Type 2 diabetes in children

Date Updated: 08/26/2020

Overview

Type 2 diabetes in children is a chronic disease that affects the way your child's body processes sugar (glucose). Without treatment, the disorder causes sugar to build up in the blood, which can lead to serious long-term consequences.

Type 2 diabetes occurs more commonly in adults. In fact, it used to be called adult-onset diabetes. But type 2 diabetes in children is on the rise, fueled by the obesity epidemic.

There's plenty you can do to help manage or prevent type 2 diabetes in children. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If diet and exercise aren't enough to control type 2 diabetes in children, oral medication or insulin treatment may be needed.

Symptoms

Type 2 diabetes in children may develop so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up.

Other children might experience:

Increased thirst and frequent urination. Excess sugar building up in your child's bloodstream pulls fluid from tissues. As a result your child might be thirsty — and drink and urinate more than usual.
Fatigue. Lack of sugar in your child's cells might make him or her exhausted.
Blurry vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. Your child might be unable to focus clearly.
Darkened areas of skin. Before type 2 diabetes develops, certain areas of the skin begin to darken. These areas are often found around the neck or in the armpits.
Weight loss. Without the energy that sugar supplies, muscle tissues and fat stores simply shrink. However, weight loss is less common in children with type 2 diabetes than in children with type 1 diabetes.

When to see a doctor

See your child's doctor if you notice any of the signs or symptoms of type 2 diabetes. Undiagnosed, the disease can cause serious damage.

Diabetes screening is recommended for children who are overweight or obese who have started puberty or are at least 10 years old and have at least one other risk factor for type 2 diabetes. Other risk factors include having a family history of diabetes, being a nonwhite race or having signs of insulin resistance, such as darkened skin patches on the neck or armpits.

Causes

The exact cause of type 2 diabetes is unknown. But family history and genetics appear to play an important role. Inactivity and excess fat — especially fat around the belly — also seem to be important factors.

What is clear is that people with type 2 diabetes can't process glucose properly. As a result, sugar builds up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.

Most of the sugar in people's bodies comes from the food they eat. When food is digested, sugar enters the bloodstream. Moving sugar from the bloodstream to the body's cells requires the hormone insulin.

Insulin comes from a gland located behind the stomach called the pancreas. The pancreas releases insulin into the blood after a person eats.

As insulin circulates, it allows sugar to enter the cells — lowering the amount of sugar in the bloodstream. As the blood sugar level drops, so does the secretion of insulin from the pancreas.

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops making enough insulin. The resulting buildup of sugar in the bloodstream can cause symptoms of high blood sugar.

Risk factors

Researchers don't fully understand why some children develop type 2 diabetes and others don't, even if they have similar risk factors. However, it's clear that certain factors increase the risk, including:

Weight. Being overweight is a strong risk factor for type 2 diabetes in children. The more fatty tissue children have — especially around the abdomen — the more resistant their bodies' cells become to insulin.
Inactivity. The less active your child is, the greater his or her risk of type 2 diabetes. Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin.
Family history. Children's risk of type 2 diabetes increases if they have a parent or sibling with the disease.
Race or ethnicity. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are more likely to develop type 2 diabetes.
Age and sex. Many children develop type 2 diabetes in their early teens. Adolescent girls are more likely to develop type 2 diabetes than are adolescent boys.
Birth weight and gestational diabetes. Low birth weight and being born to a mother who had gestational diabetes during the pregnancy are both associated with a higher risk of developing type 2 diabetes.
Pre-term birth. Babies born prematurely — before 39 to 42 weeks' gestation —have a greater risk of type 2 diabetes.

Complications

Type 2 diabetes can affect nearly every major organ in your child's body, including the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes develop gradually over many years. Eventually, diabetes complications may be disabling or even life-threatening.

Complications of type 2 diabetes include:

High blood pressure
High cholesterol
Heart and blood vessel disease
Stroke
Nonalcoholic fatty liver disease
Kidney disease
Blindness
Amputation

Keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Prevention

Healthy lifestyle choices can help prevent type 2 diabetes in children. If your child already has type 2 diabetes, lifestyle changes can reduce the need for medications and the risk of complications. Encourage your child to:

Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
Get more physical activity. Encourage your child to become active. Sign your child up for a sports team or dance lessons, or look for active things to do together.

Better yet, make it a family affair. The same lifestyle choices that can help prevent type 2 diabetes in children can do the same for adults. The best diet for a child with diabetes is also the best diet for the whole family.

Diagnosis

If diabetes is suspected, your child's doctor will likely recommend a screening test. A diagnosis of type 2 diabetes in children generally requires abnormal results from two tests taken on different days. There are several blood tests for diabetes.

Random blood sugar test. A blood sample is taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher suggests diabetes.
Fasting blood sugar test. A blood sample is taken after your child fasts for at least eight hours, or overnight. A fasting blood sugar level of 126 milligrams per deciliter (mg/dL) (7.0 millimoles per liter or mmol/L) or higher indicates type 2 diabetes.
A1C test. This test indicates your child's average blood sugar level for the past three months. An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes. It may also be called the hemoglobin A1C test or the glycated or glycosylated hemoglobin A1C test.
Oral glucose tolerance test. A blood sample is taken after your child fasts for at least eight hours or overnight. Then your child will drink a sugary solution. Over the next few hours, his or her blood sugar levels will be checked again several times. A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher generally means your child has type 2 diabetes.

Additional tests

Your doctor will likely recommend additional tests to distinguish between type 1 diabetes and type 2 diabetes, because treatment strategies for each type differ.

After the diagnosis

Your child will need regular follow-up appointments to check his or her A1C levels and ensure good diabetes management. Your doctor will also periodically check your child's:

Growth
Blood pressure
Cholesterol levels
Kidney and liver function
Risk of polycystic ovary syndrome and obstructive sleep apnea

Your child will also need annual eye examinations.

Treatment

Treatment for type 2 diabetes is lifelong and includes:

Healthy eating
Regular physical activity
Blood sugar monitoring
Insulin or other medications
Weight loss surgery

As your child grows and changes, so will his or her diabetes treatment plan. You'll work closely with your child's diabetes treatment team — doctor, certified diabetes educator and dietitian — to keep your child's blood sugar level as close to normal as possible in order to prevent complications later.

Blood sugar monitoring

Your doctor will let you know how often you need to check and record your child's blood sugar. Children who take insulin usually need to test more frequently, possibly three times a day or more. Checking your blood sugar usually requires finger sticks, although some blood glucose meters allow for testing at other sites. Testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows.

Healthy eating

Because kids are still growing, the focus is on slowing down weight gain instead of losing weight. Your child's dietitian will likely suggest that your child — and the rest of the family — consume fewer animal products and sweets.

Your dietitian is also likely to recommend that you:

Eat lower calorie, lower fat foods
Decrease portion sizes, and don't ask kids to finish everything on their plate
Substitute a fruit or vegetable for a carbohydrate-rich food
Replace high-calorie beverages, such as soft drinks or fruit juices, with water
Eat at home more frequently instead of eating at restaurants
Have kids help make meals
Eat at the dinner table instead of in front of the TV

Physical activity

Physical activity lowers blood sugar. Encourage your child to get regular aerobic physical activity for at least an hour a day and, better yet, exercise with your child. Activity time doesn't have to be all at once — you can break it down into smaller chunks of time.

Medication

There are three medications that have been approved by the Food and Drug Administration for treating type 2 diabetes in children — metformin (Glumetza, others), liraglutide (Victoza) and insulin. Metformin is a pill and liraglutide and insulin are taken by injection.

Metformin reduces the amount of sugar a child's liver releases into the bloodstream between meals and helps the body's cells use insulin more effectively. Liraglutide helps the body release more insulin from the pancreas after meals, when blood sugar levels are higher. Both drugs may have digestive system side effects, such as nausea or diarrhea.

Insulin

Sometimes, insulin may also be needed if your child's blood sugar levels are very high. With lifestyle changes and other medications, your child may be able to be weaned off insulin.

There are a number of different insulins, but a long-acting insulin, such as insulin glargine (Lantus), is often used for type 2 diabetes in children. Insulin is typically delivered via a syringe or an insulin pen. An insulin pump programmed to dispense specific amounts of insulin might also be an option for children who need to take insulin more frequently.

Weight loss surgery

These procedures are not an option for everyone. But, for teens who are significantly obese — a BMI above 35 — having weight loss surgery may lead to a remission in type 2 diabetes.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 2 diabetes — such as low blood sugar, high blood sugar and ketoacidosis — require immediate care.

Low blood sugar (hypoglycemia)

Hypoglycemia (sometimes called an "insulin reaction") is a blood sugar level below your child's target range. Blood sugar can drop for many reasons, including skipping a meal, eating fewer carbohydrates than you planned to, getting more physical activity than normal or injecting too much insulin. Children with type 2 diabetes have less risk of low blood sugar than do kids with type 1 diabetes.

Signs and symptoms of low blood sugar include:

Pale complexion
Sweating
Shakiness
Hunger
Irritability
Nervousness or anxiety

If your child has a low blood sugar reading:

Give your child fruit juice (1/2 cup or 118 milliliters), glucose tablets, hard candy, regular (not diet) soda or another source of sugar
Retest the blood sugar in about 15 minutes to make sure it has gone up into the normal range
If the blood sugar is still low, re-treat with more sugar and then retest in another 15 minutes

High blood sugar (hyperglycemia)

Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating the wrong types of foods, and not taking enough diabetes medication or insulin.

Signs and symptoms of high blood sugar include:

Frequent urination
Increased thirst or dry mouth
Blurred vision
Fatigue
Nausea

If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is persistently above his or her target range, call your child's doctor or seek emergency care.

Diabetes ketoacidosis

A severe lack of insulin causes your child's body to produce certain toxic acids (ketones). If excess ketones build up, your child may develop a potentially life-threatening condition known as diabetic ketoacidosis (DKA). DKA is more common in children with type 1 diabetes, but can sometimes occur in children with type 2 diabetes.

Signs and symptoms of DKA include:

Thirst or very dry mouth
Increased urination
Exhaustion
Nausea, vomiting or abdominal pain
A sweet, fruity smell on your child's breath
Confusion

If you suspect DKA, check your child's urine for excess ketones using over-the-counter ketone strips. If the ketone levels are high, call your child's doctor or seek emergency care.

Lifestyle and home remedies

Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment. But careful management of type 2 diabetes can reduce your child's risk of serious complications.

As your child gets older:

Encourage him or her to take an increasingly active role in diabetes management
Stress the importance of lifelong diabetes care
Teach your child how to test his or her blood sugar and inject insulin if needed
Help your child make wise food choices
Encourage your child to remain physically active
Foster a relationship between your child and his or her diabetes treatment team

School and diabetes

You'll need to work with your child's school nurse and teachers to make sure they know the symptoms of high and low blood sugar levels. Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children get a proper education.

Alternative medicine

Although many alternative therapies have been touted as possible ways to treat or prevent type 2 diabetes, there's no definitive evidence that any of these alternative therapies are effective.

Some supplements or alternative therapies might be harmful if combined with certain prescription medications. Talk with your child's doctor about the pros and cons of specific alternative therapies you might be considering.

Coping and support

Living with type 2 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning. If you notice that your child or adolescent is persistently sad or pessimistic, or experiences dramatic changes in sleeping habits, friends or school performance, have your child assessed for depression.

Your child may find encouragement and understanding in a type 2 diabetes support group for children. Support groups for parents also are available. Websites that offer support include the American Diabetes Association (ADA).

Preparing for an appointment

Your child's family doctor or pediatrician will probably make the initial diagnosis of diabetes. However, you'll likely then be referred to a doctor who specializes in metabolic disorders in children (pediatric endocrinologist).

Your child's health care team will also generally include a dietitian, a diabetes educator and a doctor who specializes in eye care (ophthalmologist).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment take these steps:

Be aware of any pre-appointment restrictions. If the doctor is going to test your child's blood sugar, your child might need to avoid eating or drinking anything but water for eight hours, depending on the type of test.
Write down any symptoms your child is experiencing, including any that may seem unrelated.
Ask a family member or friend to join you, if possible. Managing your child's diabetes well requires you to retain a lot of information. Someone who accompanies you may remember information that you missed or forgot.
Write down questions to ask your doctor.

Some basic questions to ask your child's doctor include:

How often do I need to monitor my child's blood sugar?
What should my child's blood sugar levels be during the day and before bedtime?
What changes need to be made in the family diet?
How much exercise should my child get each day?
Will my child need to take medication? If so, what kind and how much?
Does my child need to take insulin? What are the options for insulin delivery, and what do you recommend?
What signs and symptoms of complications should I look for?
My child has another health condition. How can we best manage them together?
How often does my child need to be monitored for diabetes complications? What specialists do we need to see?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may come up during the appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

What's a typical day's diet?
Is your child exercising? If so, how often?
On average, how much insulin is your child using each day?
Has your child experienced any low blood sugars?
Do you feel confident about your child's treatment plan?
How do you feel your child is coping with diabetes and its treatment?

Contact your child's doctor or diabetes educator between appointments if your child's blood sugar isn't well controlled, or if you're not sure what to do in a certain situation.