Pediatrics - Diabetes, Type 2
Type 2 Diabetes, also called Adult Onset Diabetes, is the most common form of diabetes. Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel. Normally, insulin, a hormone, helps glucose get into the body cells where it is used for energy. People with Type 2 Diabetes produce insulin, but they either do not produce enough or the insulin is not very effective in allowing glucose to get into the body's cells. As a result, glucose remains in the bloodstream. Too much sugar in the blood can make people ill and result in medical complications.
While many cases of Type 2 Diabetes may be controlled, it remains the leading cause of diabetes related complications such as blindness, lower leg amputations, and chronic kidney failure. There is no cure for diabetes. People with diabetes need to diligently manage their disease to remain healthy and reduce the risk of medical complications.
Most people with Pre-Diabetes do not have any symptoms. Symptoms of Pre-Diabetes include increased thirst, frequent urination, blurred vision, or extreme tiredness. Type 2 Diabetes may or may not produce symptoms. Many people with Type 2 Diabetes do not know that they have it. In most cases, the symptoms develop gradually when blood sugar levels become high.
A common symptom of Type 2 Diabetes is frequent urination. This happens as the body tries to remove excess blood sugar by passing it out of the body in urine. In turn, your child may feel extremely thirsty and your child’s mouth may feel dry. Because your child’s body is not getting energy from blood sugar, it signals him or her to eat a lot. Your child may feel hungry even after he or she has just eaten. However, even though your child is eating and drinking enough, your child may actually lose weight. This is because your child’s body starts to use fat and muscle for fuel, when it cannot use the blood sugar. Your child may feel tired and weak because his or her body cells cannot use glucose for energy.
Type 2 Diabetes can cause cuts or sores to heal slowly. The skin in your child’s vaginal or groin area may feel itchy. Your child may get frequent yeast infections. The skin in your child’s neck, armpit, and groin may become dark and velvety; a condition called acanthosis nigricans. Males may experience impotence or erectile dysfunction. Type 2 Diabetes can cause a sudden weight gain. Your child’s hands and feet may feel numb or tingle. Additionally, your child’s vision may decrease.
Treatment for Type 2 Diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with Type 2 Diabetes may occur. These conditions include hyperglycemia, ketoacidosis, hypoglycemia, and hyperosmolar hyperglycemic nonketotic syndrome.
Hyperglycemia, also called high blood glucose, can lead to medical complications. Hyperglycemia can occur for many reasons. People with Type 2 Diabetes may experience it if their body is not using insulin effectively, if they ate more than planned and exercised less than planned, or were sick or stressed.
The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst. You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in your child’s urine—this is very important. If you fail to do so, ketoacidosis could occur. If there are ketones in your child’s urine, he or she should not exercise. Exercising will only make the situation worse.
Ketoacidosis is a serious condition—it can lead to diabetic coma or death. Ketoacidosis occurs rarely in people with Type 2 Diabetes. Ketones are acids that accumulate in the blood when the body breaks down fats. The body releases ketones through urine. Ketones appear in urine when the body does not have enough insulin. Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body. Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours.
The first symptoms of ketoacidosis include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. These symptoms are followed by dry or flushed skin; continual tiredness; nausea, abdominal pain, or vomiting; difficulty breathing; impaired attention span or confusion; and fruity smelling breath. If your child has any of the symptoms contact your doctor immediately; call emergency services, usually 911; or go to the nearest emergency room of a hospital. Treatment for ketoacidosis usually involves a hospital stay.
You can help prevent ketoacidosis by monitoring your child for warning signs and checking his or her urine and blood regularly. Follow your doctor’s instructions if you detect high levels of ketones. If your child has high levels of ketones, he or she should not exercise. Exercise increases the levels of ketones.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a serious condition that most frequently occurs in older persons with Type 2 Diabetes. An illness or infection usually brings on HHNS. HHNS can cause severe dehydration and lead to seizures, coma, and death.
With HHNS, dehydration occurs as the body tries to remove excess blood sugar by passing it out of the body in urine. Urination may be frequent at first, but then decrease. Your child may become very thirsty. Your child’s urine will become very dark. It is important to drink plenty of liquids to remain hydrated. Warning signs and symptoms of HHNS include a blood sugar level of over 600 mg/dl; a dry parched mouth; extreme thirst that may gradually disappear; warm dry skin that does not sweat; a high fever, over 101° Fahrenheit; sleepiness or confusion; vision loss; auditory or visual hallucinations, seeing or hearing things that are not there; and weakness on one side of the body. Call your doctor immediately if your child experiences any of these symptoms.
You can avoid HHNS by checking your child’s blood glucose levels regularly. You need to check your child’s blood glucose levels more often when he or she is sick or has an infection. You should work with your doctor and health care professionals to develop a monitoring plan for when your child is sick.
Hypoglycemia, also called low blood sugar or insulin reaction, is not always preventable. Hypoglycemia can occur even if your child does everything that he or she can to manage diabetes. Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, headache, pale colored skin, sudden moodiness, clumsiness, seizure, poor attention span, confusion, and tingling sensations around the mouth.
Check your child’s blood if you suspect that your child’s blood glucose level is low. You should treat hypoglycemia immediately. The quickest way to treat hypoglycemia is to raise your child’s blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy. Ask your doctor for a list of appropriate foods. Once you have tested your child’s blood glucose level and treated your child’s hypoglycemia, repeat the process again until your child’s signs and symptoms have cleared.
It is important to treat hypoglycemia immediately or your child could pass out. If your child passes out, your child needs immediate treatment. Your child should receive an injection of glucagon. Glucagon is a medication that raises blood sugar. You should tell those around your child, how and when to use it. If glucagon is not available, your child needs emergency medical assistance. Someone should take your child to the emergency room of a hospital or call emergency medical services, usually 911. If your child passes out from hypoglycemia, you should not inject insulin or have your child consume food or fluids.
Additionally, some people with Type 2 Diabetes need to take medications to stimulate insulin production and to increase their body’s sensitivity to insulin. There are many oral medications that are available and your doctor will discuss which may be best suited for your child.
Am I at Risk
Is My Child at Risk?
Risk factors may increase your child’s likelihood of developing Type 2 Diabetes. People with all of the risk factors may never develop the disease; however, the chance of developing diabetes increases with the more risk factors your child has. You should tell your doctor about your child’s risk factors and discuss your concerns.
Type 2 Diabetes was formerly called Adult Onset Diabetes. However, it is occurring in people of younger ages as obesity rates increase. Additionally, people of ethnic minority groups, including African Americans, Native Americans, Hispanics, Latinos, Asians, and Pacific Islanders, develop diabetes more frequently than Caucasians.
Risk factors for Type 2 Diabetes include:
____ A family history of diabetes is associated with an increased chance of developing Type 2
Diabetes. If your child’s parents, brothers, or sisters have diabetes, your child’s risk increases.
_____ Being overweight or obese and particularly carrying weight on the abdomen is a risk factor. Obesity can promote insulin resistance and reduce the use of insulin.
____ People over the age of 45 have an increased risk because as people age, they are less able to process glucose appropriately.
_____ High blood pressure increases the risk of developing diabetes. The mechanism is unclear, but it appears that the higher the blood pressure, the worse the insulin resistance.
_____ High cholesterol increases the risk of developing diabetes. Insulin resistance is associated with low HDL levels or good cholesterol, and high triglyceride levels.
_____ Inactive people, people who do not exercise regularly, are at an increased risk for diabetes. They may have higher blood sugar levels from lack of exercise. Exercise helps to move glucose out of the bloodstream.
____ Women who developed Gestational Diabetes during pregnancy or delivered a baby weighing over nine pounds have an increased risk of developing Type 2 Diabetes later on in life.
____ Women with Polycystic Ovary Syndrome (PCOS) have an increased risk because of irregular hormone production that can cause insulin resistance and Diabetes.
Many doctors believe in testing for Pre-Diabetes at age 30 for people with a family history of
diabetes or who are overweight. Your child should be tested for Pre-diabetes if he or she has any of the risk factors for diabetes that are listed above or if your child previously had an abnormal glucose tolerance test or impaired fasting glucose level.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.