TYPE 2 DIABETES MELLITUS, DIAGNOSIS, PAEDIATRIC
Type 2 diabetes (type 2 diabetes mellitus) is a long-term (chronic) disease. In type 2 diabetes, one or both of these problems may be present:
- The pancreas does not make enough of a hormone called insulin.
- The cells in the body do not respond properly to insulin that the body makes (insulin resistance).
Normally, insulin allows blood sugar (glucose) to enter cells in the body. The cells use glucose for energy. Insulin resistance or lack of insulin causes excess glucose to build up in the blood instead of going into cells. As a result, high blood glucose (hyperglycaemia) develops.
Your child may be more likely to develop type 2 diabetes if he or she:
- Has a family member with type 2 diabetes.
- Is overweight or obese.
- Has an inactive (sedentary) lifestyle.
- Was unusually small before birth (intrauterine growth restriction).
- Was born to a mother who had a temporary form of diabetes during pregnancy (gestational diabetes).
- Has been diagnosed with insulin resistance.
In the early stage of this condition, your child may not have symptoms. Symptoms develop slowly and may include:
- Increased thirst (polydipsia).
- Increased hunger (polyphagia).
- Increased urination (polyuria).
- Increased urination during the night (nocturia). Bedwetting may be a sign of nocturia.
- Unexplained weight loss.
- Frequent infections that keep coming back (recurring).
- Pain in the abdomen.
- Irritability or behaviour changes.
- Vision changes, such as blurry vision.
- Cuts or bruises that are slow to heal.
- Tingling or numbness in the hands or feet.
- Dark patches on the skin (acanthosis nigricans).
This condition is diagnosed based on your child’s symptoms, his or her medical history, a physical exam, and his or her blood glucose level. Your child’s blood glucose may be checked with one or more of the following blood tests:
- A fasting blood glucose test (FBG). Your child will not be allowed to eat (he or she will fast) for at least 8 hours before a blood sample is taken.
- A random blood glucose test. This test checks blood glucose at any time of day regardless of when your child ate.
- An A1c (haemoglobin A1c) blood test. This test provides information about blood glucose control over the previous 2–3 months.
- An oral glucose tolerance test (OGTT). This test measures your child’s blood glucose at two times:
- After fasting. This is your child’s baseline blood glucose level.
- Two hours after drinking a beverage that contains glucose.
Your child may be diagnosed with type 2 diabetes if his or her:
- FBG level is 126 mg/dL (7 mmol/L) or higher.
- Random blood glucose level is 200 mg/dL (11.1 mmol/L) or higher.
- A1c level is 6.5% or higher.
- OGGT result is higher than 200 mg/dL (11.1 mmol/L).
These blood tests may be repeated to confirm your child’s diagnosis.
Your child’s treatment may be managed by a specialist called a paediatric endocrinologist. Type 2 diabetes may be treated by following instructions from your child’s health care provider about:
- Encouraging your child to make diet and lifestyle changes. This may include having your child:
- Follow an individualized nutrition plan that is developed by a diet and nutrition specialist (registered dietitian).
- Exercise regularly. Exercise can lower blood glucose. It is especially important to check blood glucose before and after exercise. Your child may need to eat a snack before exercising to help prevent low blood glucose.
- Checking your child’s blood glucose as often as told.
- Giving diabetes medicines or insulin daily. This helps keep your child’s blood glucose levels in the healthy range.
- If your child takes insulin, you may need to adjust the dosage based on how physically active your child is and what foods your child eats. Your child’s health care provider will tell you how to do this.
- Giving medicines to help prevent complications from diabetes.
- Making a written care plan (504 Plan) for managing your child’s diabetes at school.
Your child’s health care provider will set individualized treatment goals for your child based on age and any other medical conditions your child has. Generally, the goal of treatment for most children and adolescents is to maintain the following blood glucose levels:
- Before meals (pre-prandial): 90–130 mg/dL (5–7.2 mmol/L).
- At bedtime and overnight: 90–150 mg/dL (5–8.3 mmol/L).
- A1c level: less than 7.5%.
Questions to Ask Your Child’s Health Care Provider
Consider asking the following questions:
- Do my child and I need to meet with a diabetes educator?
- Where can I find a support group for children with diabetes?
- What equipment will I need to manage my child’s diabetes at home?
- What diabetes medicines does my child need, and when should I give them?
- How often do I need to check my child’s blood glucose?
- What number can I call if I have questions?
- When is my child’s next appointment?
- Give over-the-counter and prescription medicines only as told by your child’s health care provider.
- Keep all follow-up visits as told by your child’s health care provider. This is important.
- Your child’s blood glucose is out of his or her healthy range. Your child’s health care provider will give you guidelines about when you should contact a health care provider in these cases.
- Your child develops a serious illness.
- Your child has been sick or has had a fever for 2 days or more, and he or she is not getting better.
- Your child cannot eat or drink.
- Your child has nausea or vomiting.
- Your child has diarrhoea.
- Your child’s blood glucose is lower than 54 mg/dL (3 mmol/L).
- Your child becomes confused or has trouble thinking clearly.
- Your child has difficulty breathing.
- Your child has moderate or large ketone levels in his or her urine.