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Type 2 Diabetes Mellitus (T2DM) In Children: Symptoms, Causes, And Risks

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In type 2 diabetes mellitus (T2DM), the body cells resist the effects of insulin for glucose metabolism. This chronic disease could result in long-term or short-term complications in the absence of appropriate management.

Pediatric-onset type 2 diabetes mellitus is becoming more and more prevalent. It could be due to an increase in predisposing factors such as obesity and physical inactivity. Seek medical care if you notice any signs and symptoms of diabetes in your child. Not only can this prevent severe complications but also appropriate actions including lifestyle modifications incorporated earlier in the disease process can delay the progression of prediabetes to diabetes mellitus (1).

Causes Of Type 2 Diabetes Mellitus In Children

The exact cause of diabetes mellitus type 2 is yet to be discovered. However, genetics and lifestyle factors, such as decreased physical inactivity and increased energy consumption leading to being overweight or obese, may increase the risk of developing type 2 diabetes (2).

Children with type 2 diabetes mellitus have insulin resistance, so their body can’t use insulin to metabolize glucose. This may cause the accumulation of sugar in the bloodstream and result in signs and symptoms of high blood sugar levels. Children with T2DM are more likely to suffer from conditions like hypertension, hyperlipidemia, polycystic ovary disease, and fatty liver as compared to their peers without diabetes.

Risk Factors For Type 2 Diabetes Mellitus  In Children

The following factors may increase the risk of developing type 2 diabetes mellitus (3).

  • Being overweight or obese could increase insulin resistance. Fat around the abdominal area is known to be a strong risk factor for type 2 diabetes.
  • Physical inactivity makes cells less responsive to insulin. Thus, glucose builds up in blood since it cannot enter the cells for energy production.
  • Positive family history with an affected parent or sibling may increase the risk of diabetes mellitus type 2.
  • Presence of certain genes in some ethnic groups may increase the risk of type 2 diabetes.
  • Maternal diabetes during pregnancy (gestational diabetes) may increase the risk of diabetes in children.

Although children of any age can be affected by diabetes type 2, teens are mostly affected by it. Type2 diabetes mellitus rarely manifests before puberty. Adolescent girls have a higher risk of diabetes than boys (3).

Symptoms And Signs Of Type 2 Diabetes In Children

Many children may not have any noticeable symptoms of type 2 diabetes, and it is often diagnosed during routine medical care. However, some may have a gradual onset of signs and symptoms, including (4):

  1. Increased thirst
  1. Frequent urination
  1. Bed wetting
  1. Fatigue
  1. Blurred vision
  1. Darkening of skin areas such as the armpit or neck
  1. Weight loss
  1. Recurrent infections
  1. Delay in wound healing
  1. Numbness or tingling of extremities

These signs and symptoms are due to excess glucose in the bloodstream. Weight loss in children is more common in type 1 than type 2 diabetes mellitus.

Complications Of Type 2 Diabetes Mellitus In Children

Children with diabetes mellitus may often experience short-term complications due to fluctuating blood sugar levels based on diet, medications, and physical activity. These complications are short-term yet require emergency care since they can be fatal. Complications may include (5):

  • Hypoglycemia (low blood sugar)
  • Hyperglycemia (high blood sugar)
  • Diabetic ketoacidosis (ketones built up in the body with high blood sugar)

Regular monitoring of glucose, planned diet, exercise, and medications as per the recommended requirements could help prevent these complications.

It should be duly noted that T2DM is considered to be a part of a spectrum of disorders which are grouped together as insulin resistance syndrome in medical terminology. As such, a child with T2DM may have other comorbidities as listed below, besides diabetes mellitus:

  • Hypertension
  • Hypercholesterolemia and hypertriglyceridemia
  • Damage to blood vessels, especially of heart, kidney and retina
  • Increased fat deposition in liver (fatty liver) and muscles
  • Sleep disordered breathing

This means that unlike type 1 DM where poor glucose control may be the only cause of development of these disorders, children with T2DM may suffer from these conditions in addition to DM. Good control of blood sugar levels will help in controlling these comorbidities but may not eliminate these altogether as they coexist with diabetes and are not due to diabetes per say.

However, poorly managed type 2 diabetes mellitus may accelerate the overall disease process, leading to severely disabled organ functions and increasing the risk of life-threatening and devastating complications (6):

  • Cardiovascular diseases
  • Liver disease
  • Kidney disease
  • Stroke
  • Visual impairment and blindness
  • Non-healing sores or ulcers, especially on the limbs

The risk of developing these complications can be reduced by maintaining appropriate blood glucose levels. Also, it is important to screen for likely comorbidities at regular intervals. Therefore, it is essential to seek early medical care to avoid severe complications.

When To See A Doctor

Seek medical care if you are concerned about the signs and symptoms of diabetes in your child. Although similar symptoms can be seen in other conditions, confirming the blood sugar levels can be useful to diagnose and begin early management for diabetes mellitus type 2.

Diagnosis Of Type 2 Diabetes Mellitus In Children

Any of the following screening tests can be ordered if the doctor suspects diabetes in your child (7) (5).

  • Random blood glucose test analyzes blood samples during the visit, and blood sugar levels of more than 200mg/dL or 11.1 mmol/L suggest diabetes.
  • Fasting blood glucose test is done after an overnight fast or a fast for a minimum of eight hours, and the sugar level higher than 126mg/dL or 7 mmol/L indicates diabetes.
  • Hb A1C test or A1C test (glycated or glycosylated hemoglobin test) gives the average glucose levels for the past three months, and more than 6.5 % on two tests suggest the diagnosis of diabetes.
  • OGTT (oral glucose tolerance test) is where the child’s blood sugar level is analyzed two hours after consuming a special sugar drink.

The diagnosis of diabetes is made only after obtaining two abnormal results on different days. Pediatricians order additional tests to differentiate type 1 diabetes from type 2 diabetes and to assess organ functions.

Treatment For Type 2 Diabetes Mellitus In Children

Type 2 diabetes mellitus requires lifelong management. Your child’s treatment plans may vary as they grow to maintain the optimal sugar levels. Complications can be prevented by keeping blood sugar at normal levels as possible.

The diabetes management plan may include (5):

  • Education for diabetes self management: Get a thorough understanding of the condition until all your queries are resolved from two sources – first your treating doctor and anyone else suggested by them and second from reliable internet resources (after checking for their reliability with your doctor). Ensure that the child is actively involved in this process and even their doubts are cleared.
  • Healthy diet: Low fat and low calorie (low carbohydrate) diets are recommended to maintain blood sugar levels. Replacing high-calorie soft drinks, refined sugars, and carbohydrate-rich foods with proteins and low-calorie vegetables and fruits and reducing portion size are useful to maintain glucose levels. Also minimize the use of processed, packaged and convenience foods. Reading and interpreting nutrition labels is an important skill that should be acquired by everyone.

It is essential that adults emphasize healthy food choices and eating on schedule by becoming role models and not by words alone. Maintaining food logs will also come in handy.

  • Regular exercise: An hour of aerobic physical activity a day is the minimum recommended. Regular exercise can help keep sugar levels low. An exercise routine can be easily set up if a family member or friend participates in these activities with the child.
  • Adequate sleep: A good night’s sleep is an independent factor in improving metabolic disorders (like type 2 diabetes mellitus) and achieving good health.
  • No smoking and alcohol: Such bad habits can lead to devastating complications in diabetics. Don’t indulge yourself so that children have good role models to follow.
  • Blood sugar monitoring: Measure your child’s blood glucose levels using glucometers at regular intervals as suggested by your pediatrician to decide the dose of insulin, diet, and physical activity to maintain healthy blood sugar levels. A number of apps have been developed in recent times which are very useful in day to day management of diabetes mellitus.
  • Medications: Metformin (Glumetza) pill, insulin injection, and liraglutide injection are the three medications approved to treat diabetes mellitus type 2 in children.

Metformin increases insulin use by body cells by limiting glucose release by the liver between meals. It, on it’s own, almost never causes hypoglycemia. Side effects like diarrhea and nausea may occur initially but they soon resolve. May produce B12 deficiency with prolonged use and so periodic B12 monitoring is advised.

Liraglutide enhances the release of insulin from the pancreas after meals. It is not for use in T1DM or in diabetic ketoacidosis.

Insulin, usually long-acting insulin (glargine), is used for controlling high blood sugar levels. Insulin is delivered by injection or insulin pump, depending on the requirement.

  • Weight loss surgery: Teenagers who are obese with a BMI of more than 35 may require weight loss surgery to control type 2 diabetes if there are no other ways to reduce weight.
  • Management of comorbidities: These children are screened for the presence of other features of insulin resistance syndrome as described earlier including hypertension, renal damage, hypertriglyceridemia, hypercholesterolemia etc at the time of diagnosis and at regular intervals later on and managed accordingly.

Insulin treatment may be stopped if the blood sugar can be managed with other treatment options but only if the child’s pediatrician so advises. Encourage your child to be physically active and follow a healthy diet to lower sugar levels with or no medications.

Although some alternative approaches and herbal treatments are said to be effective in managing diabetes, they lack scientific evidence. Some may interact with medications or cause harmful effects. Always ensure the safety of any therapies with your child’s doctor to avoid complications.

How To Help Your Child To Deal With Diabetes?

Consistent commitment from parents or caregivers is essential for following diabetic treatment plans. You may try the following to help your child tackle the challenges caused by the disease.

  • Explain about the illness and the ways to control it.
  • Encourage regular physical activity.
  • Teach them to choose healthy food.
  • Help your child to understand the calculations of insulin dose depending on activities, diet, and glucose levels.
  • Teach them to use glucometers and insulin injections.
  • Encourage your child to have a friendly relationship with the diabetes treatment
  • Explain to them the warning signs of hypoglycemia, hyperglycemia, or diabetic ketoacidosis and how to call emergency help for it.

You may also tell your child’s teachers and school nurse about diabetes to ensure immediate help if the child develops low or high sugar levels during school hours.

Prevention Of Type 2 Diabetes In Children

A healthy diet and regular exercise may help prevent type 2 diabetes mellitus in children (8).

Low- calorie, and low-fat foods, including fruits, vegetables, and whole grains, are good food choices. Physical activities, such as sports training and dance, can be useful. If all the family members follow a healthy lifestyle, it can encourage the child to observe healthy eating habits and exercise regularly.

Living with diabetes can be challenging, but the right amount of support and encouragement can make the process easier. Some children may feel stressed due to the condition and its management. Stay alert to any signs, such as depression, inadequate sleep, and poor academic performance. Consult your doctor or psychologist for a prompt resolution.

Joining local or online diabetic support groups can also help the child and the family manage the condition smoothly.

References:

1. Diabetes: Differences Between Type 1 and 2; C.S. Mott Children’s Hospital
2. Type 2 diabetes; MedlinePlus; The United States National Library of Medicine
3. Type 2 Diabetes in Children; Lucile Packard Children’s Hospital
4. Type 2 Diabetes; Boston Children’s Hospital
5. Type 2 diabetes in children; St.Clair Hospital
6. Type 2 diabetes; The National Institute of Diabetes and Digestive and Kidney Diseases
7. Cara V. Tillotson, et al.; Pediatric Type 2 Diabetes Mellitus; The United States National Library of Medicine
8. Prevent Type 2 Diabetes in Kids; The Centers for Disease Control and Prevention

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