More kids getting type of diabetes related to obesity

Until 10 years ago, children who were diagnosed with diabetes nearly always had type 1 disease, once called juvenile-onset.

What a difference a decade makes. An increasing number of kids are getting type 2 diabetes, the kind that used to be called adult-onset because it started in middle age.

Although a recent study indicates pediatric type 2 diabetes is still relatively infrequent, experts are concerned about the trend and the impact the condition, particularly its complications, might have on affected children and families.

“It does exist and it’s increasing,” said endocrinologist Dr. Silva Arslanian, director of the Weight Management and Wellness Center at Children’s Hospital in Pittsburgh. “It’s increasing because more and more children are becoming obese.”

Stephanie Wilkerson, of Ross, Pa., sought solutions for daughter Umayma Dixon’s weight problem for years, but, as she put it, diabetes never crossed her mind.

“Until she was diagnosed, I wasn’t even aware it was happening in children,” Wilkerson said.

Umayma’s doctors checked her for thyroid and other problems that can lead to a person becoming overweight, but none mentioned diabetes. Her worried mom learned about the importance of screening for it while reading books about childhood obesity.

In a June issue of the Journal of the American Medical Association, researchers from the SEARCH for Diabetes in Youth Study Group estimated that 3,700 youths are diagnosed with type 2 diabetes annually in the United States.

Cases are more common among older teens who belong to racial or ethnic minorities, the study group said.

Black, Hispanic, Asian-Pacific Islander and American Indian children are at greater risk, as are those with a family history of diabetes, said Arslanian.

Also, “if the mother during her pregnancy had diabetes or gestational diabetes, then the risk for the adolescent to have type 2 diabetes is very high,” the doctor said. “The risk for obesity is very high, too.”

While not every overweight youngster is or will become diabetic, the association between the two is unavoidable.

If a child has a body mass index, or BMI, that ranks above the 85th percentile in comparison with peers of the same sex and age, along with two additional risk factors, “then one needs to rule out the possibility of type 2 diabetes, which can be a silent disease,” Arslanian recommended.

Despite greater public and professional awareness of the problem, many children don’t get diagnosed until they already have symptoms, she added.

Umayma didn’t urinate more frequently and wasn’t excessively thirsty. But she did have dark, thick skin lesions called acanthosis nigricans, which can be a marker for high insulin levels as well as other conditions.

In type 2 diabetes, the pancreas must increase insulin production because muscle and other cells become less sensitive to the hormone, which is known as insulin resistance. In type 1, the pancreatic cells that make insulin are destroyed by the immune system. In both types, blood sugar rises.

There were other reasons to consider screening Umayma for type 2 diabetes. Her maternal grandmother, one of 14 children, had 10 siblings who were diagnosed with the condition as adults, Wilkerson said.

But Umayma’s size sounded the loudest alarm. Even as a toddler, she was large for her age, her mother noted.

Now 10, Umayma is 5 feet, 3 inches tall and weighs 190 pounds, and her BMI exceeds the 95th percentile. Soon to be a fifth-grader, “she’s as big or bigger than most of her teachers,” her mom said.

In 2004, when she was 7, Umayma had blood tests that showed she had type 2 diabetes. Soon, she was taking metformin, an oral medication, to control her blood sugar. The dose was increased a couple of times before the level was in the appropriate range.

Twice daily, the girl pricks her finger to test her blood sugar, and keeps a log of the results to show her doctor. And she’s trying hard to lose weight by watching what she eats and exercising.

Sometimes, though, “I pack her a good lunch and she goes to school and trades it,” said a rueful Wilkerson. “It’s being a kid.”

But, she noted, people who don’t know Umayma don’t realize she’s a kid, and that can be frustrating and hurtful. It’s not the fault of diabetes, Wilkerson knows, but the result of being tall and heavy for her age.

Umayma understands that the only way to find out if dropping the extra pounds will make the diabetes go away is to do it and see what happens, said her mom, who also wants the girl to be aware of the complications of the disease.

Wilkerson has a relative who lost toes to type 2 diabetes, so as she put it, Umayma knows “there are consequences in not taking care of this properly.”

“You’re the person responsible to avoid it,” she tells her. “I can help you, but I can’t do it.”