Type 2 diabetes in children

Symptoms

Type 2 diabetes in children comes on so slowly that you may not see symptoms. Sometimes a healthcare professional diagnoses the condition during a routine checkup.

Some children might have these symptoms because of too much sugar in their bloodstreams:

• Increased thirst and hunger.
• Urinating often.
• Tiredness.
• Blurred vision.
• Darkened areas of skin, most often around the neck or in the armpits and groin. Darkened skin may look dark brown or black on brown or Black skin and light brown or tan on white skin.
• Weight loss without trying. This is less common in children with type 2 diabetes than in children with type 1 diabetes.
• Yeast infections.

When to see a doctor

See your child's healthcare professional if you see any symptoms of type 2 diabetes. Without treatment, the condition can cause great damage.

The American Diabetes Association suggests screening in children who:

• Have started puberty or have reached the age of 10.
• Are overweight or have obesity.
• Have at least one other risk factor for type 2 diabetes.

Risk factors

Researchers don't know why some children get type 2 diabetes and others don't, even if their risk factors are alike. But certain factors raise the risk, including:

• Weight. Being overweight is a strong risk factor for type 2 diabetes in children. The more fatty tissue children have, the more the cells resist insulin. This is mainly true for fatty tissue inside and between the muscle and skin around the belly.
• Not being active. The less active children are, the greater their risk of type 2 diabetes.
• Eating habits. Eating a lot of red meat, processed foods, saturated fat and sugar is linked with a higher risk of prediabetes.
• Family history. Children's risk of type 2 diabetes rises if they have a parent, sibling, grandparent, aunt or uncle with the condition.
• Race or ethnicity. It's not clear why, but certain people are more likely to get prediabetes. In the United States, these include Black, Hispanic, American Indian and Asian American people.
• Age and sex assigned at birth. Many children get type 2 diabetes in their early teens. But it can happen at any age. Teens assigned female at birth are more likely to get type 2 diabetes than are teens assigned male at birth.
• Gestational diabetes. Children born to someone who had gestational diabetes during pregnancy have a higher risk of getting type 2 diabetes.
• Low birth weight or preterm birth. Babies with low birth weights have a higher risk of getting type 2 diabetes. So do babies born before 39 to 42 weeks of pregnancy, called premature.

Type 2 diabetes in children is often linked with metabolic syndrome and polycystic ovarian syndrome.

Metabolic syndrome

People who have certain conditions with obesity may have a higher risk of diabetes, heart disease and stroke. Those with three or more of these conditions often are diagnosed with what is called metabolic syndrome:

• High blood pressure.
• Low levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol.
• High triglycerides.
• High blood sugar levels.
• Large waist size.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) affects people assigned female at birth. It happens after puberty. An imbalance of hormones causes PCOS. Symptoms include weight gain, irregular menstrual periods, and excess face and body hair.

People with PCOS often have issues with how their bodies turn food into energy, called metabolism. Those issues can lead to insulin resistance and type 2 diabetes.

Prevention

Healthy-lifestyle choices can help prevent type 2 diabetes in children. Urge your child to:

• Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains.
• Get more physical activity. Help your child be active. Sign up your child for a sports team or dance lessons.

Make healthy eating and physical activity a family affair. The lifestyle choices that can help prevent type 2 diabetes in children can do the same for adults.

Treatment

Treatment for type 2 diabetes is lifelong. It includes:

• Healthy eating.
• Regular physical activity.
• Insulin or other medicines.
• Blood sugar checks.
• Weight-loss surgery, for some people.

You work closely with your child's diabetes treatment team. The team may include a healthcare professional, a certified diabetes care and education specialist, a registered dietitian, and other specialists as needed.

The goal of treatment is to keep your child's blood sugar within a target range. This target range helps to keep your child's blood sugar level as close to the standard range as possible.

Your child's healthcare professional tells you what your child's blood sugar target range is and may also set an A1C target. These numbers may change as your child grows. So may your child's diabetes treatment plan.

Healthy eating

Food is a big part of any diabetes treatment plan, but that doesn't mean your child has to follow a strict "diabetes diet." Your healthcare professional may suggest weight loss so your child can get to a healthy weight. Blood sugar levels can improve with weight loss.

Your child's dietitian can help your child and the rest of the family follow a healthy-eating plan that suits your family's culture and tastes. Healthy eating includes fruits, vegetables, nuts, whole grains and olive oil. Choose foods low in fat and calories and high in fiber. Give your child many healthy food choices.

Your child's dietitian can help you make a meal plan that fits your child's health goals and includes foods your child likes. You can plan to include treats at times. Your dietitian also may suggest that your child:

• Cut portion sizes and not feel a need to eat all the food on the plate.
• Choose fruits or vegetables instead of carbohydrate-rich foods.
• Drink water instead of sugary soft drinks or fruit juices.
• Eat at home more often instead of eating at restaurants or getting food to carry out from them.
• Help make meals.
• Eat at the dinner table instead of in front of the TV.

Physical activity

Moving more helps children manage their weight, use up sugar for energy and make the body use insulin better. This can lower blood sugar.

Make physical activity part of your child's daily life. Activity time doesn't have to be all at once. It's OK to break it down into smaller chunks of time. Try to have your child get at least 60 minutes of physical activity daily. Even better, exercise with your child.

Medicines

In the U.S., the Food and Drug Administration has approved three medicines for treating type 2 diabetes in children.

• Metformin. This pill cuts the amount of sugar a child's liver puts into the bloodstream between meals. It helps the body's cells use insulin better.

• Semaglutide (Ozempic, Rybelsus, Wegovy). Children 10 and older take this medicine as a shot. It helps the pancreas put more insulin into the body after meals. This is when blood sugar levels are higher. This medicine may cause stomach upset and loose stools.

  Other medicines in this class include liraglutide (Saxenda, Victoza), dulaglutide (Trulicity), exenatide (Byetta) and lixisenatide (Adlyxin).

• Insulin. Some children whose blood sugar levels are very high need insulin. So do some children for whom lifestyle changes don't do enough. Insulin lets sugar into the cells for energy, cutting the amount of sugar in the bloodstream.

  There are different insulins. Children with type 2 diabetes often take a long-acting insulin once a day and a short- or fast-acting insulin with meals. They most often take insulin with a syringe or an insulin pen. With lifestyle changes and other medicines, your child may be able to stop taking insulin.

Blood sugar monitoring

Your healthcare professional tells you how often you or your child need to check and record your child's blood sugar. Children who take insulin need to test more often, maybe four times a day or more.

Some children use continuous glucose monitoring. This uses a sensor placed under the skin to measure blood sugar levels. Testing often is the only way to make sure that your child's blood sugar level stays within the target range.

Weight-loss surgery

This surgery isn't for everyone. But for teens who have a body mass index (BMI) at or above 35, weight-loss surgery may help them manage their type 2 diabetes.

Continuing medical care

Children need regular appointments to manage their diabetes. Visits with your child's healthcare professional can include a review of your child's blood sugar patterns, eating habits, physical activity, weight and medicine, if taken.

Your healthcare professional may check your child's A1C levels. An A1C of less than 7% is standard for children and teens with diabetes.

Sometimes your healthcare professional also checks your child's:

• Growth.
• Blood pressure.
• Cholesterol levels.
• How the child's kidneys and liver work.
• Eyes. This test is most often yearly.
• Feet.
• Risk of polycystic ovary syndrome and obstructive sleep apnea.

Your child's healthcare professional may suggest a flu shot for your child every year. Vaccines for children age 5 and older may include the pneumonia vaccine and the COVID-19 vaccine.

Signs of trouble

Even with your best efforts, issues may come up. For some short-term complications of type 2 diabetes, your child needs medical care right away. These include low blood sugar, high blood sugar, diabetic ketoacidosis and hyperosmolar hyperglycemic state (HHS). These may be life-threatening.

Low blood sugar

A blood sugar level below your child's target range is called hypoglycemia. Blood sugar levels can drop for many reasons, including skipping a meal, eating fewer carbohydrates than planned, getting more physical activity than typical or using too much insulin. Children with type 2 diabetes have less risk of low blood sugar than do kids with type 1 diabetes.

Symptoms of low blood sugar include:

• Being pale and sweaty. Being pale may be harder to see on Black or brown skin.
• Being shaky and hungry.
• Being fussy or having other mood changes.
• Having trouble thinking or feeling dizzy or lightheaded.
• Being less able to move your body well.
• Slurring speech.
• Passing out or having seizures.

Teach your child the symptoms of low blood sugar. When your child isn't sure, the child should always do a blood sugar test. If your child has symptoms of low blood sugar and doesn't have a blood glucose meter nearby, treat for low blood sugar. Then test as soon as possible.

If your child has a low blood sugar reading:

• Give a fast-acting carbohydrate. Give your child 15 grams of something that raises blood sugar fast. This may be fruit juice, glucose tablets, hard candy, sugary soda or another source of sugar. Foods with added fat, such as chocolate or ice cream, don't raise blood sugar as fast. Fat slows the sugar from being taken in.
• Retest blood sugar. Retest your child's blood sugar in 15 minutes to make sure it's back in the target range. If it's not, repeat giving a fast-acting carbohydrate and testing in 15 minutes as needed until you get a reading in your child's target range.

High blood sugar

High blood sugar, also called 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 certain types of foods, and not taking enough diabetes medicine or insulin.

Symptoms of high blood sugar include:

• Urinating often.
• More thirst or dry mouth.
• Blurred vision.
• Tiredness.
• Upset stomach.

If you think your child has hyperglycemia, check the blood sugar. You might need to change your child's meal plan or medicines. Contact your child's healthcare professional if your child's blood sugar is out of the target range often.

Diabetic ketoacidosis

A serious lack of insulin causes your child's body to make certain toxic acids called ketones. If ketones build up, your child may have a life-threatening condition called diabetic ketoacidosis (DKA). DKA is more common in children with type 1 diabetes but can happen in children with type 2 diabetes.

Symptoms of DKA include:

• Thirst or very dry mouth.
• More urinating.
• Dry or flushed skin.
• Upset stomach, vomiting or stomach pain.
• A sweet, fruity smell on your child's breath.
• Not thinking clearly.

If you suspect DKA, check your child's urine for too many ketones using a ketone test kit you can buy without a prescription. If the ketone levels are high, call your child's healthcare professional or seek medical care right away.

Hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic state (HHS) may come on over a few days in children with type 2 diabetes. Blood sugar levels may be 600 mg/dL or higher. There may be bad infections, illness or other medical conditions.

The body tries to get rid of the sugar by passing it in the urine. This can cause a serious loss of body fluids called dehydration.

Symptoms of HHS include:

• No or few ketones in the urine.
• More urinating.
• More thirst.
• Dry mouth and warm, dry skin.
• Not thinking clearly or wanting to fight.
• Seizures.
• Coma.

HHS can be life-threatening. Your child needs care right away.

Coping and support

Living with type 2 diabetes isn't easy for you or for your child. Good diabetes management means a lot of changes. That's why some diabetes specialists include a social worker or psychologist in their diabetes care teams. You're not alone. Your diabetes treatment team is there to support you and your child.

If you see that your child or teen often is sad or has big changes in sleeping habits, friends or schoolwork, ask your diabetes care team about having your child screened for depression.

Your child also may rebel. Children who have been good about their diabetes self-care may rebel as teens and stop caring for themselves. Also, using drugs or alcohol or smoking can be a great danger for people with diabetes.

Talking with a counselor or therapist may help you and your child cope with the big lifestyle changes that come with a diagnosis of type 2 diabetes. Websites that offer support include the American Diabetes Association.