Article written by Christina Elston
With childhood obesity on the rise, physicians have seen an increase in type 2 diabetes in children. But of the two types of diabetes (type 1 and type 2), type 1, commonly known as juvenile diabetes, is still the most prevalent in children.
Three years ago, Andrea Shahmardian had a healthy kid - or so she thought. Her 13 year-old son, Christian, had been outside enjoying a summer Friday afternoon with friends, but he came inside complaining of a headache and stomach ache. “We just thought he had the flu,” Shahmardian says.
By Sunday, Christian had lost 13 pounds and was severely dehydrated. “He came out of his room and he just looked like he was going to die,” his mother recalls. At a local health clinic, Shahmardian says, “The doctor called me aside and said, 'He's diabetic, he's in critical condition, and I'm calling an ambulance right now.'”
After two days in the hospital, which included intensive training in managing Christian's type 1 diabetes, the family returned home.
“It was absolutely the scariest thing I've ever had to do in my life,” Shahmardian says. “I was convinced I was going to leave the hospital and [accidentally] kill this kid.”
“It was absolutely the scariest thing I've ever had to do in my life. I was convinced I was going to leave the hospital and [accidentally] kill this kid.”
- Andrea Shahmardian - Mother of a diabetic son
An estimated 176,500 people under age 20 have diabetes in the United States. That's about one in every 500 or so children and young adults. With childhood obesity on the rise, physicians have seen an increase in type 2 diabetes in children, causing alarm and media attention. But of the two types of diabetes (type 1 and type 2), type 1, commonly known as juvenile diabetes, is still the most prevalent in children.
A recent study conducted at the University of Washington in Seattle and reported in the Archives of Pediatrics and Adolescent Medicine found that as many as 39,005 kids ages 12 to 19 have type 2 diabetes. And an astounding 2.7 million kids could be in danger of developing type 2 diabetes. Meanwhile, a report on drug therapy trends that followed millions of children nationwide from 2003 to 2005 found a 40-percent increase in insulin prescriptions, the type prescribed for people with type 1 diabetes.
Living with Diabetes One of the toughest aspects of diabetes for kids, according to doctors and parents, is that they have to test their blood sugar every few hours. Small, portable glucose meters requiring just a tiny blood sample are making this easier.
For kids taking insulin shots, there are self-injector pens to hide the needles. There are also insulin “pumps,” with a canula (small, flexible plastic hollow needle attached to a tube) that stays in place under the skin for days at a time. The canula is attached to a device that regulates and delivers the insulin, allowing kids to adjust their dose without additional shots. New insulin created in recent years works more efficiently, and is closer to the insulin that the body would create on its own.
Another important development has been the recognition that kids with diabetes can still be kids, says Larry Deeb, M.D., president elect of medicine and science for the American Diabetes Association (ADA). “It's the understanding that if he wants to play football, he will. And if she wants to be a volleyball star, she can.”
“Life is the same as for all children and families, but with more tasks, planning and attention to details,” notes Margie Lawlor, the coordinator of pediatric research and education at the world-renowned Joslin Diabetes Center in Boston. Once a diabetic child and his family have learned about blood-sugar testing, proper eating, carb counting and medication, it's time to move on. “Your life has to get back to normal,” Lawlor says. “It's just a new normal.”
Type I vs. Type 2
The Difference - Both types of diabetes involve problems with insulin, the hormone that allows glucose (blood sugar) to enter the body's cells and be body produces little or no insulin. In type 2, the body produces insulin, but a number of factors - including low activity level, poor diet and being overweight - cause the body's fat and muscle cells to become insulin resistant, blocking insulin from entering. Either way, because the glucose is not being used as fuel, high levels build up in the bloodstream and cause illness.
Larry Deeb, M.D., of the American Diabetes Association, believes research will eventually show that the two types of diabetes are actually quite similar. Studies have found indications of a genetic component that makes people susceptible to type 2 diabetes, while there are also likely environmental and lifestyle factors that “trigger” onset of Type 1.
The Effects - For kids with either form of diabetes, low blood sugar levels - also called hypoglycemia - can result in headaches, shaking, sweating, fatigue, weakness and hunger. In extreme cases, it can lead to a coma or even death. Long-term complications are usually due to cell damage, and can include heart disease and blockages of the major arteries of the legs, glaucoma or blindness, kidney disease, nerve damage and foot and skin problems. Diagnosis - Type 1 diabetes, primarily a genetic problem, is usually diagnosed in childhood or adolescence. Type 2 is usually diagnosed in adulthood, though incidence in children is increasing, due in large part to the childhood obesity problem.
Treatment - Type 1 is treated with insulin injections. Type 2 is treated by a combination of lifestyle changes - improved diet, increased physical activity, and healthy weight maintenance - plus medications that might include insulin
- Christina Elston
For the Shahmardian family, this meant going ahead with Christian's plans to enter an expeditionary junior high school, where the kids would spend lots of time in the field on rafting and camping trips. Christian, now 16, says that it took about four months to overcome his fear of needles and get used to managing his diabetes.
“That was all I could think about when I was first diagnosed,” he says. “I knew that it would involve shots, and that scared me a lot.” His insulin pump, he says, makes life much easier.
While Christian's parents thought he had the flu when his diabetes first flared up, Donna Levin thought her son, Josh, had a urinary tract infection. Josh was 9 at the time, and had begun wetting the bed. His pediatrician sent him to the lab for blood work. “They called us back and told us we had to head over to the hospital, and they were waiting for us,” says the mother of two.
Not familiar with type 1 diabetes, and baffled as to how her young, thin son could possibly be diabetic, Levin quit her night job and took a position at Josh's school to be on hand for any medical needs he might have.
“When he was younger, it was really hard,” she says. “I always made myself available to be there to keep an eye on him.”
About three years ago, at 13, Josh started administering his own injections. But his mom says it took some work to convince school administrators to allow him to carry his supplies - a blood test kit, insulin pen and snacks - with him, instead of storing them in the nurse's office.
Connecting with other parents through message boards on the ADA Web site, and attending diabetes family camps, have helped the Levins find support. They also attend a diabetes symposium held yearly at Stanford University. But they still struggle with a lack of understanding on the part of others - mostly with the assumption that diabetes is always the result of giving children too many sweets or high-fat foods.
“You can't cause your child to develop type 1 diabetes,” Levin says. “No, we did not overfeed our child sugar, junk food and soda to bring this on!”
Laura Plunkett, a psychologist and mother of two, put her family's story on paper in hopes of helping others. Her son Danny, now 12, was diagnosed with type 1 at age 7. Despite receiving excellent care at top hospitals, Danny's blood sugar levels were under control, but consistently above those recommended to prevent long-term complications. Danny's doctors were not as concerned, telling her, “This is excellent control,” Plunkett says.
But the education she initially received didn't focus on lifestyle changes for kids with type 1. Plunkett started researching the issue and found information on how moving toward more whole foods and complex carbs - found in whole grains and vegetables - could help. She began re-vamping her family's lifestyle to include a healthier diet and more physical activity. The changes have paid off. The whole family is healthier, she says, and Danny's numbers are down.
Plunkett and her mother, newspaper columnist Linda Weltner, turned the story of her family's adjustment and what Plunkett learned into a book, The Challenge of Childhood Diabetes. Plunkett says she doesn't expect her family's way of doing things will be an exact fit for other families, but she does want to encourage parents to try to find their own way. “If you have the resources, just look around and find what works for you,” she urges.
With knowledge about diabetes rapidly increasing, Deeb holds out hope that even better treatments - and a cure - are on the way.
“When we first started, we were guessing in the dark,” he says. “Now we're guessing in the dawn. I expect we'll be operating in the sunshine in 10 years.”
Research efforts, such as the Search for Diabetes in Youth and the TODAY studies (see Resources), are helping health experts better understand both types of diabetes. On the horizon could be “smart” insulin pumps that automatically test blood sugar, glucose meters that require no finger stick, and even cell transplantation to help kids with type 1 produce insulin again.
Meanwhile, kids living with diabetes are making the best of it.
“It really hasn't hurt my social life or my fun or anything,” says Christian Shahmardian. “I do everything a 16-year-old boy without diabetes can do.”
Christina Elston is the contributing health editor for United Parenting Publications.
For more articles by Laura Plunkett, go to www.challengeofdiabetes.com