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Daily Dose

Diagnosing Diabetes

1:30 to read

After just wrapping up National Diabetes month, it seems a good time to review the fact that type 1 diabetes, formerly known as juvenile onset diabetes (JODM) is diagnosed in about 13,000 children every year. In type 1 diabetes the pancreas stops producing insulin, which is the hormone that is necessary to take glucose (sugar) from the bloodstream into the cells, which then provides the body energy.  Without insulin a person’s blood sugar continues to rise, which causes a myriad of effects.  In children the symptoms are increased thirst, weight loss (despite an increased appetite), new onset bedwetting, fatigue, and lethargy.  It is myth that children who eat a lot of sugar are at risk of developing diabetes, but it is known that there seems to be a genetic pre-disposition to developing diabetes, and there may also be a viral trigger involved.  Interestingly, type 1 diabetes is more commonly diagnosed during winter months when there are more circulating viruses.  

Type 1 diabetes, a lifelong disease, is treated with insulin. It was not uncommon to have children giving themselves 2 -3 shots of insulin a day. With improved delivery and monitoring systems many children with type 1 diabetes are now using insulin pumps which provide different amounts of insulin which can be programmed throughout the day.  There are also ongoing studies with pancreas and islet cell transplants as well as stem cell transplants, so stay tuned for new developments in the fight to cure type 1 diabetes.

Type 2 diabetes was previously thought to occur only in adults, but over the last decade there has been an increase in cases among children and notably adolescents. This is thought to be due to the increased incidence of obesity in children, which is a contributing factor to developing type 2 diabetes. In this case, while the pancreas continues to make insulin, it seems that body cannot use the insulin efficiently and the pancreas cannot keep up. This again causes the blood sugar to rise.   In this case many people do not realize that they are slowly developing diabetes and do not have the same symptoms as a child with type 1 diabetes.  One of the early signs may be a rash (acanthosis nigracans) which appears as thickened darkened skin along the nape of the neck or under the arms. 

For many children with type 2 diabetes losing weight and having a regular exercise routine will help to improve blood sugar levels and they may never require insulin.  But, this requires a commitment to lifetime lifestyle changes. 

Lastly, the days of totally restrictive diets for diabetics is “old news” as researches have found that a well balanced diet including some carbohydrates and fats, as well as portion control, are the key to maintaining healthy blood sugars.  This sounds like a healthy meal plan for everyone!

Your Child

Pre-teen Cholesterol Check-Up

1.45 to read

Do you know your child’s cholesterol level? Unless you have a family history of high cholesterol, getting your child’s checked probably hasn’t been high on your list of medical exams.

A panel of experts appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, are recommending that children be tested for high cholesterol by age eleven. They also recommend that children who are overweight, be screened every 2 years for diabetes.

Major medical groups already suggest children, with a family history of high cholesterol or diabetes, be screened early. Children without a family history of heart disease or diabetes have traditionally not been screened until their later years. Times have changed though and because of the childhood obesity epidemic many kids are developing heart disease and Type 2 diabetes at a much younger age.

Fats build up in the heart arteries in the first and second decade of life but usually don't start hardening the arteries until people are in their 20s and 30s, said one of the guideline panel members, Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center.

"If we screen at age 20, it may be already too late," she said. "To me it's not controversial at all. We should have been doing this for years."

An alarming statistic shows how destructive childhood obesity has become. Autopsy studies show that children already have signs of heart disease, long before they show symptoms. By the fourth grade, 10 percent to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.

According to the National Cholesterol Education Program's Expert Panel on Blood Cholesterol in Children and Adolescents, the acceptable level for total cholesterol in kids 2 to 19 years old is less than 170 mg/dL. Their LDL cholesterol should be less than 110 mg/dL, HDL levels should be 35 mg/dL or greater, but preferably over 60, and triglycerides should be 150 mg/dL or less.

Doctors recommend screening between ages 9 and 11 because cholesterol dips during puberty and rises later. They also advise testing again later, between ages 17 and 21.

The rise in Type 2 diabetes, in children, has also increased in the last decade. It is hard to detect type 2 diabetes in children, because it can go undiagnosed for a long time; children may have no symptoms or mild symptoms; and because blood tests are needed for diagnosis. That’s why early screening is so important.

The guidelines also say doctors should:

  • Take yearly blood pressure measurements for children starting at age 3.
  • Start routine anti-smoking advice when kids are ages 5 to 9, and counsel parents of infants not to smoke in the home.
  • Review infants' family history of obesity and start tracking body mass index, or BMI, a measure of obesity, at age 2.

There has been some controversy over doctors using terms like overweight and obese when talking with parents and children about their weight. The panel suggests that these are medically correct terms and should be used so that parents and children understand the importance of the problem.

Children whose BMI is in the 85th to 95th percentile should be called overweight, not "at risk for overweight," and kids whose BMI is in the 95th percentile or higher should be called obese, not "overweight; even kids as young as age 2, the panel said.

"Some might feel that 'obese' is an unacceptable term for children and parents," so doctors should "use descriptive terminology that is appropriate for each child and family," the guidelines recommend.

They were released online by the journal Pediatrics.

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