Diabetes Rising

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The rise in Type ll diabetes in children is linked not only to genetics, but increasingly, to a sedentary lifestyle and an environment where health is not prioritized.

Full435.jpgParents, take back control of the reins!

America’s super-sized, laid-back lifestyle is a recipe for obesity and the many ailments associated with it. In fact, in the last three decades the number of overweight children has tripled. More than 20 percent of all preschool children are now overweight, double the number in 1970; more than one in 10 are considered clinically obese.

Type ll diabetes is one of the diseases of obesity that is striking at a much younger age than ever before. In the late 1980s and early 1990s, only about one to four percent of the children with diabetes had Type ll; by the mid- to late 1990s, pediatricians across the country began to sound the alarm that the number of children diagnosed with Type ll diabetes had risen to about 10 percent. Within certain ethnic and socio-economic populations, the number approached 50 percent.

There are two types of diabetes – Type l and Type ll. Type l diabetes is an autoimmune disorder in which the body’s own immune system destroys the insulin-producing islet cells in the pancreas. It is sometimes called “juvenile diabetes,” with onset occurring sometime in childhood, primarily in the teens and early 20s.

Type ll used to be called “adult-onset” diabetes and was most often diagnosed in middle age. In this form, the body produces insulin, but either there’s not enough or the cells become resistant, “locking out” the insulin. Insulin takes the sugar from the blood into the cells and is necessary for the body to be able to use sugar, which is the basic fuel for cells.

In Type ll diabetes, too much sugar (glucose) stays in the bloodstream and over time, wreaks all kinds of havoc within the body. Long-term consequences may include heart disease, kidney failure, blindness, nerve damage and loss of limbs. Complications from diabetes occur when diabetes is not properly managed.

Type I diabetics requires insulin, since they are no longer able to manufacture it. The treatment for children with Type ll is the same as for adults. They may require insulin at first, but once their blood sugar levels get to a normal range, they may be able to switch to an oral medication.

In addition to taking a pill, those with Type ll diabetes must check their blood sugar level and record it twice a day. This requires a finger prick to obtain a drop of blood, which is inserted into a glucose monitor to get a reading. A program of physical activity and dietary modification also is usually recommended. Some people may be able to completely control their diabetes through diet and exercise.

Pediatricians usually refer children to pediatric endocrinologists to conclusively diagnose and treat diabetes. Children then receive primary care from their regular pediatrician and diabetes care from the endocrinologist, assisted by a registered dietician.

Type ll Diabetes Linked to Lifestyle

Until the late 1990s, Type ll diabetes was considered an adult disease. Why are so many children developing it now?

Experts agree on two causes: obesity and genetics. “Children are at a much greater risk of developing Type ll diabetes if their parents, grandparents, aunts, uncles or cousins have the disease, and the risk goes up even more when the child is overweight,” explains Travis Walters, M.D., a pediatrician with Green Hills Pediatric Associates.

Certain ethnic groups, including Mexican Americans and African Americans, also have a higher incidence of both Type ll diabetes and obesity. This is true for both children and adults.

Even without a family history, being overweight can lead to development of the disease,” Walters says. “More than 85 percent of the kids with Type ll diabetes are obese.”

Environmental factors are closely linked to the genetic component. “It’s very rare that an overweight child doesn’t have at least one overweight parent,” Walters points out. “The child’s weight problems usually start at about 9 months, when table foods are introduced. Even when a baby has been tracking normally on the growth chart, by about 12 to 15 months there can be a huge gain in the weight curve when the child starts eating what the parents eat.”

Local Registered Dietician Heather Holden also sees the environmental link to being overweight. She says it’s difficult to say what percentage is attributable to genetics and how much is influenced by lifestyle, including societal habits. Holden is coordinator of SHAPEDOWN, a family-based weight loss program at Vanderbilt University Medical Center. She also works on an individual basis with children with Type ll diabetes in the outpatient pediatric endocrine clinic.

Children are very much ‘monkey-see, monkey-do’ with the adult figures in their lives,” she says. “If parents or guardians aren’t willing to make changes in their eating and exercise habits, the kids won’t, either. Our main focus is changing lifestyle habits (of the whole family) rather than on a specific number of pounds lost.”

Holden says that societal pressures over the last 30 to 40 years have had an impact on America’s waistlines. “We’re not manual laborers any more, but we still eat like we are,” she points out. “Rarely do we walk like we did when communities were small and we could walk to the corner grocery or drugstore or school.

“And look how families have evolved,” she continues. “It’s almost an economic necessity for both parents to work outside the home. Kids have to be driven to their activities all over town. Rarely do families get to sit down to dinner together, so everyone grabs fast food – either from a drive-through or a package heated in the microwave.”

She also says that soft drinks or athletic drinks such as Gatorade have become the drink of choice for many children, replacing milk or even fruit juice. Sodas are high in empty calories, adding pounds without nutrition. Sports drinks are designed to replace sugar and electrolytes lost by heavy exercise and are not a good choice for a routine beverage.

Holden stresses that diet modifications include quantity as well as type of food. She recommends “getting back to basics – drinking water, low-fat milk or sugar-free drinks – and making changes slowly.” This might be as simple as cutting out that bag of chips the child grazes on over the course of several hours of TV-watching. “Just like adults, they don’t realize how much they’re eating,” she points out, “and they eat well beyond hunger satisfaction.”

In fact, getting the kids off the couch and out into the yard for a game that requires running, jumping or other heart-pumping exercise is even better than arguing over the right to eat chips and drink sodas. Not only will they reduce their intake of calories, they’ll actually burn off some of the excess.


Whatever Happened to Phys. Ed.?

Holden and Walters both cite the changes in school physical education requirements as a negative impact on children’s health. “From 1991 to 1995, overall daily high school P.E. classes decreased from 40 to 25 percent,” Walters points out, “and only 50 percent of high school students report having regular vigorous activity.”

He recommends that parents get their children involved in sports, including dance, gymnastics, skating and other noncompetitive activities, as early as possible. “The whole family can walk the dog or go for a bike ride,” he says. “It doesn’t have to be all about sports. It’s important to choose something that’s fun and that involves everyone in the family.”

Consequences of Childhood Obesity

The consequences of not making changes to control weight in children are grave – some have called it tantamount to child abuse. Overweight children are more likely to develop a number of potentially life-threatening conditions, including Type ll diabetes, and suffer the complications at a much earlier age.

It usually takes about 20 years for the first signs of diabetes complications to show up, according to the American Diabetes Association. “With more and more children developing Type ll diabetes, we’re going to start seeing 20- and 30-year-olds dying from heart disease, going on kidney dialysis or losing their sight,” warns Walters.

A Lifestyle You Can Live With

What kind of changes should parents make if their children are overweight, or heading in that direction? First of all, Walters and Holden concur, remember who’s the parent. Children may demand only certain foods, but parents do not have to cave in to their demands. “Children will eat enough to grow even if they’re picky,” says Walters.

Use the food pyramid as your guide to meal planning. Replace refined starches such as white bread with whole grains; drink skim or low-fat milk; bake or broil lean meats; replace processed snacks with fresh fruit. Read food labels and avoid items with hydrogenated oils as much as possible to cut down on trans fatty acids. Remember: everyone needs at least 30 minutes of vigorous physical activity every day, so get moving!.

Nancy W. Brown is a freelance writer and mother living in Nashville.

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