Endocrine Disorders

Not for Adults Only: Diabetes in Kids

About a decade ago, it was assumed that the cause of high blood sugar levels in children was type 1 diabetes, which was then known as juvenile diabetes. But today, more and more children and teenagers are being diagnosed with type 2 diabetes. While type 1 diabetes results from an autoimmune problem, type 2 diabetes, formally known as adult onset diabetes, often develops when people are overweight and inactive.

It's thought that the startling rise in type 2 diabetes is tied to the increase in obesity among children. This health trend is particularly worrisome because it raises children's risk of life-threatening medical problems such as heart disease and kidney disease. Early management of diabetes in children and teenagers, however, can help bring blood sugar levels down and delay diabetes complications.

"I remember one of my first cases of type 2 diabetes in children, when there was a lack of knowledge amongst the pediatric endocrinologists," says Wendy Brickman, MD, an assistant professor at the Feinberg School of Medicine at Northwestern University and an attending physician in the division of endocrinology at Children's Memorial Hospital in Chicago. "This used to be primarily an adult disease, but now type 2 diabetes and its complications is something pediatricians and pediatric endocrinologists need to know about."

Below, Dr. Brickman discusses how type 2 diabetes appears in children and teenagers, how families can learn to prevent it, and how endocrinologists are learning to treat it.

How does type 2 diabetes differ from type 1?
Glucose, or blood sugar, levels are controlled by the hormone insulin, which is secreted by one type of cell in the pancreas. The insulin sends signals to cells in certain tissues, such as muscle, and in response the cells use glucose for energy or store it for later use.

There are at least two problems with insulin in type 2 diabetes. One is insulin resistance, when your cells do not respond properly to the insulin signal and blood sugar is not stored or used, and the other is poor insulin secretion, where the cells of the pancreas cannot make enough insulin to overcome the insulin resistance. In type 1 diabetes, there is an autoimmune process that destroys the cells that make insulin, so it's purely a problem with insulin production and secretion.

There are differences in the way these diseases appear. In type 2 diabetes, the disease can be present while the kids feel completely asymptomatic. With type 1 diabetes, children usually have an increase in thirst and urination. When a child makes so little insulin that the body starts to use fats for energy, s/he starts to get very sick very quickly.

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