The Other Kids with Diabetes

We all know the stereotype of someone newly diagnosed with type 2 diabetes: an overweight adult, lethargic and unhealthy, right? Wrong. Just as society is still unclear on who can get type 1 diabetes (adults too!), type 2 diabetes is rising at alarming rates among children. Even if you don’t typically think this topic affects you personally, remember that all of these newly diagnosed young people with type 2 will become part of our diabetes community quicker than you think. So we thought it was worth some closer examination — especially for the parents, who are most likely new to diabetes too.

A recent infographic from GOOD Magazine shows that obesity rates in children have doubled in the last 10 years, and in 2005, an estimated 30-40% of those children were at-risk or had type 2 diabetes.

Melinda Sothern, a professor at Louisiana State University Health and Sciences Center and who has studied obesity in children, says that she has seen children as young as 7 years old with insulin resistance. This is not something that just might “kick in” later — it’s starting now and it’s starting young.

Despite Michelle Obama’s campaign on childhood obesity, the issue of type 2 diabetes in teens and children is still not very visible. Over the past several years, the NIH conducted the TODAY trial (Treatment Options for type 2 Diabetes in Adolescents and Youth) to explore the best treatment strategies. Starting in 2004, the trial was conducted at 13 sites around the country, where enrolled kids and their families got free diabetes care, medical exams, medicines, and testing supplies. The trial has already ended, but we’re still waiting on the results, expected to be announced sometime next year, most likely at the ADA Scientific Sessions in June.

Another attempt to raise awareness about this issue was made on World Diabetes Day in 2009, when PBS launched a site called MyType2 which featured “video diaries” of seven teens with type 2 diabetes. But now in 2011, the project is no longer active and only some of the videos are available. Bummer. The videos that are still up are heartfelt, as the teens discuss what it’s like to find out that they have type 2 diabetes and the struggles they’ve encountered in learning to take care of themselves.

“When I got diabetes, I thought it was something that only older people got,” Misty, an 18-year-old college freshman, explained. “It took a good year to completely understand what was going on with me… Diabetes is only a problem if you don’t take care of it.”

“Even though I had all these warnings from nutritionists, my mind was blown,” Donareese, who was diagnosed with pre-diabetes at 15, said. “I knew exactly what would happen, and yet I did it anyway. I can’t explain to you why I didn’t do anything. When I got the test results back, reality set in.”

The myth that type 1 diabetes only affects children has been squashed, and now it’s time to revise our thinking that type 2 diabetes only affects older folks, just as Misty thought. With obesity being a primary risk factor for diabetes, plus a whole host of other conditions, like high blood pressure and high cholesterol, we’re left wondering: How do you approach the sensitive topic of type 2 diabetes? i.e. How do you talk about weight and food with a child?

We decided to query some top experts in the field of type 2 diabetes and nutrition to find out what they recommend:

Dr. Francine Kaufman, Chief Medical Officer and Vice President of Global Clinical Affairs for the Diabetes business of Medtronic, and author of Diabesity

“My first piece of advice is to discuss with the heathcare provider what their weight and BMI is. If it’s over 85%, that’s overweight, over 95% is obese, and 99% is morbidly obese.

“Some children with type 2 diabetes are treated with metformin, which is the only approved drug for children, as is insulin. Other drugs are not approved, but that doesn’t mean they aren’t used.

“Understand the importance of monitoring blood glucose. For children, it’s not as infrequent as with adults, mainly because more children with type 2 are on insulin, so they should usually test at least four times a day. From there, children with type 2 have more co-morbidities, like hypertension. There’s also a risk for sleep apnea. Girls can have polycystic ovarian syndrom. It’s a significant disease in children in that, overall, it can have more co-morbidities and earlier complications than children who have type 1.

“Children with type 2 diabetes also have more depression. You should determine if your child is depressed and discuss with your healthcare professional to assess the situation. A lot of these children do need psychological counseling to deal with depression or being teased. Most children who are told they have a chronic disease need help to get adjusted to that. Positive rewards for children is helpful. Adults work for positive results — it’s called a paycheck. Negative rewards don’t work so well, but positive rewards do.”

Erinn T. Rhodes, MD, MPH, Director of the Type 2 Diabetes Program, Children’s Hospital Boston

“Reducing risk for type 2 diabetes and managing it in kids both require a focus on healthy lifestyle. A great way for parents to promote a healthy lifestyle for their children is to model healthy lifestyle behaviors themselves. Creating a healthy home environment by keeping temptations out of the home is also very helpful. Specific healthy behaviors we encourage include increasing physical activity, reducing screen time, eating meals at regular times together as a family, and watching portion size. Parents should encourage their children to target small, realistic goals for changes in their diet or physical activity that will result in gradual improvements.

“A diagnosis of type 2 diabetes and the added responsibilities of taking medication and checking blood sugars can feel overwhelming for a child. Kids, even teenagers, shouldn’t have to manage their diabetes alone. However, every family is different, so it’s important that adolescents and young adults feel empowered to ask for help with their diabetes management when and how they need it. Managing diabetes is about planning and balance. For some adolescents, these are difficult skills and so the support of parents, friends, and the medical team can be really important.”

Kelly Lowry, Medical Psychologist, Children’s Memorial Hospital

“I do not recommend a focus on weight. The number on a scale isn’t a behavior and is the result of so many things (food intake, energy output, fluid volumes, typical growth and development). I recommend keeping the focus on healthy ‘do’ behaviors (e.g., try a new vegetable every week, try to be active every day) versus ‘don’t’ behaviors (e.g, don’t watch television, don’t eat certain foods). The overall messages are more positive this way and tend to lead to opportunities for goals that are fun or inspire.

“Finally, perhaps the most important piece of information that I share with parents is to be a good role model. Live your life the way you want your children to live. No one likes feeling like s/he is the only one in the family who has to make changes. If these changes are new for your child, make them a family focus and talk about why these changes are beneficial for ALL family members. If eating yummy healthy foods and having fun through active play are normal everyday activities for your family, they will become normal everyday routines for your child.”

Dr. Emily Israel, Associate Director of Patient Care at the New Balance Foundation Center for Obesity Prevention Boston Children’s Hospital

“I think focusing on weight alone is a very tricky issue with children. We often place many judgments on individuals’ weight, which often have negative implications on patients’ self-efficacy and feelings of self-worth.

“Instead of focusing on the topic of weight, we encourage our families to focus on overall health and wellness. This helps take a lot of the judgments and feelings of guilt out of the conversation. Children don’t often understand how food and exercise and healthy lifestyle behaviors can positively impact all areas of their life. It is important for parents/adults to help children understand that food/exercise/healthy are not things we have to focus on because the children are ‘bad’ (a judgment) but because it will help enhance their lives, help them feel better, and help them live longer with less medical issues.

“Usually when parents become worried about weight they focus on encouraging children/teens to restrict food. It’s important to encourage kids to eat more NUTRITIOUS foods and to understand that they can enhance their body’s performance (school, energy, mood, attention) if they get more nutrients. In addition, they will find that exercise often helps them feel better with mood, attention, and sleep better (which is important as sleep is the foundation for health). It is important to try to encourage kids to feel positive about their bodies instead of focusing on what they need to change.”

Melinda Sothern, Ph.D., Professor at LSU Health Sciences Center

“The younger child, the more the parent is in complete control of the home, school, social interactions. The child doesn’t have a lot of autonomy. The mother controls the food in the house, what activities the child participates in home, the scheduling, when they have access to snack foods, what kind of sports are they engaging in. Working slowly to make changes actually works better. You do baby steps. In the first week you make a goal not to bring soda in to the house, buy 2% milk, and make family dinner on Saturday. Next week is not to bring candies or cookies into the house and try one new vegetable. Each week you add another strategy, and a child doesn’t even know it has anything to do with weight. You can say you’re doing this because you saw something on TV or an article or the other parent saw something. You can relate these behavior and changes something other than weight.

“In teens, it’s trickier. They want autonomy and are at odds with parents. They are already feeling pretty bad and getting teased and have low self-esteem. It’s affecting their social interaction and functioning, academics. Teens who are overweight are at a huge disadvantage. Parents do need to approach teens, but don’t talk about weight. Talk about the risk for diabetes. The best place to do this in presence of an endocrinologist or diabetes educator or dietician. The parents will have a team behind them to help emphasize that this isn’t about aesthetics, this is about your future life.”

Lynn Polmanteer, RD, Friedman Diabetes Institute

“Parents need to be aware of how much sugar and calories are in juice, juice-like beverages, regular soda, and sports drinks. All of these sugary beverages all are loaded with calories, which can lead to weight gain. Since these drinks are so concentrated they also spike blood sugar. A better option is to eat a piece of fruit and drink a glass of water or seltzer.

“It’s important to focus on the fact that nutrition and exercise play a vital role in the management of type 2 diabetes. To optimize diabetes control, snacking on fruit, vegetables, and low-fat cheese is better than grabbing chips and cookies on-the-go. Making meals together as a family is healthier than eating calorie-rich fast food. Limiting the daily use of electronics (TV, computer, video games) is suggested. It’s ideal for children to get physical activity on a daily basis such as dancing, sledding, swimming, basketball and biking.”

We noticed some repetitive themes here, ay? Good advice for everyone trying to live healthier.

Kelly Lowry also shared a couple of books for parents and children who are dealing with weight and self-esteem issues. For parents, she recommends I’m Like, So Fat! Helping your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World by Dianne Neumark-Sztainer, Ph.D. For children struggling with self-esteem issues, she suggests I Want Your Moo: A Story for Children about Self-Esteem by Marcella Bakur Weiner & Jill Neimark and You Are Important by Todd Snow.

Overall, it’s clear that healthy living is a family mission. When it’s the child dealing with type 2 diabetes, just like with type 1, the whole family needs to work together to make the right changes. If your child was diagnosed with pre-diabetes or type 2 diabetes, we’d love to hear how you handled this sensitive yet vitally important information with your child.