Type 2 Diabetes

Because our research informs our treatment, our diabetes team is known for our innovative treatments and science-driven approach. Children’s Hospital Boston is home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our physicians never forget that your child is precious, and not just a patient.

In dealing with your child’s diabetes, you probably want to know the basics about what diabetes is, and how type 2 diabetes differs from other forms of the disease.
 

What are the major forms of diabetes?

Diabetes (diabetes mellitus) is a lifelong condition that occurs when the body doesn’t make enough insulin, or when the body doesn’t respond properly to the insulin it makes. There are many forms of diabetes mellitus, several of which have undergone name changes as the disease has become better understood.

• type 2 diabetes: Formerly known as “adult onset” or “non-insulin dependent” diabetes, type 2 diabetes typically occurs in people who are overweight, physically inactive and over age 40, although more and more children are developing type 2 diabetes, possibly because of childhood obesity. Some children need insulin; others can control their diabetes with healthful eating and exercise, or oral medicines (hypoglycemic agents).
   
• type 1 diabetes: Formerly known as “juvenile” or “insulin-dependent” diabetes,type 1 diabetesis caused by the immune system’s failure to recognize the beta cells as belonging to the body, so it attacks and destroys them. This is why type 1 diabetes is considered an autoimmune disease. Children with type 1 diabetes must take insulin injections every day.

• maturity onset diabetes of youth (MODY): The main feature of MODY is that diabetes has been diagnosed before the age of 35 years in at least three generations of family members. Doctors have identified many specific genetic defects (mutations) in such families. Some people who have MODY need insulin. Others can effectively manage their condition with diet and/or oral medicines. MODY is increasingly being seen in children.

• secondary diabetes: This is a form of the disease in which the beta cells are destroyed, not by the body’s immune system, but rather by cystic fibrosis (“secondary to cystic fibrosis”), pancreatic surgery or another cause.

Note: diabetes insipidus is a very different condition from diabetes mellitus.
 

What is insulin?
 
Insulin is the hormone that allows glucose to enter the cells of the body to provide fuel in the form of glucose. Without insulin, glucose builds up in the bloodstream, starving the body’s cells of energy. Some children with type 2 diabetes need insulin injections. Others can manage their condition with diet, exercise and medication.

• Insulin is a protein hormone made by the beta cells of an area of the pancreas (an organ that lies behind the stomach).
   
• Insulin is needed to help glucose (sugar) enter the cells of the body.
  • When glucose enters the cells, it can be used to produce energy, or it can be stored in the liver and muscles (as glycogen) for later use.
     
• Fatty tissue increases the body’s resistance to its own insulin—this is why obesity is the major reason for children or teens to develop type 2 diabetes.
   
• If the body becomes resistant to its natural insulin, the insulin must be injected so the body can function properly.
   
• Insulin can’t be taken by mouth because the digestive system would destroy it.
   
• Human insulin is the kind most commonly used today to treat diabetes. It’s made in special bacteria (by genetic engineering) so that it’s identical to the insulin the human body produces.
   

What are the signs and symptoms of type 2 diabetes?

While each child may experience symptoms differently, some of the most common include:

• frequent infections that are not easily healed
• frequent urination
• unusual thirst
• blurred vision
• extreme hunger but loss of weight (usually following morbid obesity)
• extreme weakness and tiredness
• irritability and mood changes
• nausea and vomiting
• high levels of sugar in the blood
• high levels of sugar in the urine
• dry, itchy skin (in combination with other signs)
• tingling or loss of feeling in the hands or feet
• acanthosis nigricans (skin disorder characterized by dark, thick, velvety skin in body folds and creases)
   

What are the risk factors associated with type 2 diabetes?

The major risk factors for type 2 diabetes include:

• being overweight (Body Mass Index [BMI] >= 85^th percentile)
• age (incidence increases with age)
• family history of type 2 diabetes
• lack of regular exercise
• being a member of certain racial and ethnic groups, such as African-Americans, Hispanics, and Native Americans, Asians and Pacific Islanders
• conditions associated with insulin resistance, such as:
  • abnormal cholesterol
  • high blood pressure

Children considered to be at risk for type 2 diabetes should be tested periodically, regardless of whether they show signs or symptoms. (For details on diagnosing type 2 diabetes, see Tests.)
 

What is pre-diabetes?

Pre-diabetes is a condition in which your child’s blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. Having pre-diabetes is a significant risk factor for development of diabetes.
 

Can my child prevent or delay the onset of type 2 diabetes?

Your child may be able to prevent or delay type 2 diabetes by eliminating or reducing her risk factors—particularly through weight management and increasing exercise. The Type 2 Diabetes Program at Children’s can work with you and your child to develop a plan for this.
 

How do you diagnose diabetes?

Often, clues are when a child is very thirsty and needs to urinate frequently. Your child’s doctor may also order blood and urine tests including:

• hemoglobin (A1C) test: indicates average blood sugar level for the past two to three months
• random blood sugar test
• fasting blood sugar test: taken after an overnight (eight-hour) fast
• oral glucose tolerance test: a two-hour test that includes checking blood sugar after your child drinks a prescibed sugar drink
• check for autoantibodies in the blood less common in type 2 diabetes (vs. type 1)
• check for the presence of ketones (byproducts from the breakdown of fat in children without enough insulin) in the urine or blood

Test results may need to be confirmed with a second test on a different day, so it’s possible that your child will have blood drawn more than once. Distinguishing between type 1 and type 2 diabetes in children can sometimes be difficult, and your child's doctor may need to do additional testing or monitor your child for some time before the type of diabetes can be confirmed.

Your child will be diagnosed with diabetes if her:

• blood glucose is 126 mg/dL or higher first thing in the morning before eating or drinking (fast for at least eight hours)
  -or-
• blood glucose is 200 mg/dL or higher at any time if symptoms of high blood sugar are also present
  -or-
• blood glucose is 200 mg/dl or higher at two hours during a standard oral glucose tolerance test
  -or-
• hemoglobin (A1C) test is 6.5 percent or higher 

How do you treat type 2 diabetes?

Our diabetes team will help you to determine and balance your child’s insulin, food and exercise to keep her blood glucose levels in a safe and healthy range—and point her on the way to a lifestyle that promotes good general health.

Treating type 2 diabetes is an ongoing process of management and education that includes not only the child with diabetes, but also family members, and often the condition can be controlled through losing weight, improved nutrition and exercise.

If your child has type 2 diabetes, the goal of her treatment is to keep blood-sugar levels as close to normal as possible. Her diabetes team will work with you to develop ways to control her blood sugar (glucose) through: 

• increased and regular physical activity, which improves the body’s insulin sensitivity
• weight management
• routine health care, including frequent monitoring of blood-sugar levels

Through education, dietary consultation and behavior modification therapy, your child’s diabetes team can empower her and you to successfully manage her diabetes. Our registered nutritionists and dietitians will work with you to develop a meal plan based on your child’s specific needs. And our diabetes nurse-educators will work with you and your family to increase your knowledge and confidence, so you can best care for your child.                                               

But sometimes even these steps aren’t enough—and your child’s doctor may need to prescribe oral medications and/or insulin. (See What is insulin? above.)
 

What about emergencies?

We’ll teach you how to cope with emergency situations in which you may need to administer extra insulin (“booster shot”) or check your child’s urine for ketones (toxins released by the body’s breakdown of fat caused by a lack of sugar to the cells of the body). We’ll help you recognize signs that your child may need emergency attention.

For more details, see What are some of the complications associated with diabetes? below.
 

Who will be on my child’s diabetes team at Children’s?

Children’s provides your child—and your family—with a multidisciplinary team whose members include:

• pediatric endocrinologists: medical doctors who specialize in the care of children with disorders that affect any of the body’s hormone-producing glands, such as diabetes mellitus. The endocrinologist supervises the work of the diabetes team and is responsible for your child’s care.
   
• diabetes nurse-educators: nurses who specialize in teaching families how to care for a child who has diabetes. The nurse educator, together with your child’s staff nurses, will teach you about managing your child’s diabetes. After your child returns home, the nurse educator continues to teach and support you, and is available by phone for urgent advice.
    
• registered nutritionists and dietitians: nutritional professionals who’ll help you develop a healthful meal plan that meets your child’s nutritional needs.
   
• behavioral medicine specialists: psycho-social specialists who help families deal with the difficult feelings around living with diabetes. Your social worker or psychologist can offer guidance about your child’s behavior and provide you with information about community resources.
   

If my child needs insulin, how and when should I give it to her?

Not all children with type 2 diabetes need insulin injections. Many cases can be controlled with a combination of weight management, healthful eating, increased exercise and oral medication. But if your child does need insulin, her diabetes team will help you decide what types of insulin she should have, and when you should give it.

• Your child’s nurse will teach you how to measure and inject the insulin.
   
• Your team will also give you tips for:
  • the best time(s) in the day to give insulin—the timing of meals, as well as the pre-meal blood glucose level, may affect the time you should give the injection
  • storing and transporting your child’s insulin
     

What’s a  healthful diet for kids with type 2 diabetes?

Proper meal-planning is very important if your child has diabetes, since the type and amount of food your child eats affects her blood sugar levels. If she eats too much, her blood sugar may go up too high. If she skips meals, her blood sugar may go too low. Good blood sugar control requires a balance of food, exercise and medication. Healthy meals include foods that contain the right amounts of carbohydrates, protein and fat. Learn more.
 

How can I monitor my child’s diabetes day-to-day?

Checking your child's blood glucose (sugar) levels each day will tell you if she’s maintaining a good balance of insulin, food and exercise.

• Your child’s diabetes doctor or nurse educator will recommend the best goal or target range for your child’s blood glucose levels. If these levels are in the target range most of the time, this means that her diabetes is well controlled.
   
• It’s important to measure your child’s blood glucose levels at certain times during the day. Your diabetes team will give you specific recommendations on when and how often you should check her levels.
   
• You’ll use a blood glucose meter to measure the amount of glucose in a drop of your child’s blood, in order to check if her blood glucose levels are within her goal range. Your diabetes team member will recommend a meter for your child and teach you how to use it. These are small and simple to use—and involve just a tiny pinprick.
   

What about exercise for kids with type 2 diabetes?

Exercise is always important for growing children, regardless of diabetes. When exercise is combined with the right amounts of food and insulin (if needed), it will help keep your child healthy, and her blood glucose levels will remain in balance.

In general, exercise tends to lower blood glucose levels.

• When your child exercises, her muscles use glucose at an increased rate to provide energy.
   
• Exercise increases the body’s sensitivity to insulin.
  • The insulin has a greater effect on lowering blood glucose levels when a child is exercising, and even for some time after the exercise is over.

To avoid low blood glucose when exercising for a child on insulin:

• Plan vigorous activities for roughly the same times each day.
• Plan activities to follow meals and snacks.
• Check your child’s blood glucose level before and after exercise.
• Add an extra snack before exercise.
• Plan activities and snacks according to when insulin starts to work, when its peak effect is reach and how long it works to lower blood glucose levels.
   

What are the dangers of not treating diabetes?

Longstanding uncontrolled diabetes can be dangerous. It can lead to serious, even life-threatening, problems such as:

• kidney damage (nephropathy)
• diabetic retinopathy
• poor circulation (especially of the feet)
   

What are some complications associated with diabetes?

People with type 2 diabetes can also be at risk for:

• polycystic ovary syndrome (PCOS)
• high blood pressure
• high cholesterol and triglycerides (metabolic syndrome)
• eventual damage to heart, vessels, nerves, feet skin, eyes, kidneys, gums         

Although type 2 diabetes can cause many different problems, there are several key complications that if uncontrolled, can cause emergencies.

• (only for patients on insulin) hypoglycemia (low blood sugar)
  • occurs when blood sugar drops too low—so the body doesn’t have the source of energy it needs to function properly
  • if unchecked, can result in a low blood glucose medical emergency with loss of consciousness or seizure
  • can result from:
    • too high an insulin dose
    • a missed meal or snack
    • more physical activity than usual
    • sickness with vomiting and/or diarrhea
• common signs and symptoms include shakiness, sweating, weakness, blurry vision, rapid heartbeat
• If your child has signs or symptoms of hypoglycemia, measure her blood glucose level (if possible) and give her 15 grams of a fast-acting carbohydrate such as fruit juice, hard candy or raisins. If the child has lost consciousness, is having a seizure or is unable to take food or fluids by mouth, administer injectable glucagon (a hormone that raises blood sugar) as directed by your diabetes team, or call for medical assistance from your local emergency services (e.g., 911).
   
• hyperglycemia (high blood sugar):
  • can be a sign that diabetes is not well controlled
  • caused by build-up of glucose in the bloodstream; possible causes:
    • not enough insulin—glucose can’t enter the body’s cells
    • too much food, wrong kinds of food
    • less physical activity than recommended
    • sickness or stressors
       
  • excessive urination, bedwetting, weight loss, thirst, yeast infections, nausea and vomiting
     
  • If your child has signs or symptoms of hyperglycemia
    • measure her blood glucose level
    • check her urine or blood for for ketones
    • if you should administer a “booster shot” of extra insulin
       
  • Speak with your diabetes team to discuss a management plan for hyperglycemia. Untreated hyperglycemia and the presence of ketones in the urine or blood could signal and medical emergency called diabetic ketoacidosis. Ketoacidosis develops when the body doesn't have enough insulin and breaks down fats instead of sugar to use for energy. Ketones are produced as part of this process; the body cannot release all of the ketones, which then build up in the blood. Ketoacidosis can be life-threatening and needs immediate treatment. Symptoms include shortness of breath, breath that smells fuity, nausea, vomiting and dehydration.
     
• diabetic ketoacidosis (more common in type 1 diabetes, but can occur in type 2):
  • lack of sugar to the cells of the body cause the body to break down fats, releasing toxins (ketones) into the bloodstream faster than the kidneys can get rid of them
  • Diabetic ketoacidosis is a serious condition that requires immediate medical attention; children become very sick; call your doctor if your child has ketones in her blood or urine.
     

Food, exercise and insulin: How can we find the right balance?

Many factors can affect your child’s blood sugar level, including:

• exercise
• some foods
• some medications (non-diabetic)
• illness, fever

The key to maintaining your child’s blood sugar in a normal range is to balance your child’s type and amount of food intake, level of exercise and insulin dosage (if this is needed). Your diabetes team will help you determine a healthful regimen for your child that balances these key elements.
 

How do we cope with traveling and vacationing?

Traveling with a child who has diabetes requires some advance planning—but it is doable, and your child’s condition doesn’t have to slow up the family’s plans. Joseph Wolfsdorf, MD, associate chief of Children’s Division of Endocrinology, has written a helpful article called Traveling with Diabetes. Wolfsdorf’s article offers indispensable tips for packing, airline travel, spending time outdoors, dining out, transporting insulin, wearing an ID bracelet, packing an emergency kit and lots more.

Your diabetes team will give you a great deal of helpful information about helping your child manage other kinds of stays outside your home when you’re not around—such as sleepovers, school, day care and summer camp (including diabetes camp programs). Here, too, some planning and communication smooth the way.
 

Will my child be OK?

With proper attention to maintaining the balance among your child’s food exercise and insulin (if needed), she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous and lead to damage to nerves, blood vessels, eyes, kidneys and circulation.
 

What new research is Children’s doing on type 2 diabetes?

Our Type 2 Diabetes Program, part of the Optimal Weight for Life (OWL) Program at Children’s Hospital Boston, is actively involved in developing novel dietary approaches and progressive clinical protocols to treat childhood obesity and type 2 diabetes. We’re also engaged in a variety of studies to improve the treatment and ongoing management of overweight children and adolescents, including those with type 2 diabetes.

For more on Children’s diabetes research, see Research & Innovation.

 

FAQ

Q: What is type 2 diabetes?

A: Formerly known as “adult onset” or “non-insulin dependent” diabetes, type 2 diabetes typically occurs in people who are overweight, physically inactive and over age 40, although more and more children are developing type 2 diabetes, possibly because of childhood obesity. Some children need insulin; others can control their diabetes with healthful eating and exercise, or oral medicines (hypoglycemic agents).

Q: If my child has diabetes, will she be OK?

A: With proper attention to maintaining the balance among your child’s food exercise and insulin (if needed), she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous, leading to damage to nerves, blood vessels, heart, eyes, kidneys and circulation.

Q: How does Children’s treat type 2 diabetes?

A: Treating type 2 diabetes is an ongoing process of management and education that involves not only the child with diabetes, but also family members, and often the condition can be controlled through weight management, improved nutrition and increased exercise and activity levels.

Through education, dietary consultation and behavior modification therapy, our team can empower you and your child to successfully manage your child’s diabetes. Our registered nutritionists and dietitians will work with you to develop a meal plan based on your child’s specific needs. And our diabetes nurse-educators will work with you and your family to increase your knowledge and confidence, so you can best care for your child.

After stabilizing your child, the goal of treating her for type 2 diabetes will be to keep blood-sugar levels as close to normal as possible. Your child’s diabetes team will help you control her blood sugar (glucose) through:

• meal planning
  • healthful food choices
  • portion control
  • meals at regular intervals
  • reduced snacking
     
• increased and regular physical activity, which improves the body’s insulin acceptance
   
• weight management
   
• routine health care, including frequent monitoring of blood-sugar levels

But sometimes even these steps these aren’t enough—and your child’s doctor will need to prescribe oral medications and/or insulin. (See What is insulin? in the In-depth tab.)

Q: What are the signs and symptoms of type 2 diabetes?

A:

• frequent urination
• extreme hunger but loss of weight
• unusual thirst
• blurred vision
• extreme weakness and tiredness
• frequent infections that don’t heal easily
• irritability and mood changes
• nausea and vomiting
• high levels of sugar in the blood
• high levels of sugar in the urine
• dry, itchy skin (in combination with other signs)
• tingling or loss of feeling in the hands or feet
• acanthosis nigricans (skin disorder characterized by dark, thick, velvety skin in body folds and creases)

Q: What causes diabetes?

A: Type 2 diabetes often starts with the body’s resistance to insulin. As a result, the body needs to produce more insulin to allow glucose (sugar) to fuel its cells. The pancreas may initially be able to keep up with this increased demand, but eventually it loses its ability to produce enough insulin.

The exact cause of type 2 diabetes is unknown. Although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity—including childhood obesity—to bring on the disease.

Q: If my child has diabetes, what should I ask her doctor?

A: Some of the questions you may want to ask include:

• How is type 2 diabetes different from other types?
• Are other tests needed to confirm the diagnosis?
• What actions might you take to stabilize her?
• What about ongoing treatment and management?
• What can we do at home? What should we change about our lifestyle?
• Is there a danger of emergencies? What should we do in an emergency?
• Will there be long-term effects?

Q: How is diabetes usually diagnosed?

A: If your child is experiencing extreme thirst and frequent urination, these are often clues. Your child’s doctor may also order blood and urine tests including:

• hemoglobin (A1C) test: indicates average blood sugar level for the past two to three months
• random blood sugar test
• fasting blood sugar test: taken after an overnight (eight-hour) fast
• oral glucose tolerance test: a two-hour test that includes checking blood sugar after your child drinks a prescribed sugar drink
• check for autoantibodies in the blood less common in type 2 diabetes (vs. type 1)
• check for the presence of ketones (byproducts from the breakdown of fat in children without enough insulin) in the urine or blood

Test results may need to be confirmed with a second test on a different day, so it’s possible that your child will have blood drawn more than once. Distinguishing between type 1 and type 2 diabetes in children can sometimes be difficult, and your child's doctor may need to do additional testing or monitor your child for some time before the type of diabetes can be confirmed.

Your child will be diagnosed with diabetes if her:

• blood glucose is 126 mg/dL or higher first thing in the morning before eating or drinking (fast for at least eight hours)
  -or-
• blood glucose is 200 mg/dL or higher at any time if symptoms of high blood sugar are also present
  -or-
• blood glucose is 200 mg/dl or higher at two hours during a standard oral glucose tolerance test
• hemoglobin (A1C) test is 6.5 percent or higher

Q: What’s the long-term outlook for a child who has type 2 diabetes?

A: With proper attention to maintaining the balance among your child’s food exercise and insulin, she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous, and can lead to damage to nerves, blood vessels, heart, eyes, kidneys and circulation.

Q: What is Children’s experience treating type 2 diabetes?

A: Children’s Hospital Boston’s Type 2 Diabetes Program provides children and families with a multidisciplinary diabetes team of pediatric endocrinologists, diabetes nurse-educators, staff nurses, registered nutritionists and medical social workers.

Ranked second in the nation in Diabetes by U.S. News & World Report, we are known for our comprehensive services for infants, children, adolescents and young adults with all types of diabetes. This includes type 1 diabetes, type 2 diabetes, cystic fibrosis-related diabetes, steroid-induced diabetes, post-pancreatectomy diabetes and other rare forms of diabetes.
 

Causes

Type 2 diabetes often starts with the body’s resistance to insulin. As a result, the body needs to produce more insulin to fuel its cells. The pancreas may initially be able to keep up with this increased demand, but eventually it loses its ability to produce enough insulin.

The exact cause of type 2 diabetes is unknown. Although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity—including childhood obesity—to bring on the disease.
 

Signs and symptoms

• frequent infections that are not easily healed
• frequent urination
• extreme hunger but loss of weight
• unusual thirst
• blurred vision
• extreme weakness and tiredness
• irritability and mood changes
• nausea and vomiting
• high levels of sugar in the blood
• high levels of sugar in the urine
• dry, itchy skin (in combination with other signs)
• tingling or loss of feeling in the hands or feet
• acanthosis nigricans (skin disorder characterized by dark, thick, velvety skin in body folds and creases)
   

When to seek medical advice

Consult your pediatrician immediately if your child shows signs of some of the following:

• frequent infections that are not easily healed
• frequent urination
• extreme hunger but loss of weight
• unusual thirst
• blurred vision
• extreme weakness and tiredness
• irritability and mood changes
• nausea and vomiting
• high levels of sugar in the blood
• high levels of sugar in the urine
• dry, itchy skin (in combination with other signs)
• tingling or loss of feeling in the hands or feet
• acanthosis negricans (skin disorder characterized by dark, thick, velvety skin in body folds and creases)
   

Questions to ask your doctor

If your child is diagnosed with diabetes, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns are addressed.

Some of the questions you may want to ask include:

• How is type 2 diabetes different from other types?
• Are other tests needed to confirm the diagnosis?
• What actions might you take to stabilize her?
• What about ongoing treatment and management?
• What can we do at home? What should we change about our lifestyle?
• Is there a danger of emergencies? What should we do in an emergency?
• Will there be long-term effects?
   

Who’s at risk

Major risk factors for type 2 diabetes include:

• being overweight
• age (incidence increases with age)
• family history of diabetes
• lack of regular exercise
• being a member of certain racial and ethnic groups, such as African-Americans, Hispanic Americans, and Native Americans
• low-level HDL (high density lipoprotein, the good cholesterol)
• high level of triglycerides

Children considered to be at risk for type 2 diabetes should be tested periodically, regardless of whether they show signs or symptoms.

For details on diagnosing type 2 diabetes, see Tests.
 

For teens

If you’re a teen with diabetes, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you’ll also have to deal with medical appointments, taking your insulin (if you need it), and learning how to strike a balance with your, food, exercise and insulin. Weight control is especially important, as is getting a lot of high-energy exercise.

Even if you’ve been very cooperative until now, you might be feeling lots of pressure to fit in with your classmates, so you may be tempted to neglect the daily steps you need to take to manage your diabetes. Try to resist this temptation. If you neglect your care, you could become very ill. If you follow your regular care regimen—including healthful eating and vigorous exercise—you’ll be able to do most everything your peers can do.

If you feel down, angry or anxious through this important time in your life, speak to your doctor or counselor to get help. And remember: your parents are your partners in managing your diabetes. Trust that they have your best interests at heart; remain “interdependent” with your folks, and keep the lines of communication open.
 

For parents

Regardless of your child’s age, a diagnosis of diabetes can be devastating. Your child may resist all the lifestyle changes that must come with a diagnosis of type 2 diabetes. She may experience feelings of:

• vulnerability
• anger
• difference from peers (“Why me?”)

If your child is a teen with diabetes, the normal challenges of the teenage years can even more intense. Teens want to belong, and being different in any way from one’s peers can be emotionally stressful. She may:

• become rebellious and refuse to comply
• experience denial of the disease
• become aggressive in reaction to the stress of managing diabetes

Helping your teenager with her blood sugar control is especially hard. Researchers believe the growth hormone produced during adolescence that stimulates bone and muscle growth may also act as an anti-insulin agent. Blood sugar levels become harder to control—resulting in blood sugar levels that swing from too low to too high. This lack of control over blood sugar levels can be very frustrating for your teen.

Although a child who’s diagnosed with type 2 diabetes needs supervised medical care, the ideal relationship between parents and child is one of interdependence—with family members working together as a team—especially with a  healthful diet—to help the child live normally and happily. With your encouragement and our diabetes team’s guidance, your child will learn how to take care of her diabetes—and her increasing independence will improve her self-esteem.
 

Prevention

Your child may be able to prevent or delay type 2 diabetes by eliminating or reducing her risk factors—particularly through weight management and increasing exercise. The Type 2 Diabetes Program at Children’s can work with you and your child to develop a plan for this. Your child’s diabetes team is committed to helping you control and manage her type 2 diabetes—so your whole family can thrive.
 

Long-term outlook
 

With proper attention to maintaining the balance among your child’s food, exercise and insulin (if needed), she should not only be OK——she should be able to maintain good general health. But untreated diabetes can be dangerous, leading to damage to nerves, blood vessels, heart, eyes, kidneys and circulation.
 

Diabetes glossary

• autoimmune disease: a disorder in which the body’s immune system reacts against itself and produces antibodies to attack its own healthy cells and tissue
   
• carbohydrates: an important source of energy for kids, and they affect the body's blood sugar the most since the body turns carbohydrates into blood sugar. But if your child eats too many foods with carbs, her blood sugar can go too high.
   
• The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
   
• diabetes (diabetes mellitus): a lifelong condition that occurs when the body doesn’t make enough insulin, or when the body doesn’t respond properly to the insulin it makes. There are many forms of diabetes mellitus, including type 1 diabetes, type 2 diabetes, MODY and secondary diabetes. 
   
• diabetic ketoacidosis (diabetic coma): loss of consciousness due to untreated or under-treated diabetes; a lack of sugar to the cells of the body cause the body to break down fats, releasing toxins (ketones)
   
• (blood) glucose: Found in foods, glucose is an important source of immediate energy for the body. Glucose can also be stored as other forms in the liver and muscles for later use. Excess glucose is converted to fat. Glucose is the main source of fuel for the brain, and is especially important for babies and young children. Complex hormonal and neurologic mechanisms regulate the amount of glucose between meals.
   
• hyperglycemia: condition in which the body’s blood sugar level is too high
   
• hypoglycemia: a condition in which the body’s blood sugar level drops too low
   
• insulin: the hormone that allows glucose to enter the cells of the body to provide fuel in the form of glucose. Without insulin, glucose builds up in the bloodstream, starving the body’s cells. People with type 1 diabetes must take daily insulin injections and must regularly monitor their blood sugar levels. People with type 2 diabetes may or may not need to take insulin.
   
• ketones: toxins that are released when a lack of sugar to the cells of the body causes the body to break down fats
   
• MODY: mature onset diabetes of youth; a form of diabetes that has been diagnosed before the age of 35 years in at least three generations of family members. Many specific genetic defects (mutations) have been identified in such families. Some patients who have MODY need insulin. Others can effectively manage their condition with diet and/or oral medicines.
   
• pancreas: a large gland behind the stomach that plays a key role in digestion. Beta cells in the pancreas create insulin.
   
• secondary diabetes: a form of the disease in which the beta cells are destroyed, not by the body’s immune system, but by  cystic fibrosis (“secondary to cystic fibrosis”), pancreatic surgery or another cause
   
• type 1 diabetes: Formerly known as “juvenile” or “insulin-dependent” diabetes,type 1 diabetesis caused by the immune system’s failure to recognize the beta cells as belonging to the body, so it attacks and destroys them. This is why type 1 diabetes is considered an autoimmune disease. People with type 1 diabetes must take insulin injections every day.
   
• type 2 diabetes: Formerly known as “adult onset” or “non-insulin dependent” diabetes, type 2 diabetes typically occurs in people who are overweight, physically inactive and over age 40, although it’s affecting more and more children, possibly because of childhood obesity. Some patients need insulin; others can control their diabetes with diet and exercise, or oral medicines (hypoglycemic agents).