Type 2 diabetes in children

Overview

Type 2 diabetes in children is a chronic disease that affects the way your child's body processes sugar (glucose) for fuel. Without treatment, the disorder causes sugar to build up in the bloodstream, which can lead to serious long-term consequences.

Type 2 diabetes occurs more commonly in adults. In fact, it used to be called adult-onset diabetes. But the increasing number of children with obesity has led to more cases of type 2 diabetes in younger people.

There's plenty you can do to help manage or prevent type 2 diabetes in your child. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If healthy eating and exercise aren't enough to control type 2 diabetes, oral medication or insulin treatment may be needed.

Symptoms

Type 2 diabetes in children may develop so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up.

Some children might experience these signs and symptoms as a result of too much sugar in their bloodstreams:

• Increased thirst
• Frequent urination
• Increased hunger
• Fatigue
• Blurry vision
• Darkened areas of skin, most often around the neck or in the armpits and groin
• Unintended weight loss, although this is less common in children with type 2 diabetes than in children with type 1 diabetes
• Frequent infections

When to see a doctor

See your child's health care provider if you notice any of the signs or symptoms of type 2 diabetes. Undiagnosed, the disease can cause serious damage.

Diabetes screening is recommended for children who have started puberty or are at least 10 years old, who are overweight or obese, and who have at least one other risk factor for type 2 diabetes.

Causes

The exact cause of type 2 diabetes is unknown. But family history and genetics appear to play an important role. What is clear is that children with type 2 diabetes can't process sugar (glucose) properly.

Most of the sugar in the body comes from food. When food is digested, sugar enters the bloodstream. Insulin allows sugar to enter the cells — and lowers the amount of sugar in the blood.

Insulin is produced by a gland located behind the stomach called the pancreas. The pancreas sends insulin to the blood when food is eaten. When the blood sugar level starts to drop, the pancreas slows down the secretion of insulin into the blood.

When your child has type 2 diabetes, this process doesn't work as well. As a result, instead of fueling cells, sugar builds up in your child's bloodstream. This can happen because:

• The pancreas may not make enough insulin
• The cells become resistant to insulin and don't allow as much sugar in

Risk factors

Researchers don't fully understand why some children develop type 2 diabetes and others don't, even if they have similar risk factors. However, it's clear that certain factors increase the risk, including:

• Weight. Being overweight is a strong risk factor for type 2 diabetes in children. The more fatty tissue children have — especially inside and between the muscle and skin around the abdomen — the more resistant their bodies' cells become to insulin.
• Inactivity. The less active children are, the greater their risk of type 2 diabetes.
• Diet. Eating red meat and processed meat and drinking sugar-sweetened beverages is associated with a higher risk of type 2 diabetes.
• Family history. Children's risk of type 2 diabetes increases if they have a parent or sibling with the disease.
• Race or ethnicity. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are more likely to develop type 2 diabetes.
• Age and sex. Many children develop type 2 diabetes in their early teens, but it may occur at any age. Adolescent girls are more likely to develop type 2 diabetes than are adolescent boys.
• Maternal gestational diabetes. Children born to women who had gestational diabetes during pregnancy have a higher risk of developing type 2 diabetes.
• Low birth weight or preterm birth. Having a low birth weight is associated with a higher risk of developing type 2 diabetes. Babies born prematurely — before 39 to 42 weeks' gestation —have a greater risk of type 2 diabetes.

Type 2 diabetes in children is often associated with metabolic syndrome and polycystic ovarian syndrome.

Metabolic syndrome

When certain conditions occur with obesity, they are associated with insulin resistance and can increase the risk of diabetes — and heart disease and stroke. A combination of the following conditions is often called metabolic syndrome:

• High blood pressure
• Low levels of high-density lipoproteins (HDL), the "good" cholesterol
• High triglycerides
• High blood sugar levels
• Large waist size

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) affects young females after puberty. PCOS is caused by an imbalance of hormones, resulting in signs such as weight gain, irregular menstrual periods, and excess face and body hair. People with PCOS often have problems with metabolism that can result in insulin resistance and type 2 diabetes.

Complications

Type 2 diabetes can affect nearly every organ in your child's body, including the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes develop gradually over many years. Eventually, diabetes complications may be severe or even life-threatening.

Complications of type 2 diabetes are related to high blood sugar and include:

• High cholesterol
• Heart and blood vessel disease
• Stroke
• Nerve damage
• Kidney disease
• Eye disease, including blindness

Keeping your child's blood sugar level close to the standard range most of the time can dramatically reduce the risk of these complications. You can help your child prevent diabetes complications by:

• Working with your child to maintain good blood sugar control as much as possible
• Teaching your child the importance of healthy eating and participating in regular physical activity
• Scheduling regular visits with your child's diabetes treatment team

Prevention

Healthy-lifestyle choices can help prevent type 2 diabetes in children. Encourage your child to:

• Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
• Get more physical activity. Encourage your child to become active. Sign up your child for a sports team or dance lessons.

Better yet, make it a family affair. The lifestyle choices that can help prevent type 2 diabetes in children can do the same for adults.

Diagnosis

If diabetes is suspected, your child's health care provider will likely recommend a screening test. There are several blood tests to diagnose type 2 diabetes in children.

• Random blood sugar test. A blood sample is taken at a random time, regardless of when your child last ate. A random blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher suggests diabetes.
• Fasting blood sugar test. A blood sample is taken after your child hasn't had anything to eat or drink but water for at least eight hours or overnight (fasting). A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher suggests diabetes.
• Glycated hemoglobin (A1C) test. This test indicates your child's average blood sugar level for the past 3 months. An A1C level of 6.5% or higher indicates diabetes.
• Oral glucose tolerance test. Your child will need to fast overnight and then drink a sugary liquid at the health care provider's office or a laboratory testing site. Blood sugar levels are tested periodically for the next two hours. A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher generally means your child has diabetes.

Additional tests

Your health care provider may recommend additional tests to distinguish between type 1 diabetes and type 2 diabetes, because treatment strategies for each type differ.

Treatment

Treatment for type 2 diabetes is lifelong and can include:

• Healthy eating
• Regular physical activity
• Insulin or other medications
• Blood sugar monitoring
• Weight-loss surgery, in some cases

You'll work closely with your child's diabetes treatment team — including a health care provider, certified diabetes care and education specialist, registered dietitian, and other specialists as needed. The goal of treatment is to keep your child's blood sugar within a certain range. This target range helps to keep your child's blood sugar level as close to the standard range as possible.

Your child's health care provider will let you know what your child's blood sugar target range is, and may also set an A1C target. These numbers may change as your child grows and changes and so will your child's diabetes treatment plan.

Healthy eating

Food is a big part of any diabetes treatment plan, but that doesn't mean your child has to follow a strict "diabetes diet." Your health care provider may recommend weight loss to achieve and maintain a healthy weight. Blood sugar levels can improve with weight loss.

Your child's dietitian will likely suggest that your child — and the rest of the family — consume foods that are high in nutritional value and low in fat and calories.

Healthy eating includes a diet high in fruits, vegetables, nuts, whole grains and olive oil. Choose foods low in fat and calories and high in fiber. Eat a variety of foods to help achieve your child's goals without compromising taste or nutrition.

Your child's dietitian can help you create a meal plan that fits your child's food preferences and health goals, as well as help you plan for occasional treats. Your dietitian is also likely to recommend that your child:

• Reduce portion sizes and not feel a need to finish everything on the plate
• Substitute a fruit or vegetable for a carbohydrate-rich food
• Replace high-calorie beverages, such as soft drinks or fruit juices, with water
• Eat at home more frequently instead of eating at restaurants or getting food to carry out from restaurants
• Help make meals
• Eat at the dinner table instead of in front of the TV

Physical activity

Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. Physical activity helps children control their weight, uses up sugar for energy, and makes the body use insulin more effectively. This can lower blood sugar.

Make physical activity part of your child's daily routine. Activity time doesn't have to be all at once — it's OK to break it down into smaller chunks of time. Encourage your child to get at least 60 minutes of physical activity daily or, better yet, exercise with your child.

Medication

There are three medications that have been approved by the Food and Drug Administration (FDA) for treating type 2 diabetes in children.

• Metformin (Glumetza, others). This pill reduces the amount of sugar a child's liver releases into the bloodstream between meals and helps the body's cells use insulin more effectively.
• Liraglutide (Victoza). This medication is taken by injection. Liraglutide helps the body release more insulin from the pancreas after meals, when blood sugar levels are higher. This medication may have digestive system side effects, such as nausea or diarrhea.

• Insulin. Sometimes, insulin may be needed if your child's blood sugar levels are very high. Insulin allows sugar into the cells for energy, reducing the amount of sugar in the bloodstream.

  There are a number of different insulins, but a long-acting insulin once a day, along with a short- or rapid-acting insulin with meals, is often used for type 2 diabetes in children. Insulin is typically delivered via a syringe or an insulin pen.

  With lifestyle changes and other medications, your child may be able to be weaned off insulin.

Blood sugar monitoring

Your health care provider will let you know how often you or your child need to check and record your child's blood sugar. Children who take insulin usually need to test more frequently, possibly four times a day or more.

Depending on treatment needs, continuous glucose monitoring may be an option. Frequent testing is the only way to make sure that your child's blood sugar level remains within the target range.

Weight loss surgery

These procedures are not an option for everyone. But for teens who are significantly obese — a body mass index (BMI) at or above 35 — having weight-loss surgery may lead to improved management of type 2 diabetes.

Ongoing medical care

Your child will need regular appointments to ensure good diabetes management. Visits with your child's health care provider can include a review of your child's blood sugar patterns, typical eating habits, physical activity, weight and medication if taken. Healthy-lifestyle changes can reduce the need for medications.

Your health care provider may check your child's A1C levels. The American Diabetes Association generally recommends an A1C of 7% or lower for all children and teens with diabetes.

Your health care provider will also periodically check your child's:

• Growth
• Blood pressure
• Cholesterol levels
• Kidney and liver function
• Eyes — usually annually
• Feet
• Risk of polycystic ovary syndrome and obstructive sleep apnea

Your child's health care provider will likely recommend a flu shot for your child every year, and may recommend the pneumonia vaccine and the COVID-19 vaccine if your child is age 5 or older.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 2 diabetes — such as low blood sugar, high blood sugar, diabetic ketoacidosis and hyperosmolar hyperglycemic state — require immediate care.

Low blood sugar (hypoglycemia)

Hypoglycemia is a blood sugar level below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, eating fewer carbohydrates than planned, getting more physical activity than typical or injecting too much insulin. Children with type 2 diabetes have less risk of low blood sugar than do kids with type 1 diabetes.

Signs and symptoms of low blood sugar include:

• Pallor
• Shakiness
• Hunger
• Sweating
• Irritability and other mood changes
• Difficulty concentrating or confusion
• Dizziness or lightheadedness
• Loss of coordination
• Slurred speech
• Loss of consciousness
• Seizures

Teach your child the symptoms of low blood sugar. When in doubt, your child should always do a blood sugar test. If a blood glucose meter isn't readily available and your child is having symptoms of a low blood sugar, treat for low blood sugar and then test as soon as possible.

If your child has a low blood sugar reading:

• Give a fast-acting carbohydrate. Have your child consume 15 to 20 grams of a fast-acting carbohydrate, such as fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Foods with added fat, such as chocolate or ice cream, don't raise blood sugar as quickly because fat slows down the absorption of the sugar.
• Retest blood sugar. Retest your child's blood sugar in about 15 minutes to make sure it's back in the target range. If it's not, repeat giving a fast-acting carbohydrate and testing in 15 minutes as needed until you get a reading in your child's target range.

High blood sugar (hyperglycemia)

Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating certain types of foods, and not taking enough diabetes medication or insulin.

Signs and symptoms of high blood sugar include:

• Frequent urination
• Increased thirst or dry mouth
• Blurred vision
• Fatigue
• Nausea

If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. Contact your child's health care provider if your child's blood sugar is regularly above his or her target range.

Diabetes ketoacidosis

A severe lack of insulin causes your child's body to produce certain toxic acids (ketones). If excess ketones build up, your child may develop a potentially life-threatening condition known as diabetic ketoacidosis (DKA). DKA is more common in children with type 1 diabetes but can sometimes occur in children with type 2 diabetes.

Signs and symptoms of DKA include:

• Thirst or very dry mouth
• Increased urination
• Dry or flushed skin
• Nausea, vomiting or abdominal pain
• A sweet, fruity smell on your child's breath
• Confusion

If you suspect DKA, check your child's urine for excess ketones using an over-the-counter ketone test kit. If the ketone levels are high, call your child's health care provider or seek emergency care.

Hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic state (HHS) may develop over a period of a few days in children with type 2 diabetes. The extremely high blood sugar level of HHS — 600 mg/dL or higher — may develop with severe infections, illness or other medical conditions. The body's attempt to get rid of the high level of sugar by passing it in the urine results in severe dehydration.

Signs and symptoms of HHS include:

• No or minimal ketones in the urine
• Increased urination
• Increased thirst
• Dry mouth and warm, dry skin
• Confusion or combativeness
• Seizures
• Coma

HHS can be life-threatening and requires emergency care.

Lifestyle and home remedies

Helping your child follow the diabetes treatment plan takes round-the-clock commitment. But careful management of type 2 diabetes can reduce your child's risk of serious complications.

As your child gets older:

• Encourage your child to take an increasingly active role in diabetes management
• Stress the importance of lifelong diabetes care
• Teach your child how to test blood sugar levels and to take medication and inject insulin if needed
• Help your child make healthy food choices
• Encourage your child to remain physically active and limit electronic screen time
• Foster a relationship between your child and the diabetes treatment team
• Make sure your child wears a medical identification tag

School and diabetes

You'll need to work with your child's school nurse and teachers to make sure they know the symptoms of high and low blood sugar levels. The school nurse might need to administer insulin or check your child's blood sugar.

Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children get a proper education.

When to contact your diabetes care team

Contact your child's health care provider, certified diabetes care and education specialist, or registered dietitian between appointments if your child's blood sugar is consistently out of the target range your health care provider recommended. Also contact the care team if you're not sure what to do in a certain situation.

Coping and support

Living with type 2 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning. That's why some diabetes specialists regularly include a social worker or psychologist as part of their diabetes care teams. Don't forget that you're not alone and your diabetes treatment team can help.

If you notice that your child or adolescent is persistently sad or pessimistic, or experiences dramatic changes in sleeping habits, friends or school performance, have your child assessed for depression.

Rebellion also may be an issue, particularly for teens. A child who has been very good about sticking to the diabetes treatment plan may rebel in the teen years by ignoring diabetes care. Additionally, experimenting with drugs, alcohol and smoking can be even more dangerous for people with diabetes.

Talking to a counselor or therapist may help your child or you cope with the dramatic lifestyle changes that come with a diagnosis of type 2 diabetes. Websites that offer support include the American Diabetes Association (ADA).

Preparing for an appointment

Your child's family health care provider or pediatrician will probably make the initial diagnosis of diabetes. However, you'll likely then be referred to a specialist in metabolic disorders in children (pediatric endocrinologist).

Your child's health care team also generally includes a certified diabetes care and education specialist and a registered dietitian.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment take these steps:

• Ask about any pre-appointment restrictions. If the health care provider is going to test your child's blood sugar, your child might need to fast for eight hours, depending on the type of test.
• Make a list of any symptoms your child is experiencing, including any that may seem unrelated to the reason for your appointment.
• Ask a family member or friend to join you, if possible. Managing diabetes requires you to remember a lot of information. Someone who accompanies you may recall something that you missed or forgot.
• Make a list of questions to ask your health care provider.

Some basic questions to ask your child's health care provider include:

• How often do I need to monitor my child's blood sugar?
• What should my child's blood sugar levels be during the day and before bedtime?
• What changes need to be made in the family diet?
• How much exercise should my child get each day?
• Will my child need to take medication? If so, what kind and how much?
• What signs and symptoms of complications should I look for?
• My child has another health condition. How can we best manage them together?
• How often does my child need to be monitored for diabetes care? What specialists do we need to see?

Don't hesitate to ask additional questions during the appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• How comfortable are you with managing your child's diabetes?
• What's a typical day's eating like for your child?
• Is your child exercising? If so, how often?
• How do you feel your child is coping with diabetes and its treatment?