Type 2 diabetes in children: an emerging epidemic

In South Africa forty to fifty percent of adults are obese and one out of four children is overweight (Health24.com). Sister Lynne Starck, Diabetes Nurse Specialist at Red Cross Children's Hospital in the Western Cape, confirms that there has been an increase in the number of children diagnosed with type 2 diabetes

Why are our children getting type 2 diabetes?

According to Sister Gwen van der Merwe, Diabetes Educator at the Panorama Medi-Clinic, there is a direct link between increased child obesity and the onset of type 2 diabetes. “Although in some cases genetics or ethnic factors might be at play, diabetes type 2 is most often caused by irregular eating habits, large portions of food with low nutritional value and a lack of exercise,” says van der Merwe.

Why are our children obese?

According to the Heart Foundation of South Africa, the onset of the modern urban lifestyle has much to do with this trend. Many children are physically inactive opting to rather stay in-doors and watch television or play computer games rather than running around outdoors or taking part in sport.

Children are also more tempted (largely due to advertising) to eat fast foods and “junk foods” such as hamburgers, chips, pizzas, chocolates, ice cream, fizzy drinks and sweets. These foods are high in fat and sugar, with little nutritional value and contribute to obesity.

How do I know if my child has type 2 diabetes?

“A family history of diabetes always puts the child at risk,” says Sister Karen Pike of Constantiaberg Medi-Clinic's Diabetic Clinic, “other symptoms include constant tiredness, hunger and thirst as well as the frequent passing of sweet smelling urine.”

Van der Merwe warns that besides being clinically overweight there are often no noticeable symptoms, “a diagnosis can however be confirmed with a fasting blood glucose test or a glucose tolerance test”.

What are the dangers associated with type 2 diabetes?

“There are a number of long term complications associated with diabetes which can be quite severe,” says Pike, “cataracts and retinopathy (gradual damaging of the eye) may lead to blindness. The kidneys are at risk of damage, leading to kidney failure, dialysis and a kidney transplant. Patients often complain of painful feet due to nerve and small blood vessel damage putting them at risk of infections which can lead to gangrene and amputation. Heart attacks and strokes may occur due to the hardening and narrowing of the arteries.”

What is the treatment for type 2 diabetes and how can I help my child manage this condition?

Van der Merwe recommends a four sided approach:
1. Dietary changes: Dietary advice should be directed to the whole family. A dietician will draw up a meal plan indicating mealtimes, routines, and preferences that are important for the child's family. The aim of the dietary changes is to lower the Glycemic Index and fat content of the foods consumed.
2. Increased exercise: By increasing cardiovascular exercise, insulin receptors function more effectively and the body is better able to utilise glucose in the blood. Exercise should form part of a child's daily routine – remember playing can also be very good exercise! Participation in sport should be encouraged.
3. Monitoring: Blood glucose readings are essential to ensure that the blood glucose levels are within the recommended range, thereby avoiding complications caused by elevated blood glucose levels. These readings can be obtained by doing a simple home test.
4. Medication: After lifestyle changes have been put into place, oral anti-diabetic agents can be very effective in the treatment of type 2 diabetes in young people. Although type 2 diabetes is called non-insulin dependent diabetes, many people may need insulin treatment at a later stage.

She also recommends enlisting the help of your child's teacher/s in managing the condition: “Help the teacher to understand the disease and request that he/she refrain from labelling the child,” suggests van der Merwe, “also ensure that your school's tuck shop provides healthy alternative snacks and that your child's teacher accommodates your child's need for snacks in the daily routine of the classroom.”

Is there a cure for type 2 diabetes?

There is no cure for diabetes, type 1 or type 2. Once you are diagnosed as a diabetic you will always be one. According to the International Diabetes Federation adults who reduce their weight, can reduce the development of type 2 diabetes. Pike adds that with good management (losing weight and exercising), type 2 diabetes can be very well controlled and medication may be reduced or, in rare cases, even stopped for a period of time.

What can I do to minimise the risk of my child becoming a type 2 diabetic?

Van der Merwe recommends that parents set an example of a balanced lifestyle as children learn from what they see their parents do!

She suggests:
- Become active as a family by taking up an active hobby for example hiking, cycling or ten pin bowling.
- Minimise television watching and computer games and rather use these activities as a reward.
- Offer vegetables (carrots / cucumber sticks) or fruit as a snack.
- Minimise junk food by consuming less (junk food) and making a habit of serving meals with a salad.
- Avoid diets and instead teach your child healthy eating habits.

What is the difference between type 1 and type 2 diabetes?

The cause of type 1 diabetes is unknown. In this instance the pancreas does not and never will produce enough insulin. As a result, people with type 1 diabetes need to inject themselves with insulin up to four times a day for the rest of their lives. Type 1 diabetes usually occurs before the age of 40 and symptoms (frequent urination, tiredness, thirst, hunger and weight loss) occur rapidly.

Type 2 diabetes usually occurs in adults, but can occur at any age. Patients are usually overweight and when symptoms occur they are usually mild and vague and often go unnoticed. Symptoms include blurred vision, fatigue, dizziness, thirst, frequent urination, recurring skin, mouth and bladder infections and wounds that are slow to heal.

What is the relationship between diabetes and obesity?

When food is digested, glucose is released into the blood stream. This glucose is used in the cells of the body for growth, repair and energy. Normally when blood glucose levels increase, the pancreas produces insulin to lower the blood glucose levels. Each cell has insulin receptors (door locks) in which the key (insulin) has to fit enabling glucose to enter the cells. When a person is obese, these insulin receptors do not function effectively – they do not open the door into the cell effectively enough to give the cell access to the glucose in the blood. The glucose accumulates in the blood; this is known as insulin resistance and places a greater demand on the pancreas to produce more insulin leading to the development of clinical diabetes.

Issued by: Magna Carta Cape Town
On behalf of: Medi-Clinic Private Hospital Group

Contact:Natalie Bezuidenhout

Tel:021 417 5773

Email: natalie.bezuidenhout@cape.magna-carta.co.za