Childhood Diabetes Type 2: Causes, Symptoms, and Treatment

What is type 2 diabetes in children?

Type 2 diabetes affects the way the body processes sugar. It is a chronic condition that develops over time, primarily due to increased sugar levels circulating in the bloodstream. If your child has type 2 diabetes, their pancreas secretes insulin, but their body’s cells don’t respond to it. This is known as insulin resistance and leads to regularly elevated blood glucose levels. 

Type 2 diabetes is more common in older adults. However, there has been an increase in the number of children diagnosed with this type of diabetes. 

Prevalence of childhood type 2 diabetes 

The prevalence of type 2 diabetes among children and adolescents in the US went up by 4.8% per year¹ from 2002-2003 to 2014-2015. According to the CDC 2020 National Diabetes Statistics Report,² out of all the new diabetes diagnoses in children aged 10 through 19 between 2014 and 2015, almost 24% were type 2 diabetes. This is a substantial population of children in the US. 

Type 2 diabetes prevalence among children and adolescents in the US is around 12:100,000. This ratio is quite high compared to Europe’s 2.5:100,000.

What causes type 2 diabetes in children?

Type 2 diabetes was previously known as adult-onset diabetes. But this condition is increasingly affecting those 18 years and under. Potential causes include the rising rates of obesity. 

Obesity has been a growing problem in the US for all age groups, especially within the last five decades. CDC statistics within the last ten years indicate that the percentage of children and adolescents with the condition has more than tripled since the 1970s.

Risk factors 

These are some of the factors that increase the risk of type 2 diabetes in children:

Being overweight

Having a body mass index (BMI) in the overweight or obese range is a strong risk factor for type 2 diabetes. In the pediatric age group, it’s one of the most strongly correlated conditions. Insulin resistance tends to rise with increased fatty tissue, especially inside and between the skin and muscle around the abdomen (visceral fat.) 

Being inactive

A sedentary lifestyle impacts glucose metabolism and contributes to weight gain, increasing the risk of developing type 2 diabetes. This is an increasingly complex problem to overcome in today’s world. 

Despite the US establishing physical activity guidelines, many children are less active than in previous years. Schools have cut back on playtime and physical education. More children live in areas that are not conducive to spending time outdoors, and screen time on electronic devices has reached an all-time high. 

Race or ethnicity

A study focusing on different ethnicities shows that some children are more likely to develop insulin resistance if they are Hispanic, Black, Native American, or Asian American. Insulin resistance leads to type 2 diabetes. 

These differences may be due to many societal factors, such as diet, socioeconomic limitations (e.g., lack of opportunities for physical activity or access to healthy food), and cultural norms.

Diet

Some diets can put your child at a much greater risk of developing type 2 diabetes. This includes diets with highly refined, processed, sugary foods, red meat, processed meat items, and sugar-sweetened beverages. These foods contribute to obesity and fat accumulation, which can lead to insulin resistance.

Other dietary factors that can put your child at an increased risk of type 2 diabetes include: 

• Consuming the Standard American Diet³ (SAD)

• Fast foods

• Cultural food norms such as eating too many animal products and fried foods

• Lack of access to healthy foods and regular meals

A report⁴ from the 2018 Youth Risk Behavior Surveillance System revealed that only 26.6% of students surveyed had eaten vegetables at least two times a day. Only 35% had eaten breakfast in the seven days preceding the study. 

Family history

Children with a parent or sibling with type 2 diabetes may be at a higher risk of developing the condition. Statistics reveal that over 75%⁵ of children who develop childhood diabetes type 2 have a close relative with the condition. 

Age and sex

Type 2 diabetes may occur at any age, but most children develop it in their early teens. 

Children develop physiologic insulin resistance during puberty. If your child is susceptible to type 2 diabetes due to other risk factors such as obesity and genetics, this could cause its onset. 

Symptoms of type 2 diabetes in a child

If your child has type 2 diabetes, they may exhibit some of the following symptoms:

Unexplained weight loss

Unexplained weight loss refers to substantial weight loss without any lifestyle adjustments that would result in weight loss, such as changing diet or starting physical exercise. Although this is primarily a symptom of type 1 diabetes, the metabolic changes in the body related to insufficient insulin in severe disease mean it can also occur in children with type 2 diabetes.

Excessive hunger and thirst

Children with type 2 diabetes may feel excessively thirsty because elevated glucose levels cause dehydration. They often become hungry more frequently. This may be because their cells cannot access the glucose in the bloodstream, and the body sends signals to take in more calories. 

Frequent urination

Excessive glucose levels in the blood can prevent the kidneys from being able to reabsorb it, leading to the dumping of glucose into the urine, with water following. This causes the body to produce larger volumes of urine, increasing the need to urinate. 

Dry mouth

Increased urination can drain water from the body, causing dehydration and reduced moisture in the mouth. Reduced saliva production in type 2 diabetes may aggravate the feelings of dry mouth. 

Excessive fatigue

Changes in how the body uses glucose may affect your child’s energy levels if they have type 2 diabetes. As a result, they may frequently appear extremely tired compared to their typical energy level and alertness.

How is type 2 diabetes diagnosed in a child?

Doctors often find diabetes in the younger population when a urinalysis is obtained for another reason, revealing glucose in the urine. One-third of children with mild type 2 diabetes receive a diagnosis this way.

When the disease has progressed to a more severe form in which blood sugars are very high, your child will have many of the symptoms already explained. Often, parents bring children in for an evaluation. At that time, a random sample of either urine or blood will indicate elevated blood glucose levels. 

Doctors will typically order tests to confirm the diagnosis when this occurs. Below are the tests they frequently use to diagnose diabetes:

Glycated hemoglobin A1C test

This test reveals your child’s average blood glucose levels over the past 2–3 months. When glucose accumulates in the blood, it binds to the hemoglobin in the red blood cells and stays there for the life of the cells, which is usually a couple of months. 

The glycated hemoglobin A1C test can measure the amount of binding. Doctors can use the result to quantify the blood sugars over a period to diagnose diabetes. The A1C is a screening test for children with risk factors and diagnostic purposes. 

It does not require fasting and is relatively simple to perform and interpret.

Interpretation of the hemoglobin A1c test results 

• 4%-5.6% denotes a normal blood glucose level 

• 5.7%-6.4% indicates the child has prediabetes

• 6.5% and above indicate a child has diabetes

Fasting plasma glucose test

The fasting plasma glucose (FPG) test checks the blood glucose level after your child has been fasting. This means they cannot eat or drink anything other than water for at least eight hours before the test. Fasting ensures the sugars in those items do not affect the results. 

The FPG test is less convenient because it requires fasting. But you can plan for it by getting a blood draw first thing in the morning after your child fasts overnight. The results are available almost immediately. 

Interpretation of the FPG test results

• Glucose levels of 70–99 mg/dL are normal and mean the child does not have diabetes.

• 100–125 mg/dL is above the normal range, indicating the child has prediabetes.

• 126 mg/dL or more indicates diabetes. However, the clinician will need to perform another blood test to confirm the diagnosis of type 2 diabetes.  

Oral glucose tolerance test

Glucose tolerance refers to how well your child’s body processes glucose. The oral glucose tolerance test (OGTT) checks glucose levels in the blood at specific intervals. Doctors consider this test more sensitive and better at identifying diabetes in children, which the other tests may miss. 

A few days before the test, your child should consume their typical diet. The clinician should be made aware of any medications your child could be taking at the time as they may interfere with the test results. They should fast for at least eight hours before the test. 

The test begins when the doctor obtains the first blood sample to check a baseline fasting blood sugar level. They give your child an oral dose of a syrupy solution containing 75 grams of glucose. Two hours later, the doctor will draw another blood sample to check the blood glucose level. 

Interpretation of the two-hour blood glucose level

• The blood sugar is normal if under 140 mg/dL.

• 140–199 mg/dL means the child has prediabetes.

• Equal to or above 200 mg/dL indicates diabetes. The clinician will order further testing to confirm type 2 diabetes. 

Other blood tests

When your child undergoes the above tests, which indicate a diagnosis of diabetes, it is not always clear which type of diabetes they have. This is when a doctor orders specialized blood tests to make a specific diagnosis.

In type 1 diabetes, immune cells attack the pancreatic beta cells that produce insulin. There may also be antibodies against insulin and other enzymes. Since there is no insulin present, your child’s liver will produce high levels of a chemical called ketones.

These make it much more likely for you to take your child to the doctor with symptoms. Thus, testing insulin levels and checking for ketones can be helpful. 

Children with type 2 diabetes are more likely to be older, obese, and without serious symptoms. These are the cases that doctors most often pick up on a random blood or urine test. 

A smaller percentage will also have autoantibodies and ketones, so your doctor must look at the whole picture. This includes their body type, age of onset, family history, and other factors to differentiate the two conditions.

Possible complications of type 2 diabetes in children

Potential complications of childhood diabetes are similar to those of diabetes in adults. Most of them manifest in later years, upon reaching adulthood. 

The earlier someone develops diabetes, the longer they will have the disease, making them susceptible to more severe complications later. 

Complications from diabetes include:

High cholesterol 

Diabetes affects how the body uses and regulates sugar, thus leading to excessive glucose levels in the blood. These eventually lead to high cholesterol and triglycerides, fats in the blood that can start building up at a young age. This build-up leads to blood vessel disease that progresses throughout life. High cholesterol levels increase the risk of heart attacks and strokes.

Heart and blood vessel disease 

High glucose levels cause metabolic changes that promote inflammation. Chronic inflammation in the lining of the vessels results in hardening of the blood vessel walls, contributing to high blood pressure. As a result, the heart has to work harder to overcome the resistance and pump blood throughout the body.

The smaller and denser low-density-lipoprotein (LDL) cholesterol particles can easily invade cells lining the blood vessel walls. This results in a chronic inflammatory response that causes plaque to form in the arteries. Plaque buildup is the primary risk factor for heart attacks and strokes.

Stroke 

Another potential complication of type 2 diabetes is stroke. Because of the accumulation of fatty deposits in blood vessels, blood flow to different body parts is affected. A stroke happens when blood cannot reach the brain, starving it of nutrients and oxygen. 

Strokes in children are relatively rare, occurring more frequently in older people with diabetes. The risk increases the longer you have the disease.

Nerve damage 

High blood glucose can harm nerves in the body and result in diabetic peripheral neuropathy. This complication leads to numbness, bone and joint pain, and poor circulation. If nerve damage is left untreated, the reduced sensation in the area results in injuries. They may lead to infections requiring amputation of a toe, foot, or even the leg. 

Initially, scientists thought this occurred later in the disease, with children relatively spared. But recent research found evidence⁶ of peripheral neuropathy that increases over time. The risk of this condition is related to glucose control, older age, higher blood pressure, and higher BMI. 

Kidney disease 

High glucose levels cause metabolic changes that can damage blood vessels and nephrons, the tiny filters in the kidney. The small changes in diabetic kidney disease are evident as early as the first few years after the disease develops. As with the complications of diabetes, the risk of this condition increases with higher blood sugars.

The high blood pressure that may develop in children with type 2 diabetes can also damage the kidneys over time. If the condition is poorly controlled or not managed at all, progressive damage to the kidneys may lead to kidney failure later in life. 

Eye disease 

If you don’t manage your child’s type 2 diabetes properly, it can cause diabetic retinopathy,⁷ which occurs from damage to blood vessels in the back of the eye. When combined with high cholesterol and high blood pressure, this leads to vision loss and even blindness. 

Persistent high glucose levels can also lead to cataracts, a clouding of the lens, which affects vision and clarity. It also increases the risk of glaucoma, which results from damage to the optic nerve. 

Managing type 2 diabetes in children

Treatment 

Blood glucose monitoring

A diabetes care plan teaches you how to achieve healthy glucose levels for your child. Blood glucose monitoring gives you the information needed to keep your child’s blood sugars within their target range.

Managing diabetes involves keeping glucose levels as close to normal limits as possible. This prevents or delays many severe complications of diabetes that develop over the lifespan. 

Your child’s doctor may instruct them to periodically check their blood sugars, sometimes daily, to see how well they are controlling their condition. 

A small home device called a glucose monitor lets you or your child easily monitor their blood sugar levels. A pinprick collects a drop of blood that they place on a test strip. They insert the strip into the device, which will give a blood glucose reading. 

Your child can take readings at specific times to determine if their blood sugar is within their care plan. You can help your child test their blood sugar levels and explain the importance of their readings being within their doctor’s prescribed range. 

A continuous glucose monitor (CGM) measures blood glucose levels automatically. Continuous monitoring is excellent for children with type 1 diabetes, as their sugar levels fluctuate more throughout the day, even with insulin. People with type 2 diabetes don’t often use CGMs, although recent clinical studies in adults⁸ have shown benefits for those on insulin.

Switching to a healthy diet

Diet is a huge part of managing type 2 diabetes in children. A dietitian will recommend that your child consume foods low in sugar, fats, and calories but high in nutritional value and fiber. 

Healthy foods include vegetables, fruits, whole grains, legumes, and healthy fats such as those in nuts, seeds, and olive or avocado oil. Other diet recommendations include reducing portion sizes of calorie-dense foods and replacing high-calorie beverages such as soft drinks with water. 

Seek a dietitian’s help in creating a meal plan that suits your child’s health goals and allows occasional treats. 

Regular physical activity

Exercise is vital for everyone, especially for a child with type 2 diabetes. Physical activity supports weight control and the body’s effective use of sugar for energy. Most children can start with daily sessions of at least 60 minutes and increase the duration gradually. 

Your child doesn’t need to join a sports team to get the benefits of exercise. They can always go for other options such as playing outside, house chores such as cleaning, raking, and sweeping, and activities like bike riding, walking the dog, and swimming. 

If your child has been inactive, discuss this with their doctor, introduce them to exercise slowly, and develop clear goals.

Medications

The US Food and Drug Administration (FDA) has approved insulin and metformin for children. 

Metformin and lifestyle adjustments can often be sufficient for newly diagnosed type 2 diabetes. However, insulin therapy is necessary if your child’s hemoglobin A1C level is more than 9% or if their random plasma glucose test level is 250 mg/dL or more. 

Doctors may prescribe insulin for a short time in the beginning if your child’s glucose levels are very high. Your child can administer it through an injection or insulin pump. Insulin helps them on a short-term basis. They can stop taking it after starting metformin and lifestyle modifications in many cases. 

If your child is taking diabetes medication, adhere to their care plan to keep their blood sugar in a healthy range. Implementing lifestyle changes can often improve blood glucose levels well enough that their doctor can minimize their medications. 

Prevention

Healthy lifestyle habits can prevent type 2 diabetes in children. 

They include:

Consuming a healthy diet

Another effective way to prevent childhood type 2 diabetes is by improving your child’s diet. Ensure your child eats plenty of fresh vegetables, fruits, and whole grains. Restrict highly processed sugary foods and drinks. Discuss the value of diet with your child, model it by preparing and eating nutritious food, and teach them about nutrient-dense calories and healthy choices. 

Exercising regularly

Regular physical activity will help your child maintain a normal weight, significantly reducing their type 2 diabetes risk. Encourage them to cut back television and video games to no more than 2 hours a day and play outside. They should get at least one hour of moderate to vigorous exercise daily. 

Maintaining a moderate body weight

Maintaining a moderate body weight range can prevent type 2 diabetes. Your child’s doctor can advise a target weight range and recommend a program for losing weight if needed. 

When to see a doctor?

Generally, you should consider diabetes screening if your child has obesity or other risk factors for type 2 diabetes. You should also seek medical intervention if you notice signs of the condition. 

Some children may not show symptoms of type 2 diabetes. If your child’s healthcare professional suspects the condition, they’ll evaluate their medical history, perform a physical examination, and order tests. 

After diagnosis, the doctor will work with you to create a treatment plan to keep your child healthy. Early diagnosis and proper management of childhood type 2 diabetes are crucial for avoiding potential complications throughout life.

The lowdown

Type 2 diabetes in children is emerging as a new and more frequently encountered medical issue in pediatric practice. Healthy lifestyle habits, including maintaining a moderate weight, a nutritious diet, and regular physical activity, can prevent and treat the condition. Early diagnosis and treatment reduce the risk of potential complications.