Definition

Type 2 diabetes mellitus (T2DM) in children is a chronic disease that affects the body's ability to regulate blood sugar (glucose). Glucose is an energy source for the body's cells, and insulin is a vital hormone in regulating blood sugar, facilitating glucose transport from the bloodstream into the cells that need it.

Under normal conditions, insulin works as follows:

• The body breaks down nutrients in food into glucose, making it easily usable as an energy source.
• Glucose circulates in the blood, signaling the pancreas to release insulin.
• Insulin helps transport glucose from the blood into muscle, fat, and liver cells to be used for energy.
• As glucose enters the body's cells, blood glucose levels decrease, signaling the pancreas to reduce insulin production.

In children with type 2 diabetes, this mechanism is disrupted, leading to the accumulation of glucose in the bloodstream. Without proper treatment, this condition can cause blood sugar levels to rise, leading to serious long-term complications.

There are several types of diabetes, and type 2 diabetes typically occurs in adults. However, there has been an increase in cases among children, adolescents, and young adults, likely related to the rising rates of obesity in these groups.

Causes

Normally, when you consume food, the digestive system breaks it down, and the necessary nutrients are absorbed. Glucose is needed by cells as an energy source. When glucose starts circulating in the blood, the pancreas releases insulin to transport glucose into the cells. In type 2 diabetes, this process is disrupted.

The exact cause of type 2 diabetes is unknown, but the following mechanisms are observed in patients:

• Insulin resistance: Body cells become less responsive to insulin, preventing glucose in the blood from entering the cells. As a result, blood sugar levels remain high.
• Pancreatic beta cell dysfunction: The cells responsible for releasing insulin fail to compensate for insulin resistance, eventually becoming damaged and unable to produce enough insulin.

In children and adolescents diagnosed with T2DM, a family history of diabetes and genetic factors are often involved. Additionally, being overweight or obese is a significant risk factor for developing this disease.

Risk Factor

Children are at higher risk of developing type 2 diabetes if they have any of the following risk factors:

• Age 12-16 years.
• Female gender.
• Overweight or obesity.
• Physical inactivity.
• Low or high birth weight.
• Lack of breastfeeding during infancy.
• Hormonal changes.
• Premature birth.
• Maternal gestational diabetes during pregnancy.
• Family history of type 2 diabetes.
• Low HDL ("good") cholesterol and/or high triglyceride levels.

Symptoms

Symptoms of type 2 diabetes in children can develop very slowly, making them less noticeable. Many children are diagnosed during routine check-ups without showing significant symptoms.

When blood sugar levels become very high, the following symptoms may appear:

• Increased thirst or hunger.
• Frequent urination, especially at night.
• Fatigue.
• Blurred vision.
• Darkened skin areas, such as on the neck, armpits, or groin.
• Unexplained weight loss.
• Frequent infections.
• Slow healing of wounds or cuts.

Diagnosis

If type 2 diabetes is suspected in a child, the doctor will recommend initial screening tests. Blood tests that can detect type 2 diabetes in children include:

• Random blood sugar test

Blood is taken at any time without regard to the last meal. A result of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.

• Fasting blood sugar test

The child fasts for at least 8 hours before the blood sample is taken. Results are interpreted as:

• • <100 mg/dL is normal.
  • 100-125 mg/dL indicates prediabetes.
  • ≥126 mg/dL indicates diabetes.

• HbA1c test

This test measures blood sugar levels over the past three months. Results are interpreted as:

• • <5.7% is normal.
  • 5.7-6.4% indicates prediabetes.
  • ≥6.5% on two separate tests indicates diabetes.

• Oral glucose tolerance test

The child fasts overnight, then drinks a sugary liquid provided by the doctor. Blood sugar levels are checked periodically over the next two hours. Results are interpreted as:

• • <140 mg/dL is normal.
  • 140-199 mg/dL indicates prediabetes.
  • ≥200 mg/dL indicates diabetes.

Additional tests may be conducted to determine the type of diabetes and assess any damage or dysfunction in other organs.

Management

Children with type 2 diabetes are encouraged to adopt lifestyle changes with family support, particularly from parents. Doctors may prescribe medication to lower blood sugar levels. Lifestyle changes include:

• Regular physical activity of moderate to high intensity for about 60 minutes per day.
• Limiting screen time to less than 2 hours per day.
• Dietary changes, with referrals to a nutrition specialist if necessary.
• Regular blood sugar monitoring, especially if the child is on insulin treatment, has not yet reached target blood sugar levels, or is ill.

Complications

High blood sugar levels in diabetes mellitus can affect many organs, including blood vessels, nerves, eyes, heart, and kidneys. Complications in children are similar to those in adults with type 2 diabetes, typically developing over years.

Possible complications of type 2 diabetes include:

• Electrolyte imbalances.
• High cholesterol.
• Heart and blood vessel problems.
• Stroke.
• Nerve damage.
• Kidney damage.
• Eye problems, including blindness.

Prevention

You can prevent type 2 diabetes by adopting a healthy lifestyle, including a nutritious diet, regular exercise, and maintaining a healthy weight. Regular check-ups and consultations with a doctor can help monitor blood sugar levels. Steps to help prevent type 2 diabetes include:

• Monitor your child's blood sugar levels regularly to stay within the standard range and reduce the risk of complications.
• Discussing the importance of blood sugar control with your child.
• Teaching and informing your child about the importance of a healthy lifestyle and encouraging participation in physical activities.

When to See a Doctor?

Parents should recognize the risk factors their child may have for type 2 diabetes. If your child is overweight or obese and shows any of the signs and symptoms mentioned above, it is advisable to consult a doctor.

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