Under normal circumstances, rising glucose levels (a type of sugar) in the blood cause the pancreas to produce the hormone insulin. Insulin allows the glucose in the blood to enter the cells of the body and be converted into energy. Type 2 diabetes develops when the body loses its ability to respond properly to insulin.

In type 2 diabetes, the body’s cells become progressively less sensitive to insulin and, therefore, very large amounts are required for glucose control. Unfortunately, the pancreas cannot maintain this elevated level of insulin production indefinitely, and eventually the body loses the ability to produce all the insulin it needs. At this point, blood sugar levels rise. Despite these high blood sugar levels, symptoms of diabetes may either be absent or so mild as to escape attention.

In contrast, type 1 diabetes, occurs only after the pancreas is severely damaged by the body’s immune system. The damaged pancreas can no longer produce adequate amounts of insulin. Therefore, instead of the high levels of insulin and insulin resistance seen in type 2 diabetes, very low levels of insulin occur in type 1 diabetes. As a result, sudden serious illness requiring emergency insulin treatment is quite common in type 1 diabetes.

Finding the Causes and Risk Factors

Obesity is the major cause of most type 2 diabetes because the tissue of overweight people frequently becomes resistant to insulin. Since physical activity improves tissue sensitivity to insulin, physically inactive people also have tissues that are more insulin resistant.

The short-term effects of type 2 diabetes include:

• Frequent urination
• Increased thirst
• Fatigue

Possible long-term effects of type 2 diabetes include:

• Eye disease and vision problems
• Kidney disease
• Heart disease and circulatory problems (including stroke)
• Nerve damage (neuropathy)
• Problems with wound healing
• Reduced life expectancy

Screening and Diagnosing

According to the American Diabetes Association (ADA), doctors should begin to screen children for diabetes at age 10 or puberty, whichever comes first, if they are overweight and have at least two other risk factors for diabetes. Screening should be repeated every 3 years. In addition to obesity, the risk factors for type 2 diabetes include:

• Family history: a close relative with type 2 diabetes (including mother having diabetes or gestational diabetes)
• Ethnicity: African American, Hispanic/Latino, Asian American, Native American, and Pacific Islander descent
• Conditions associated with insulin resistance, such as:
  • Thickening and darkening of skin at the back of the neck or under the arms (acanthosis nigricans)
  • Cholesterol disorders
  • High blood pressure
  • Polycystic ovary syndrome

A blood test is done for screening and diagnosis. The most commonly used test is the fasting plasma glucose, a blood test done after a person has fasted for eight hours. A fasting plasma glucose (blood sugar) level of 126 milligrams per deciliter or greater on two separate occasions is diagnostic of diabetes. Other tests, like a hemoglobin A1c (HbA1c) test or a two-hour glucose tolerance test, can also be done to diagnose diabetes.

Making Lifestyle Changes

Managing their blood sugar levels requires major lifestyle changes for children. To succeed, children need adult supervision and support. The entire family should work with a diabetes team (doctor, nurse, social worker, dietician, and exercise counselor) to develop a healthy lifestyle.

Children living with type 2 diabetes need daily strategies to maintain normal blood sugar levels. These include:

• Planning healthy meals
  • Eliminate regular sodas, limit carbohydrates and fruit juice, and have your child eat whole grains and vegetables.
  • Count grams of carbohydrates and read food labels.
• Increasing physical activity
  • Encourage your child to get plenty of active play time every day.
  • Plan for periods of low blood sugar by carrying short-acting glucose or carbohydrates.
• Monitoring and taking medicines
  • Check your child's blood sugar levels throughout the day if directed. There are different ways to check blood sugar levels. Some methods involve pricking the finger or arm and applying a drop of blood to a meter with a glucose-sensitive strip.
  • Schedule regular eye and foot exams to detect and treat early vision and circulatory problems.
  • If instructed by the doctor, monitor your child's blood pressure and cholesterol levels.
  • To control blood sugar, have your child take medicines and/or insulin injections as prescribed.

Preventing Type 2 Diabetes in Children

The primary preventive measures for type 2 diabetes are maintaining a healthy weight and getting regular exercise. A diet with age appropriate calorie intake and plenty of fruits and vegetables is ideal for diabetes prevention. Vigorous daily play should also be encouraged in school and at home. Rather than spending time online, watching TV, or playing video games, children should have fun exercising.