Diabetes Types

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Not Just for Adults Anymore

Type 2 diabetes, once considered an "adults only" disease, is appearing in children and teens in epidemic proportions. In 2000, an expert panel of the American Diabetes Association estimated that on average 20 percent of newly diagnosed diabetes in children was type 2, and 85 percent of those children were obese. This alarming surge in childhood type 2 has been fueled by the fast food, video centric culture that is part of today's lifestyle. Children lead a more sedentary lifestyle centered around passive entertainment mediums like television and online gaming; super sized, high fat, low fiber convenience food has become a dietary staple in the quest for quick and easy. As a result, an estimated 13 percent of children six to eleven years old and 14 percent of adolescents twelve to nineteen years old in the United States are overweight according to the U.S. Surgeon General. A 2002 study published in the New England Journal of Medicine found that impaired glucose tolerance and insulin resistance are highly prevalent in children and adolescents who are obese.

Kids at Risk

The same factors that place adults at great risk for type 2 diabetes apply to children as well. Obesity is far and away the primary threat in this age group.

Essential

Acanthosis nigricans is present in up to 90 percent of children and adolescents who develop type 2 diabetes. This condition is a clinical sign of insulin resistance and is more common in people with darker skin pigmentation. The dark, velvety patches typically appear in areas where skin folds gather on the neck, armpits, and groin and are associated with high levels of circulating insulin . Having a family history of type 2 diabetes among first and second degree relatives and being of African American, Native American, Asian, Pacific Island, or Hispanic descent also increase the likelihood that overweight children will develop the disease. The majority of childhood type 2 cases are diagnosed at puberty or beyond. Puberty itself is the cause of a certain degree of insulin resistance in adolescents, which is thought to be triggered by a natural rise in growth hormone during this time. In children who are already disposed toward the disease, insulin resistance remains even after growth hormone returns to normal levels.

Treating Kids for an Adult Disease

Diagnoses of type 2 in children are sometimes difficult to make, especially in children who are not overtly obese. Many physicians still consider type 2 diabetes an adults only disease. And it can present the same way as type I, with DKA or, in extreme cases, HHNS. Often because of the age of the patient, type 1 is initially suspected and the child begins insulin treatment. However, long term use of insulin after blood sugars have stabilized can contribute to further weight gain, which can worsen the problem. Children diagnosed with type 2 diabetes can usually be treated through a combination of diet and exercise. Oral medications may be helpful, but clinical data is limited on their long term effects in children. As of early 2003, metformin was the only oral agent FDA approved for use in pediatric population. However, other oral agents are sometimes prescribed for off label use in children.