses as it
does in adults. The main risk factors for complications from diabetes are the length of time a person
has diabetes and the degree of blood sugar control. A child who develops type 2
diabetes may have an increased risk of complications, because he or she will
have the disease for a long time. Some complications that children and teens may develop include:
If a child's blood sugar levels remain high for a long
time, he or she may grow at an abnormal rate—faster than normal for a while,
then slower than normal later. If blood sugar levels stay high during puberty,
normal changes and the start of menstruation may be delayed.
The way to prevent complications is to always keep blood sugar levels in a target range. This requires that your child follow his or her treatment plan
daily and monitor blood sugar levels often. Your child also will need ongoing
diabetes education and regular checkups. Other medical conditions, such as high
blood pressure and high cholesterol, need adequate medical care also, because
they raise the risk for diabetes complications.
Children with type
2 diabetes have to modify their lifestyles. Your child will be more successful
if your whole family is involved. These lifestyle changes benefit everyone by
reducing the risk for diabetes and heart
The major risk factors for
type 2 diabetes in children include:
Other things that increase risk include:
Medical conditions that contribute to the risk of
complications in adolescence and beyond include:
Teens who have diabetes and smoke have a higher risk of
complications from diabetes than do those who do not smoke.
Call 911 or other emergency services right away if your child:
Call a doctor if your child:
Check with your doctor if your child:
Watchful waiting is a period of time during
which you and your doctor observe your child's symptoms or condition without
using medical treatment. Watchful waiting is not
Most doctors can diagnose diabetes. After your child
has been diagnosed, your doctor will work with you to build a treatment plan
that fits your child's needs. Health professionals who may be involved in the
treatment of children with type 2 diabetes include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Many children have had no symptoms
before they are diagnosed with
type 2 diabetes. Usually, the illness is discovered
when a blood or urine test taken for another reason shows diabetes.
If a doctor suspects that your child may
have type 2 diabetes, he or she will do a
physical exam, and blood glucose testing. If
the results of these tests meet the
criteria for diagnosing diabetes established by the
American Diabetes Association (ADA), your child has diabetes.
If it is hard to tell whether
your child has type 2 or
type 1 diabetes, your doctor may do a
C-peptide test or an autoantibodies test.
(Autoantibodies are produced when the body's
immune system does not work right.) These tests may
not be able to confirm the type of diabetes your child has. Getting a
definite diagnosis may take months or years. In either case, your child's sugar
levels will need to be controlled right away.
Sometimes a doctor
will do a quick
home blood sugar test or a
urine test for sugar to see whether a child may have
diabetes. Although these tests are simple and can show possible diabetes,
additional testing is needed to make sure your child actually has the
Because your child is at risk for diabetes complications (eye, heart,
kidney, nerve, liver, and blood vessel problems), he or she needs to see a
doctor regularly for tests to monitor type 2 diabetes.
If your child is overweight and gets little or no exercise, he or she may be at risk for type 2 diabetes. Early detection
and treatment for type 2 diabetes can prevent or delay problems from the disease.
type 2 diabetes in children focuses on keeping blood
sugar levels within a
target range. Children may need higher blood sugar
goals than adults, because their bodies are still developing. Also, they may not
be able to recognize symptoms of
low blood sugar. To reach his or her target blood
sugar, your child needs to eat healthy meals of appropriate portion size and
get daily exercise. Treatment also may include medicine.
A healthy diet with the right
amount of calories will help your child achieve target blood sugar levels and
maintain a healthy weight. The meal plan designed for your child will spread
carbohydrate (starches and sugary foods) throughout
the day. This helps prevent high blood sugar after meals as well as weight
gain. A registered dietitian can design a meal plan that not only fits your child's
needs but also is a healthy eating plan for your family. For more information, see the topic
Healthy Eating for Children.
If your child is overweight, he or she may need to lose weight (or stay at the same weight and not gain more). This depends on his or her age, development, and other risk factors.
Physical activity is
extremely important. It helps the body use insulin correctly and helps control
weight. Your child does not have to start a rigorous exercise program, but
being more active can help control blood sugar. For example, your child could
play outside with friends, take brisk walks with family members, and
take part in individual or team sports.
Experts recommend that
teens and children (starting at age 6) do moderate to vigorous activity at
least 1 hour every day.1 And 3 or more days a week,
what they choose to do should:
It's okay for them to be active in smaller blocks of time
that add up to 1 hour or more each day.
Limit your child's screen time. Have your child take breaks from computer, cell phone, and TV use and be active instead.
Your child may need medicines if eating healthy meals and getting regular physical activity have not
lowered your child's blood sugar to his or her target level.
Your child's blood sugar level may need to be checked regularly, for example, before breakfast and 2 hours after meals.
If your child has high blood pressure or high cholesterol, those
conditions need to be treated.
Some children have very high
blood sugar levels when they are diagnosed with type 2 diabetes. A child with a
very high blood sugar level may develop the serious chemical imbalance
diabetic ketoacidosis and need to be treated with
insulin in a hospital. After blood sugar returns to a target level, the child
usually no longer needs insulin. His or her own body may start making enough
Treating diabetes with medicine increases the risk for
low blood sugar episodes. Your child's doctor will determine
the target range for your child's blood sugar that will prevent damage from diabetes
while causing as few low blood sugar episodes as possible.
lifestyle changes needed to control diabetes can be especially hard for
a child or teen. Your child will have a better chance of being successful if
the whole family is involved. Eating a healthy diet and getting regular
exercise may help other family members avoid diabetes.
Teens who have
depression or an
eating disorder may have difficulty keeping their
blood sugar at a healthy level. Also, teens who smoke or use alcohol or
other drugs have problems with blood sugar control. Support groups may help
teens deal with diabetes management issues, which can improve the teens'
perception of diabetes care and blood sugar control.
Healthy meals, physical activity, and
weight control can help prevent diabetes or can prevent or delay complications
if your child has diabetes. A
registered dietitian can help you build a healthy meal
plan for your child. Your doctor, exercise specialist, or
certified diabetes educator also can help your child
find ways to become more physically active.
Weight loss is
appropriate if your child is overweight and he or she has reached adult height.
In some severe cases, weight loss before your child reaches his or her full
adult height may be needed. See the
Interactive Tool: What Is Your Child's BMI?
Having a blood sugar level that is higher than normal but not yet at the
level of diabetes (prediabetes) increases a child's risk for type 2
diabetes. If your child
has prediabetes, eating a healthy diet and increasing physical exercise may
make his or her blood sugar return to a normal range and possibly prevent type
2 diabetes. Your child will still need to see a doctor regularly to check for
signs of the disease.
Your child needs to eat healthy
meals with appropriate portions to support growth and prevent weight gain. The
meal plan for your child will also spread
carbohydrate throughout the day to prevent high blood
sugar after meals. For information on healthy eating and weight management, see
Healthy Eating for Children.
Encourage your child (age 6 to
17) to do moderate to vigorous activity at least 1 hour every day. Limit the amount of time your child watches TV and uses the computer and cell phone. You can help your child or teen be active by looking for ways to make activity more fun and by being active along with your child.
For children age 2 and older: The
American Academy of Pediatrics advises parents to limit screen time to 2 hours a
day or less. And it's best for children younger than 2 to not watch TV, watch movies, or play games on a screen.
Work with your child's teachers and school to
make a plan to handle your child's special needs, including testing blood sugar
and eating snacks when needed.
Your child can take part in the same activities as other
children. For safety:
You and your child
will need to monitor his or her blood sugar frequently to know how well it is
under control. Talk with your doctor about a target range for
your child. Young children may need a higher blood sugar goal than adults
because of growth needs and to prevent very low blood sugar (hypoglycemia). As
your child grows older, the goal can be lowered so that it is closer to the
Your child may not need to take
insulin if his or her blood sugar levels are staying within a target range with
meal planning, exercise, and possibly other medicine. But at some point your
child may need to take insulin because the
pancreas may produce less and less insulin.
If your child takes insulin, you and your child need to know how to
prepare and give a shot.
Other important issues
Childhood and the teen years
are a difficult time to be diagnosed with diabetes. Normal developmental
changes may interfere with your child following his or her treatment.
Teens with diabetes may rebel against
treatment or participate in risky behavior, such as using drugs or drinking
You play a major role in helping your child become
independent in his or her diabetes care. Allow your child to do as much of the
care as possible. But give your child the support and guidance he or she
needs. Your child will be more successful if your family is physically active and has healthy eating habits.
The same medicines are used to treat
adults and children with
type 2 diabetes. These medicines increase
insulin production, make the body better able to use
insulin resistance), or slow the intestinal absorption
Sometimes a child needs
more than one medicine to adequately control diabetes. Two or more medicines
taken together may work more effectively than a single medicine. Taking two
medicines together also may reduce possible side effects by allowing lower
doses of each. But in some cases, taking two medicines can increase the risk of
certain side effects, such as low blood sugar (hypoglycemia).
Some children need daily
insulin shots—alone or with other medicines. Even if your doctor does not
prescribe daily insulin, your child may need to take insulin temporarily when
first diagnosed or during illness or surgery. At some point in adulthood, he or
she will likely need insulin, because over time the
pancreas does not produce enough insulin. Insulin also
may be needed during pregnancy and breast-feeding.
If your child
high cholesterol or
high blood pressure, medicine for those conditions may
be needed. Even blood pressure slightly above normal increases the risk for eye
and kidney damage from diabetes.
Medicines that decrease insulin resistance:
Medicines that increase insulin production:
Medicines that slow intestinal absorption of
If you are having trouble controlling your blood sugar with pills, your doctor may suggest one of these medicines, which are given as a shot:
Some doctors treat children with
Some children may need medicines to lower their blood pressure and
cholesterol to reduce the risk for later complications.
Metformin is the medicine of choice
for children with type 2 diabetes. It usually keeps blood sugar levels within a
target range without increasing the likelihood that
the child will gain weight. If after 3 to 6 months of treatment with metformin
the child's blood sugar levels are not consistently within a target range,
other medicine usually is added.
Insulin may be given as a single
nighttime dose, as several smaller doses throughout the day, or both. Insulin
doses for children with type 2 diabetes are usually high—to overcome the body's
resistance to insulin—which may increase the risk for
alpha-glucosidase inhibitors are safe for children,
they may cause abdominal gas, making them less acceptable to teens than other
When obesity is severe in older adolescents
type 2 diabetes, gastric bypass or other similar
surgery may be considered as a last resort. For more information, see the topic
Children who have
type 2 diabetes should not try to lose weight by
following a fad diet or by enrolling in a quick-fix weight loss program. Most
doctors recommend that overweight children eat a healthy diet that provides
appropriate calories to prevent further weight gain.
is appropriate if your child is overweight and he or she has reached adult
height. In some severe cases, weight loss before your child reaches his or her
full adult height may be needed.
Other types of treatment for diabetes are provided by therapists or
others who do not operate within mainstream medical practice. None of these
complementary therapies have been proved to be effective in treating diabetes.
But your child may benefit from safe, nontraditional therapies that complement
conventional medical treatment for the disease. Talk with your doctor before
seeking any complementary therapies for your child.
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Other Works Consulted
Alemzadeh R, Ali O (2011). Diabetes mellitus. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1968–1997. Philadelphia: Saunders.
American Diabetes Association (2000). Type 2 diabetes
in children and adolescents. Diabetes Care, 23(3): 381–389.
American Diabetes Association (2012). Diabetes care in the school and day care setting. Diabetes Care, 35(Suppl 1): S76–S80.
American Diabetes Association (2012). Diabetes management at camps for children with diabetes. Diabetes Care, 35(Suppl 1): S72–S75.
American Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.
Li C (2009). Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents. Diabetes Care, 32: 342–347.
Rewers M, et al. (2012). Diabetes mellitus. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 1053–1061. New York: McGraw-Hill.
Riddle MC, Genuth S (2010). Type 2 diabetes mellitus. In EG Nabel, ed., ACP Medicine, section 9, chap. 2. Hamilton, ON: BC Decker.
Rosenbloom AL (2011). Diabetes mellitus. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 2104–2125. New York: McGraw-Hill.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
August 16, 2013
John Pope, MD - Pediatrics & Stephen LaFranchi, MD - Pediatrics, Pediatric Endocrinology
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