Dr Archana Dayal Arya discusses the rise of Type 2 Diabetes in children
Being overweight is closely tied to the development of Type 2 Diabetes. Diabetes is increasingly seen in children because of an increase in the rate of obesity. Overweight children have an increased likelihood of insulin resistance. As the body struggles to regulate insulin, high blood sugar leads to a number of potentially serious health problems.
In the past 30 years, obesity in children has doubled and obesity in adolescents has quadrupled. Genetics may also play a role. For instance, the risk of Type 2 Diabetes increases if one parent or both parents has the condition.
Type 2 Diabetes is an asymptomatic disease (has no symptoms). Most children and adults don’t even realize that they have Diabetes and a lot of children remain undiagnosed. It is only during routine screening that these children are diagnosed with Type 2 Diabetes. Some common symptoms of Type 2 Diabetes include:
- Increased thirst
- Frequent or night time urination
- Blurry vision
- Unusual fatigue
Puberty and Diabetes
Puberty is the period of sexual development marking the transition from childhood to adulthood. It usually occurs around age 11 for girls and 12 for boys. Puberty’s physical, psychological and social changes have an impact on Diabetes management. During puberty, the production of testosterone in boys and oestrogen in girls increases. It is a period of relative insulin resistance. Obesity can also create insulin resistance. So an obese child is already insulin resistant which further worsens during puberty. As a result, the chances of developing Type 2 Diabetes increase during puberty.
The hormonal changes at puberty affect blood glucose control, often making it more difficult to manage sugar levels. Insulin’s effectiveness declines by about 30-50 per cent because growth hormones and sexual hormones create insulin resistance. In non-diabetic children, the pancreas compensates for this resistance by secreting more insulin. But if the child is prediabetic then the risk of progressing to Diabetes increases. Prediabetes is a condition where blood sugar levels are high but not high enough to be classified as Type 2 Diabetes.
Type 1 versus Type 2 Diabetes
Although Type 1 and 2 Diabetes are different their long-term consequences are the same. But in Type 1 Diabetes the pancreas actually stops functioning altogether. Type 1 Diabetes is an autoimmune disease i.e. antibodies are being produced which damage the beta cells of the pancreas and the pancreas stop making insulin, so gradually the pancreatic function goes down. C-peptide test would be very low in such cases so what happens is your blood sugar starts rising and you display symptoms. Type 1 Diabetes cannot go undiagnosed for long as the child develops symptoms such as excess thirst (polydipsia), excess production of urine (polyuria), unexplained weight loss or sudden bedwetting in a normal child. If these initial symptoms are not caught on time then the child may develop diabetic ketoacidosis (a life threatening condition in which the ketones levels are abnormally high)
On the other hand, Type 2 Diabetes is very often asymptomatic (has no symptoms). Sometimes it can be symptomatic when the blood sugar levels are very high. In such cases, children may often show symptoms such as polyuria and polydipsia. They can also present Type 1 Diabetes-like symptoms. But the C-peptide test helps to resolve the diagnostic dilemma between Type 1 and Type 2 Diabetes.
Exam stress and peer pressure don’t lead to Diabetes. These are misconceptions. Major stress can increase the risk of onset of Type 2 Diabetes only if an individual already has prediabetes. But you cannot develop Diabetes because of exam pressure.
If obese children have Type 2 Diabetes then they can develop high blood pressure and high cholesterol levels. The guidelines for treating children with high cholesterol differ from that of adults. Children are treated only when cholesterol levels are very high along with comorbidity like Diabetes. Lifestyle management through diet and exercise is recommended. Sometimes an insulin sensitizer like metformin is suggested.
Risk of complications
All children with Diabetes are at a risk of complications like:
- Heart and blood vessel diseases like heart disease, stroke, high cholesterol and high blood pressure.
- Nerve damage (neuropathy) caused by high blood sugar levels which damage tiny blood vessels (capillaries), especially in the legs. This leads to a tingling sensation, numbness, burning or pain.
- Kidney damage (nephropathy) caused by high and fluctuating blood sugar levels. This can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
- Damage to the eye (retinopathy) is caused by out of range sugar levels for a long period of time. Cataracts and retinopathy can both lead to loss of vision.
- Susceptibility to skin conditions like bacterial infections, fungal infections and itching increases with Diabetes.
Advice to readers
The youngest patient that I have treated with Type 2 Diabetes was 5 and half years old. Preventing obesity is of primary importance as it not only reduces the risk of Diabetes but also hypertension (high blood pressure), dyslipidaemia (increased cholesterol levels) and heart disease later in life.
Studies have shown that exercise has a dramatic effect on reducing insulin resistance. Parents need to be more vigilant with regards to their children’s lifestyle. Limiting intake of fats and sweets in your child’s diet and ensuring that children get adequate physical activity each day is paramount. These are two easy ways to help your child lose weight and lower blood sugar levels.
Dr Archana Dayal Arya is a renowned paediatric endocrinologist in New Delhi.