How to prevent, manage and discuss Type 2 diabetes with children

Type 2 diabetes is alarmingly on the rise in Alabama youth, but following a healthy diet and exercising regularly can help mitigate the risk and the severity. The number of Americans under the age of 20 living with Type 2 diabetes increased by 95 percent from 2001 to 2017, according to the Centers for Disease Control and Prevention. Published study results from the University of Alabama at Birmingham also showed a significant increase in new-onset Type 2 diabetes among Alabama youth during the pandemic that disproportionately affected vulnerable populations.

With an often-irreversible diagnosis and lasting health implications, diabetes is a disease that can be mitigated with the right strategies and support. Jessica Schmitt, M.D., assistant professor in the UAB Marnix E. Heersink School of Medicine Division of Pediatric Endocrinology and Diabetes and Children’s of Alabama, offers advice on how to manage and discuss Type 2 diabetes with children.

Prevention

Family history plays a critical role in the occurrence of Type 2 diabetes, according to Schmitt, but she warns that environmental impact can supersede if not managed.

“Children with a family history of Type 2 diabetes are at higher risk for diabetes, so it is essential they maintain a healthy weight and follow prevention guidelines,” Schmitt said. “Even with no family history, maintaining healthy lifestyle choices is important to reduce risk of developing Type 2 diabetes.”

Diet is a significant component that impacts health overall. According to Schmitt, avoiding certain foods and adding fruits and vegetables to one’s everyday diet can help prevent Type 2 diabetes. She recommends a 5-2-1-0 rule that can help people remember healthy goals to reach each day.

Discussion

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Graphic by: Jody Potter

“Every day, we have the opportunity to try to eat five servings of fruits or vegetables, get two hours or less of screen time a day, move our bodies in a healthy way for one hour a day, and drink zero sugary beverages,” Schmitt said.

If this sounds like too much, Schmitt recommends considering one of these goals to get started.

“For example, if you drink one cup of juice a day, try to cut back to half a cup, then no juice,” she said. “Once you succeed with one element of the 5-2-1-0 goals, move toward the next one.” 

Schmitt also recommends looking for signs that indicate the presence of prediabetes, such as darkening of the skin in the armpits or back of the neck, to help detect the problem early on.

“Parents should play close attention if the child shows increased thirst, urination and unexpected weight loss — these symptoms can be a sign of Type 2 diabetes,” Schmitt said. “Type 2 diabetes is a serious condition that can cause long-term damage to body parts including the eyes, kidneys, immune system, blood flow and nerves.”

If your child is diagnosed with Type 2 diabetes, having honest and strategic conversations about Type 2 diabetes can help children reduce their anxiety and fear of the disease. Schmitt recommends following these guidelines to converse effectively with children: 

• Ease their worries. Explain to children that Type 2 diabetes is a medical condition like asthma or high blood pressure. Children with asthma are not guilted for having trouble breathing, so children with diabetes should not feel guilt either.
• Provide background information. Explain that Type 2 diabetes is a misbalance between blood sugar and insulin, a hormone that regulates sugar in the body. You can use hand motions to demonstrate that this regulation creates two separate roller coasters: When sugar goes up, the insulin goes up, and as the sugar does down, the insulin goes down.
• Explain what is going on with their body. When someone tries to open a door and cannot on the first try, they pull harder. Similarly, when the body’s insulin is having difficulties functioning, it makes more. The reduction in effect of insulin action is called “insulin resistance” and is the first step in developing prediabetes. Prediabetes can progress to Type 2 diabetes, causing symptoms like excessive thirst and urination.
• Explain why they must go through the treatment. Treatment is crucial as it focuses on dietary and lifestyle changes to limit high sugar, increase muscle mass and decrease fat mass to make the insulin work better. Additional treatments include medications to help the body’s insulin work better or replace the insulin if the body can no longer make enough. 

Management

While Type 2 diabetes is a lifelong, serious condition, it can be managed by working with your doctor to consume a healthy diet, exercise regularly and take medications as prescribed, according to Schmitt.

Schmitt suggests to:

• Ask children to follow the 5-2-1-0 rule.
• Limit consumption of any sugary drinks. Drink only water and white milk.
• Avoid concentrated sweets and foods such as desserts, jams and jellies, and foods with added sugars.
• Make sure to include 60 minutes of playtime in your child’s daily routine, but this does not have to feel like work. All activity counts, including things they enjoy such as dancing, playing sports, walking and running. 

Managing Type 2 diabetes varies from person to person, depending on the severity and medication needs, Schmitt says. The best way to prepare and manage is to train your children to make healthy choices in a situation where parental supervision is not possible.

“School can also be a place where juice, tea, soda and chocolate milk show up, so encourage your child to pick healthy options at school,” she said. “If your child is on medication, talk to your diabetes care provider about how to manage Type 2 diabetes at school, while traveling and during fun activities like sleepovers.”