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Introduction: Type 2 diabetes -- it used to be incredibly rare in children. But in recent years the federal government has described the disease as an epidemic in children and teens. Why is this happening now? How do we recognize the illness in our children, and what can we do to keep them healthy? I'm Laurie Udesky.

Dr. Stephen Gitelman: As we started to compare notes with other doctors around the country and around the world, everyone was starting to find the same thing, which is that this epidemic of obesity was appearing in society. And following closely on its heels is type 2 diabetes.

Udesky: Dr. Stephen Gitelman is the director of pediatric diabetes at the University of California at San Francisco Children's Hospital. Twenty years ago, when Gitelman first began his practice, only about 3 percent of his young patients had it. But in the last five to 10 years, Gitelman and doctors across the nation were surprised to find that more and more of the children he treated were showing signs of type 2 diabetes. Now, he says, that up to 50 percent of his young diabetes patients have type 2, a form of the disease that usually struck in adulthood. His youngest patient is 6 years old.

Gitelman: In general, all the pediatricians were surprised. This is something you learned about in medical school as an adult issue. Although it was in the back of our mind and we saw it on occasion, we thought this was not something we would deal with in our careers.

Udesky: As Gitelman says, the condition goes hand in hand with obesity. Our blood cells need sugar for energy, and insulin is a hormone produced in the pancreas that delivers the sugar to the blood cells. But excess fat can interfere with insulin's ability to do its job. As fat cells grow larger, they release compounds that can block the action of insulin. Eventually, if it isn't corrected, more and more sugar -- or glucose -- builds up in a child's bloodstream and can begin to damage cells all over the body. This differs from type 1 diabetes in that children with type 1 are unable to make enough insulin. But kids with type 2 develop what doctors call insulin resistance. Insulin is being manufactured, but it has lost its punch. When this happens, says Gitelman, there are distinctive signs, but you have to look for them.

Gitelman: As your blood sugars start to rise, you start to urinate more frequently, and to keep up with your fluid balance you start to drink more frequently. So there's frequent urination and increased drinking. There may be a typical skin rash associated with this called akanthosis nigricans, which is just a fancy word for darkening around the neck and under the arms, and that's a hallmark of resistance to insulin.

Udesky: Gitelman stresses that early diagnosis of type 2 diabetes is critical, because children who have it often have other illnesses we usually associate with aging.

Gitelman: With type 2 diabetes, we can't just be sugar doctors and focus on the sugar. Unfortunately, there are other things that can run with type 2 diabetes, [including] high blood pressure. It's very important to make sure that blood pressure is controlled because that influences long-term health. [It's also important to manage] lipid disorders and problems with elevation in cholesterol and triglycerides, the fats floating around in your blood. They also have a big impact on your blood vessels and long-term health.

Udesky: According to the Centers for Disease Control and Prevention, type 2 diabetes most frequently strikes children and adolescents who are overweight and physically inactive. The disease is most often found among African Americans, Latinos, Native Americans, Asians, and Pacific Islanders. Gitelman says some children may need to take medication to control their blood sugar levels. If their blood sugar is very high, they may have to prick a finger several times a day to test it, and they may also have to learn to give themselves insulin injections.

But the best way to help these children become healthier is by changing their lifestyle. That means cutting out simple carbohydrates like soda and cookies and reducing other foods with high sugar content such as fruit juice. Kids with type 2 diabetes also need to stay away from high-fat foods like burgers and fries, and of course get more exercise. But, Gitelman stresses, such changes won't work unless parents are involved.

Gitelman: You can't expect just one individual in the family to make these changes. Part of it's dietary and part of it's exercise, and we really want the parents to help the child find programs that are fun. I don't want to write a prescription and institute it like a medicine. Kids aren't going to be able to stay on track for that. But hopefully there's a YMCA, a school program, or the family can do daily exercise or weekend exercise where they get out together and sweat. Hand in hand in this is reducing television viewing time and getting away from computer and video games. It's just kind of really reverting back to a simpler era when we were more physically active.

Udesky: For Consumer Health Interactive, I'm Laurie Udesky.

First published November 3, 2004
Last updated July 22, 2008
Copyright © 2004 Consumer Health Interactive