Only grown-ups used to get type 2 diabetes. Now one in three American kids is developing it...
By Julie Evans
Smart and funny, 13-year-old Jay Reilly is a computer whiz who loves submarine sandwiches and is devoted to the online strategy game StarCraft. "I can play for 3 to 4 hours at a time," he says. But last spring, while Jay was busy navigating real life in the seventh grade, a strange lethargy overtook him.
He could barely stay awake in class at his Shrewsbury, MA, middle school. He couldn't keep his eyes open long enough to finish his homework at night. Normally an A student, Jay's grades began to slip. He forgot everyday things. He got moody.
Teen angst? His parents didn't think so. They took him to the family doctor, where a blood check hinted at an unexpected diagnosis: early diabetes. And further testing confirmed it: With dangerously high blood sugar and insulin levels, Jay was on the verge of developing type 2 diabetes. His cholesterol was also a high 218.
"We thought type 2 diabetes was an adult disease," says Kathryn, his mom. "Jay is adopted, and we had no medical history. We knew it could be an issue down the road, but we never imagined he'd have to face diabetes as a young teenager."
In Jay's future might be daily medication, maybe even insulin injections. If he developed full-blown diabetes, he'd also have to prick his finger several times a day to test his blood-sugar level, watch every bite he ate, and face the prospect of horrific complications in years to come, from blindness to kidney failure to heart attack.
Looking back, his parents and doctor realized Jay had all the signs of impending diabetes: He was overweight, carried excess pounds around his middle, and was physically inactive. Jay's Korean heritage further raised his risk.
In addition, he had another warning signal found in children headed for diabetes: He had strange patches of brownish-black, velvety skin under his arms, a condition called acanthosis nigricans. "He wouldn't take his shirt off on vacation," Kathryn says. "When he did, we were shocked to see the dark skin and wondered if he had been washing."
This is a signal of higher-than-normal insulin and means that the metabolic breakdown leading to diabetes is underway.
"We'd caught it in time; now we had to do something," Kathryn says. And so the Reilly family mobilized. Jay enrolled in a program for prediabetic kids, the Optimal Weight for Life (OWL) Clinic, at Children's Hospital in Boston. A doctor gave him 2 months to lose weight and lower his blood sugar, insulin, and cholesterol levels through diet and exercise.
If he failed, he'd need diabetes drugs, blood-sugar checks, and a tightly controlled diet--no fun for a teenager.
"I gave up junk food, fried food, soda, even sugary juices and starchy foods such as pastas, potatoes, and breads," says Jay, who is articulate beyond his years. "I filled up on vegetables, broiled chicken, and some fruit. It wasn't very easy at first."
He switched off his computer, PlayStation, and favorite Disney Channel shows. "I swam at my friend's pool. I jumped on the trampoline. And I rode my scooter and my bike," he says. "One of my friends became my personal trainer, motivating me to get out and do stuff. And my friends would say, 'Come on, let's go outside.' They were helping me get healthier."
Two months later, Jay was back at the OWL Clinic to hear good news: He'd lost 15 pounds and significantly lowered his cholesterol and insulin levels. His blood sugar had returned to normal. After another few months, Jay's cholesterol dropped to 171 and his blood sugar to 64. "If I can get rid of the risk of diabetes forever," Jay says, "then all the work is worth it."
The New Childhood Epidemic
Type 2 diabetes could become the most widespread, and potentially devastating, disease to attack America's kids since polio.
A disorder of the body's power-supply system, diabetes is a slow-moving calamity that profoundly disturbs every cell in the body. At the core, it's the failure of cells to absorb glucose, the sugar molecules that fuel muscles, nerves, and the brain.
When sugar cannot enter the cells, it builds up in the blood,
leading over time to devastating complications: heart attack, stroke, kidney failure, nerve damage, even limb amputation and blindness. And when muscle and nerve cells are deprived of glucose, they function more slowly, explaining why early diabetes may reveal itself as fatigue and moodiness.
At one time, type 2 was called adult-onset diabetes; nearly all its victims were over 30. But now, type 2 affects children as young as 4, and the American Diabetes Association says it is "approaching epidemic proportions" in teens.
And it may only get worse. Because of rising obesity and lack of exercise, the Centers for Disease Control and Prevention (magazine) recently predicted that at least one in three American children born in the year 2000 will develop diabetes sometime in their lifetime.
That's potentially 1.3 million of the 4 million 3-year-olds in the US. Among African-American, Hispanic, Asian, and Native American children, the odds are closer to one in two, or every other child, says K. M. Venkat Narayan, chief of the CDC's diabetes epidemiology section.
"The fact that the diabetes epidemic has been raging was well known to us. But looking at the risk in these terms was very shocking," he says."Ten years ago, we saw maybe one or two kids a year with type 2," says Francine Kaufman, MD, a diabetes specialist at Children's Hospital in Los Angeles and immediate past president of the American Diabetes Association. Now, in children's hospitals and pediatric clinics, up to 46 percent of all new diabetes cases are type 2.
Deadly Legacy
Kids with type 2 face adult-size complications. When Canadian researchers followed 51 Native Americans, ages 18 to 33, who had developed type 2 before age 17, they found three on dialysis for kidney failure, one who was blind at age 26, one who had a toe amputated, two who died of heart attacks, and 21 of 56 pregnancies that ended in miscarriage or stillbirth.
"Our worst fears are being realized," says David Ludwig, MD, director of the OWL Clinic. "We're getting the first reports of people who were diagnosed as teenagers and who've had diabetes for 10 years. They're now in their late 20s and, as feared, they are developing kidney failure, and some have required amputations. And they're dying at a higher-than-expected rate."
Perhaps the gravest and most overlooked danger: Because of high blood-sugar and insulin levels, 20-year-old diabetics have cardiovascular diseases once found only in older, out-of-shape adults, such as high blood pressure, high cholesterol, and plaque-choked artery walls. This boosts their risk of early heart attacks and stroke. "It's unprecedented--an impending catastrophe," Ludwig says.
TV, Fast Food, and Overweight Kids
There's no invading virus or sinister bacteria to blame for this epidemic, no vaccine to ward it off nor quick-fix pill to cure it. Type 2 diabetes is a lifestyle disease--a body-fat disease--caused by too much TV, too little activity, and too much high-calorie junk food. Its rise mirrors the huge upswing in childhood obesity that's left one in five American kids overweight or obese.
"At least 80 percent of type 2 diabetic kids are overweight," says Judith Fradkin, MD, an endocrinologist at the National Institute of Diabetes and Digestive and Kidney Diseases in Washington, DC. While some kids have a genetic predisposition to type 2 diabetes, it's almost always extra pounds and inactivity that push their bodies over the edge.
"People used to think that body fat was just a place to store excess calories," Fradkin says. "But as it turns out, fat tissue is biologically active, making hormones and signaling molecules that travel to other parts of the body, telling them to be resistant to the action of insulin."
Four Years Old and Borderline Diabetic
Alexandra (Alex) Berlandi was born 2 months premature in 1996. Her mother's instincts told her to feed, feed, feed the little girl, who weighed just 3 pounds at birth. But by the time Alex was 2, Kim and Michael Berlandi noticed that their toddler was getting chunky. By her third birthday, Alex was off the charts for height and weight. And by her fourth birthday, the pediatrician recommended screening Alex, who was 42 inches tall and 92 pounds, for diabetes.
The results: blood-sugar and insulin levels that were twice the norm.
Kim, who has type 1 diabetes, was all too familiar with the disease. Type 2 ran in both her and her husband's families. Her grandfather, father-in-law, and sister-in-law all have it. And while there's no strong link between type 1 and type 2 diabetes, a recent small study suggests that children whose mothers have type 1 may be more susceptible to type 2, perhaps due to an abnormal environment in the womb. So when she learned that Alex was considered prediabetic and at high risk for developing full-blown type 2 diabetes, Kim knew what to do.
First, she overhauled her refrigerator: Salads, stir-fry vegetables, cottage cheese with kashi, and unsweetened fruit cocktail were in; pasta, bread, whole milk, juice, and desserts were out--for everyone. She trimmed portion sizes and reserved second helpings for vegetables only.
Kim and Alex also began to exercise together. Several days a week, Alex puts on her workout clothes and joins her mom in the home gym Kim set up in the basement. Alex walks on the treadmill and lifts free weights. Four days a week, Kim takes Alex to karate, and they walk or ride bikes together the other 3 days.
Kim's intense involvement in her daughter's well-being is paying off. In the past year, Alex, now 7, has grown 6 inches taller but gained only 2 pounds. "If we can continue on this path, we may be able to prevent her from getting diabetes," Kim says. She and her husband have also benefited: Kim has lost 10 pounds, and Michael's lost 30.
The Family Plan That Stops Type 2 Diabetes
Bottom line: Type 2 diabetes doesn't have to happen to your child. It can be prevented or at least delayed with the same steps proven to keep at-risk adults diabetes-free. All it takes is a family commitment to healthy eating and activity.
"The kids who do best in our obesity treatment program are the ones whose parents are not just supportive but are also participating in the same healthful lifestyle program," Ludwig notes. One reason is that children model adult behavior. If the parent unwinds after work by walking around the block instead of watching TV, for example, the child is more likely to follow suit. "Even if the parents aren't overweight, they can still benefit by decreasing their own risk for diabetes and heart disease through healthful eating and exercise," says Ludwig.
Here's the plan:
Goal #1: Eat HealthyBase meals on fruits, veggies, hearty whole grains, lean protein, fish rich in omega-3 fats (such as wild salmon), low-fat dairy, and moderate amounts of heart-healthful monounsaturated fat from olive and canola oils, suggests Jan P. Hangen, RD, nutrition team leader at the OWL Clinic.
Goal #2: Move at a minimum, children should have moderate to vigorous activity at least half an hour every day, 5 days or more a week. An hour or more a day is even better.
Goal #3: Know If Your Child Is Overweight or at Risk To find out, use the three-step plan to assess a child's weight for her height and age.
If your child is overweight, work with your pediatrician to help her achieve a healthier weight as she grows. (Weight loss diets are not healthy for most kids. The best strategy is to maintain their current weight as they grow taller.)
Kid-Tested Diabetes Fighters
So how do you get your kids to eat better and move more? Try these methods endorsed by childhood diabetes experts:
Start Young
A healthful lifestyle should begin early in childhood, even before the problem of obesity develops. Younger children, not surprisingly, are much more open to guidance from parents than are many teenagers.
Limit TV to 1 to 2 Hours a Day--Max
Not only are children completely inactive while watching TV (burning even fewer calories than they would reading or playing Monopoly), but they're a captive audience for an endless stream of junk food ads.
Give Bad Carbs the Boot
Not all carbs were created equal, and we now have a system to rank them. The glycemic index assigns carbohydrate-containing foods a number based on how they affect your blood sugar after you eat them. Foods with a low GI, such as many fruits and vegetables, legumes, and whole wheat pastas and breads, cause only a small blip in blood sugar; foods with a high GI, such as bagels, frozen waffles, and other refined or highly processed foods, send blood sugar soaring.
Drink More Milk
Not only does it build strong bones, but sipping low-fat milk may also lower kids' risk of developing insulin resistance, the metabolic problem often called Syndrome X. Not only does this lead to type 2 diabetes, but it also increases your risk for heart disease. Harvard Medical School researchers discovered that overweight young adults with the highest dairy consumption were 66 percent less likely to develop Syndrome X than overweight young adults with the lowest dairy consumption. Aim for two or three servings of milk, yogurt, and low-fat cheese daily.
Sip Less Soda
Soda, juice, and other sugar-filled drinks are making our children fat, warn nutritionists at Cornell University. They recently followed 30 children, ages 6 to 13, for 2 months and found that those who drank more than 16 ounces of sweetened drinks per day gained an average of 2 1/2 pounds. That's because children don't eat less to compensate for the extra calories they get from their drinks. Instead, keep the fridge stocked with water and sugar-free drinks such as Fruit2O or Crystal Light Fruit-Flavored Drinks.
Serve Dinner at Home Whenever Possible
Meals prepared in your own kitchen usually have less fat and fewer calories, and you can control portion sizes better. When you do go out to dinner, ask the restaurant to serve half your child's dinner and wrap the other half for later. Don't be misled by children's menus; even kiddie portions can be oversized.
Exercise as a Family
Go to the driving range, swim at your community pool, challenge your child to miniature golf, learn to inline skate together, or just take long walks. You're not only building healthier bodies and habits, but you're showing your kid that the best things in life aren't found on the TV screen or inside a french fry container.
Reward the Effort
Children need to be rewarded for adopting healthier habits, not for the number of pounds lost. "The biggest mistake parents make is offering children food-related rewards in exchange for weight loss," says Hangen. "Reaching a healthy weight is not an event, it's a process, one that takes a long time and requires making some permanent lifestyle changes."
Use Time, Not Food, to Reinforce Good Habits
The next time your child begs for candy after dinner in exchange for eating all his peas and carrots, try offering yourself as a reward instead. Together, you can put on a puppet show, build an amazing castle out of blocks, play dress up--whatever activity your child would enjoy. "We're all so short on time, yet it's the most precious commodity in the world," says Hangen.
Don't Be a Short-order Cook, but Be Flexible
If they don't like the main dish you're serving, tell them that they can have one backup food (such as whole grain cereal with low-fat milk, or scrambled eggs and whole wheat toast) that's healthy and easy to prepare. "Give them some choices that are within reason," Hangen suggests.
Talk Nutrition
It sounds corny, but sometimes they listen: Tell kids how healthy foods help their bodies grow. For little kids, talk up how milk builds bigger, stronger bones. Tell teens how fruit, veggies, and the rest can fill them up and help them look their best. "If you just hand them a diet and say, 'Vegetables are great,' you'll fail every time," says Hangen.
Find out What's on the Cafeteria Menu--and the Recess Schedule
Ironically, many schools have cut back on physical education classes and recess while offering high-fat, high-sugar food choices in vending machines and the cafeteria. If that's your school, consider talking with the principal or even the school board. Many school districts are banning soda and finding ways to bring back PE and recess.
And once in a while, go for a chocolate bar or an ice cream cone or spend a night together watching Harry Potter videos on the couch. (The Reillys still get submarine sandwiches every now and then, though they've switched to whole grain rolls, low-fat dressing, and little or no cheese.)
Parents help by cheering success and by letting kids know it's okay to mess up once in a while, says Hangen. "Whenever there is a self-esteem issue--about body weight or health--there's some guilt and shame hiding underneath. You need to get kids away from their fear long enough to think they can change," she says. "Humor and empathy are key. After all, they're still kids."
Is Your Child at Risk?
Schedule a blood-sugar test (ask for a fasting plasma glucose test) every 2 years beginning at age 10 if your child is overweight and has two or more of these diabetes risk factors. For kids under 10, talk with your doctor.
A family history of type 2 diabetes in first- and second-degree relativesMember of an at-risk race/ethnic group: Native Americans, African-Americans, Latinos, Asian-Americans, South Pacific Islanders
Signs of insulin resistance or conditions associated with insulin resistance, such as acanthosis nigricans, high blood pressure, high cholesterol, high triglycerides, or polycystic ovary syndrome
Nature Versus Nurture
Some people are more susceptible to type 2 diabetes because they're born with a genetic predisposition. If one sibling develops type 2, the risk for brothers and sisters is two times higher than normal. Having one parent with type 2 doubles a child's risk; if both parents have it, risk soars even higher.
But genes aren't destiny, says Enrique Caballero, MD, of the Joslin Diabetes Center in Boston. Even children with a strong family history can prevent or at least delay diabetes by overcoming an even more powerful family risk factor than genetics: a sit-around lifestyle and over-the-top eating habits.
Don't Delay
Many children (and adults) with diabetes have no warning signs, or they have symptoms so mild that they're missed. If your child is overweight, schedule a doctor's appointment if you see any of these type 2 clues:
- Frequent urination
- Excessive thirst
- Extreme hunger
- Unexplained weight loss
- Increased fatigue
- Irritability
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