What is Diabetes?

Diabetes is a disorder affecting the way your body turns food into energy. Normally when you eat a meal the food enters your blood stream as sugars. The sugars must be able to get into your body's cells to be used as energy. Insulin, which is produced in your body by the pancreas, helps get the sugars into your cells. If you picture the blood stream on one side of a door and the cell on the other, insulin would be the key that opens that door to let the sugar into the cell. If your body doesn't have insulin, the sugars build up in the blood. This is called diabetes. One out of every 20 people has diabetes.

There are two main types of diabetes: Type 1 and Type 2. The main difference between them is whether or not your body still produces insulin. About 10% of people with diabetes are Type 1 with the remaining 90% being Type 2.

Type 1 Diabetes is also called juvenile onset or insulin dependent diabetes. It historically has been the primary type of diabetes that we see in children. Type 1 diabetes occurs as a result of destruction of the insulin producing cells in the pancreas. It is an autoimmune process: the body thinks these cells are dangerous and so begins destroying them. People with Type 1 diabetes must take insulin, as their body no longer produces it.

Type 2 Diabetes is also called Adult onset or Non Insulin Dependent Diabetes. Historically it was found in adults over 40 who had a family history of diabetes and who where overweight. In Type 2 diabetes the cells develop resistance to insulin. The pancreas works harder to produce more insulin. Treatment for Type 2 is directed toward reducing the cell's resistance to insulin. This is done through diet and exercise initially. Many studies have shown that a 10% reduction of weight combined with 30 minutes of exercise 3-5 times per week is sufficient to decrease this resistance. If these interventions aren't effective, then oral medications are used to decrease the resistance and help stabilize blood sugars. Insulin may also be needed if the pancreas can no longer produce enough insulin on it's own.

Why worry about diabetes?

It is expected that the worldwide incidence of diabetes will increase by 60% to over 300 million people with diabetes by 2025. The majority of these cases will be Type 2 and an increasing number of these new cases will be in children.

Why are we seeing Type 2 diabetes in children?

Obesity is the number one risk factor for Type 2 diabetes. Currently 14% of children in the US are overweight and 20% are at risk for overweight. (BMI>95% or BMI >85%). The number of children who are overweight has tripled since the 1960's.

Why has this occurred?

Changes in lifestyle and diet are the primary reasons. We are more sedentary as a society. The majority of adults in the US do not exercise 3-5 times a week for 30-60 minutes so it shouldn't surprise us that there children don't either. Physical education classes and playground playtime have lost out to other demands in the school systems. There is less structured activity for children after school even though we here about the number of children who have too much structured time after school. Many go home and watch TV, play computer games, or video games.

Our diet has changed also. The easy availability of high caloric, convenient fast foods is part of the answer. We as a people spend less time together preparing and eating our food. What is quick tends to be high calorie and high in saturated fats. The fast food industry is making changes, but the first question many of us still get after ordering is "Do you want to supersize that for an extra 50 cents?" Most of the fast food meals offer enough calories for the total day's requirement. Most of us don't eat just that one meal. Super sizing doesn't occur just in the fast food business. Portion sizes have increased and even our dinner plates have increased in size to accommodate them. The end result is more calories in than we expend and added weight.

What are the symptoms parents should look for to determine if their child is at risk?

The number one risk factor is obesity. If the child's BMI, Body Mass Index is greater than 85% for his or her age group they are at risk. If the child has darkened skin on the neck (acanthosis negricans) they should be concerned, as this is a sign of insulin resistance. If there is a strong family history of diabetes they should be concerned because of the strong genetic component to Type 2 diabetes. This doesn't mean that you will never be able to avoid Type 2 diabetes, but it does mean that you have an increased risk of developing it.

What can parents do to help their children stay healthy and avoid Type 2 diabetes?

The number one thing parents can do is help guide appropriate food choices. Simple clear messages are most effective. "Drink less sugary beverages." Adding or deleting one 12 oz serving of regular soda can make a difference of 10-12 pounds per year if that is the only change you make in your diet and activity level. "Watch portion sizes." Use models to show parents and children what a serving size of a particular food is. If you go to the Spaghetti Warehouse and order pasta you are getting about 4 servings! "Decrease fast-food intake." We give parents and children a guide to fast food eating. It lists the calories and fat content of many of the foods at popular fast food restaurants. Often family's feel they don't have a choice not to choose convenience foods, helping them and their children make better choices is possible. "Avoid skipping meals." A lot of families don't eat breakfast because of time crunches. Working with them to find out what they can modify in their routines to include breakfast. "Choose healthy snack options." Kids can carry healthy snacks such as peanuts so that if a meal is delayed, they have something to eat.

Increasing physical activity is the other key to managing obesity in childhood. Social, family and school variables all contribute to our children's sedentary lifestyle. Many overweight children have never felt successful at sports or exercise programs because of their stamina or size. They are often reluctant to participate because of inability to perform. Individual activities such as walking, jogging, dancing, swimming, or biking may be better choices. Some teens find a walking program with a pedometer motivational. Making these activities part of a family outing helps improve overall family fitness and also may help in areas where street/neighborhood safety are concerns. Encourage short periods of activity if you get resistance to the 30-60 minutes per day.

Providing ongoing support to these children is invaluable. Helping them deal with teasing, supporting them in their weight management and activity measures is critical to continue them on the path to improved health. Working with community resources to develop programs that are appropriate such as mall walks, cooking classes (for children and parents), or weekend exercise camps with easy-paced activities.

Helping families to decrease calories and increase activities are major components of reversing the trend of Type 2 diabetes in children. Discussions with families must include nutrition and meal planning-decreased total daily calories, increase fresh fruits and vegetables, decrease intake of sugar sweetened beverages, decrease intake of saturated fats, increase low-fat dairy and calcium rich foods, don't skip meals, eat healthy snacks. Promote physical activity by increasing physical education time at school, adding physical recreation time to family activities, and limiting TV and video game/computer activities to 1-2 hours per day. Parents need to be supported in practicing and modeling healthy behaviors. Avoid use of food as a reward.

Finally, providers must continue to provide support for these families in non-judgmental ways, teach them skills for dealing with frustrations, failures and the teasing their children receive. The focus is not to be on the child's weight, but on healthy habits and improved fitness. Health care providers also need to be advocates for community change to support walking trails and other fitness resources, improved physical education opportunities in our schools, and nutrition education for families and their children so they can become smarter consumers.