Type 2 Diabetes Mellitus or pre-diabetes is a metabolic disorder that affects the way the body processes glucose. It is related to lifestyle (poor diet, inadequate exercise) and in recent years more and more children and adolescents suffer from it. It is important to stress the fact that adopting a proper diet and exercise program can alter the course of the disease.
Type 2 Diabetes Mellitus versus Pre-diabetes
Pre-diabetes and Type 2 Diabetes are essentially the same disease at different stages.
Pre-diabetes is the condition in which a child has a higher blood glucose level than normal and an increased risk of developing Type 2 Diabetes in the years that follow. At this stage the pancreas (beta cells) does not produce enough insulin resulting in the gradual increase of blood glucose levels. If diagnosed early, it can be addressed by a change in lifestyle and medication.
In the case of Type 2 Diabetes, the child’s body does not respond properly to insulin (insulin resistance) and has difficulty absorbing glucose. Therefore, in order to meet its needs, the body prompts the pancreas to produce additional amounts of insulin. Gradually, the pancreas (beta cells) is unable to produce a sufficient amount of the hormone, resulting in the disruption of blood glucose levels.
Type 2 Diabetes Mellitus: What are the symptoms and risk factors?
Type 2 Diabetes develops slowly, so a large percentage of the children suffering from the disease may not present with any symptoms. Acanthosis nigricans, a discolouration in the skin around the neck, is often one of the first signs of the disease.
Some of the symptoms that may occur include:
- Frequent urination (polyuria) and increased thirst (polydipsia): Excessive glucose accumulated in the body is excreted in the urine, leading to frequent urination and thirst, as water is also lost in urination.
- Blurred vision: Increased glucose attracts fluids from the lenses in the eye, creating a “swelling” of the lens and difficult focusing.
- Fatigue: Due to lack of glucose in the cells, the child feels tired.
- Frequent infections and slow-healing wounds: Type 2 diabetes affects the body’s ability to heal and the body’s defence mechanism is unable to cope with infections.
The most important risk factors include:
- Obesity: fat accumulates in cells of the child (mainly in the abdominal area) and shows a greater resistance to insulin.
- Absence of physical activities: activities help the child’s body absorb glucose as energy, while helping maintain a normal weight.
- First-degree relative suffering from the disease.
- The development of gestational diabetes during pregnancy.
- Gender: Girls are more likely to develop Type 2 Diabetes during puberty.
Visit your doctor if one of these symptoms is observed in order that the proper tests can be performed to determine if the child is suffering from diabetes and if so, which type of the disease.
Type 2 Diabetes Mellitus: What health problems can it cause?
Type 2 Diabetes can cause serious long-term health problems that affect nerves, blood vessels and the organs of the body. Some complications include high blood pressure and cholesterol levels, kidney and liver problems, ophthalmological diseases, etc.
It must be stressed that the risk of such complications is dramatically reduced when the patient maintains normal blood glucose levels.
Type 2 Diabetes Mellitus: How is it diagnosed?
Diagnosis is based on glucose levels. The criteria are:
- Fasting glucose ≥ 126 mg/dl
- Random glucose ≥ 200 mg/dl
- Glucose level after administration of 75 gr (glucose curve) ≥ 200 mg/dl.
There is also a special blood test for glycosylated haemoglobin (HbA1C), which measures the percentage of haemoglobin to which glucose is attached, indicating the blood glucose density in the prior 2-3 months. Under normal circumstances, the figure does not exceed 5.6%. When the value is between 5.7% and 6.4%, there is a predisposition for glucose and when it exceeds these limits the child has diabetes.
If the child is diagnosed with diabetes, the doctor will order some special tests to determine the type of diabetes the appropriate treatment can be administered.
Type 2 Diabetes Mellitus: What is the treatment?
The aim of the treatment is to maintain normal blood glucose levels. Hence, the treatment is modified as the child grows and his or her needs change, including:
- Measuring glucose levels: It is very important to check glucose levels daily and if the child is receiving insulin, the measurements must be taken more than once.
- Balanced diet: a child with diabetes mellitus should consume a balanced diet that includes all food groups in the correct quantities. A specialised nutritionist can assist with this effort.
- Exercise: physical activity reduces blood sugar levels.
- Medication: the doctor will prescribe appropriate medication to help regulate glucose levels. In addition to regulating glucose levels, the goal is to avoid the complications of the disease so the child has a better quality of life.
- Insulin: this medication is recommended when other types are unable to regulate glucose levels. Depending on the needs of the patient, the corresponding type of insulin (rapid, short, intermediate or long-acting) is administered, either by injection or continuous administration (insulin pump).
The doctor will monitor the development of the child regularly and will also request regular blood and urine tests to determine glucose and cholesterol levels, and to assess thyroid, kidney and liver function. Ophthalmological examinations are also recommended.
Type 2 Diabetes Mellitus: Can it be prevented?
Type 2 Diabetes can be prevented when one is aware of the risk factors. A change in lifestyle and a balanced diet and physical exercise program can reduce the chances of developing the disease.
In addition to a change in lifestyle, if the child is diagnosed with pre-diabetes, oral treatment may also be required to prevent the transition to Type 2 Diabetes.
The Paediatric-Adolescent Diabetes clinic at MITERA Children’s Hospital is run by Dr Nikolaos Kefalas, Paediatrician-Endocrinologist. The team is comprised of nurses, paediatric endocrinologist, psychologist and clinical dietician-nutritionist who oversee the treatment, support and education of children with Type 1 and Type 2 diabetes, at both the initial diagnosis and during the subsequent progression of the disease.