Type 2 diabetes in children

Type 2 diabetes in children is a long-term, also called chronic, condition. It affects the way a child's body uses sugar for fuel. Sugar also is called glucose. Without treatment, the condition causes sugar to build up in the bloodstream. This can lead to serious complications.

Type 2 diabetes happens more often in adults. In fact, it used to be called adult-onset diabetes. But the growing number of children with obesity has led to more type 2 diabetes diagnoses in younger people.

There's much you can do to help prevent or manage type 2 diabetes in your child. Urge your child to eat healthy foods, get plenty of physical activity, and get to and stay at a healthy weight. If healthy eating and exercise aren't enough to manage type 2 diabetes, your child may need to take medicine by mouth or have insulin shots.

Type 2 diabetes in children comes on so slowly that you may not see symptoms. Sometimes a healthcare professional diagnoses the condition during a routine checkup.

Some children might have these symptoms because of too much sugar in their bloodstreams:

• Increased thirst and hunger.
• Urinating often.
• Tiredness.
• Blurred vision.
• Darkened areas of skin, most often around the neck or in the armpits and groin. Darkened skin may look dark brown or black on brown or Black skin and light brown or tan on white skin.
• Weight loss without trying. This is less common in children with type 2 diabetes than in children with type 1 diabetes.
• Yeast infections.

When to see a doctor

See your child's healthcare professional if you see any symptoms of type 2 diabetes. Without treatment, the condition can cause great damage.

The American Diabetes Association suggests screening in children who:

• Have started puberty or have reached the age of 10.
• Are overweight or have obesity.
• Have at least one other risk factor for type 2 diabetes.

Experts don't know the exact cause of type 2 diabetes. But family history and genes seem to be part of the cause. What is clear is that children with type 2 diabetes can't use sugar, also called glucose, the way their bodies need to.

Most of the sugar in the body comes from food. When food is digested, sugar enters the bloodstream. Insulin allows sugar to enter the cells and lowers the amount of sugar in the blood.

A gland called the pancreas makes insulin. It sits behind the stomach. The pancreas sends insulin to the blood when you eat. When your blood sugar level starts to drop, the pancreas slows down the amount of insulin that goes into the blood.

When your child has type 2 diabetes, this process doesn't work as well. And instead of fueling cells, sugar builds up in your child's bloodstream. This can happen because:

• The pancreas doesn't make enough insulin.
• The cells resist the insulin and don't let in as much sugar.

Researchers don't know why some children get type 2 diabetes and others don't, even if their risk factors are alike. But certain factors raise the risk, including:

• Weight. Being overweight is a strong risk factor for type 2 diabetes in children. The more fatty tissue children have, the more the cells resist insulin. This is mainly true for fatty tissue inside and between the muscle and skin around the belly.
• Not being active. The less active children are, the greater their risk of type 2 diabetes.
• Eating habits. Eating a lot of red meat, processed foods, saturated fat and sugar is linked with a higher risk of prediabetes.
• Family history. Children's risk of type 2 diabetes rises if they have a parent, sibling, grandparent, aunt or uncle with the condition.
• Race or ethnicity. It's not clear why, but certain people are more likely to get prediabetes. In the United States, these include Black, Hispanic, American Indian and Asian American people.
• Age and sex assigned at birth. Many children get type 2 diabetes in their early teens. But it can happen at any age. Teens assigned female at birth are more likely to get type 2 diabetes than are teens assigned male at birth.
• Gestational diabetes. Children born to someone who had gestational diabetes during pregnancy have a higher risk of getting type 2 diabetes.
• Low birth weight or preterm birth. Babies with low birth weights have a higher risk of getting type 2 diabetes. So do babies born before 39 to 42 weeks of pregnancy, called premature.

Type 2 diabetes in children is often linked with metabolic syndrome and polycystic ovarian syndrome.

Metabolic syndrome

People who have certain conditions with obesity may have a higher risk of diabetes, heart disease and stroke. Those with three or more of these conditions often are diagnosed with what is called metabolic syndrome:

• High blood pressure.
• Low levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol.
• High triglycerides.
• High blood sugar levels.
• Large waist size.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) affects people assigned female at birth. It happens after puberty. An imbalance of hormones causes PCOS. Symptoms include weight gain, irregular menstrual periods, and excess face and body hair.

People with PCOS often have issues with how their bodies turn food into energy, called metabolism. Those issues can lead to insulin resistance and type 2 diabetes.

Type 2 diabetes can affect nearly every organ in your child's body. These include the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes come on little by little over many years. With time, diabetes complications may be life-threatening.

Complications of type 2 diabetes for children and teens may come on faster and be more serious than complications for adults with type 2 diabetes. They may include:

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

Keeping your child's blood sugar level close to the standard range most of the time can greatly lower the risk of these complications. To help your child prevent diabetes complications:

• Work with your child to stay at good blood sugar levels.
• Teach your child about healthy eating and staying active.
• Have regular visits with your child's diabetes treatment team.

Healthy-lifestyle choices can help prevent type 2 diabetes in children. Urge your child to:

• Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains.
• Get more physical activity. Help your child be active. Sign up your child for a sports team or dance lessons.

Make healthy eating and physical activity a family affair. The lifestyle choices that can help prevent type 2 diabetes in children can do the same for adults.

To diagnose diabetes, your child's healthcare professional does a screening test. There are a few types of blood tests to diagnose type 2 diabetes in children.

• Random blood sugar test. This test uses a blood sample taken at a random time. It doesn't matter when your child last ate. A random blood sugar level of 200 milligrams per deciliter (mg/dL), which is 11.1 millimoles per liter (mmol/L), or higher suggests diabetes.
• Fasting blood sugar test. This test uses a blood sample taken after your child hasn't had anything to eat or drink but water for at least eight hours or overnight. This is called fasting. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher suggests diabetes.
• Glycated hemoglobin (A1C) test. This test shows your child's average blood sugar level for the past three months. An A1C level of 6.5% or higher shows diabetes.
• Oral glucose tolerance test. For this test, your child fasts overnight and then drinks a sugary liquid at the healthcare professional's office or at a laboratory testing site. A healthcare professional tests blood sugar levels over the next two hours. A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher most often means your child has diabetes.

Other tests

Your healthcare professional may suggest other tests that can show type 1 diabetes or type 2 diabetes. Treatment depends on the type.

Treatment for type 2 diabetes is lifelong. It includes:

• Healthy eating.
• Regular physical activity.
• Insulin or other medicines.
• Blood sugar checks.
• Weight-loss surgery, for some people.

You work closely with your child's diabetes treatment team. The team may include a healthcare professional, a certified diabetes care and education specialist, a registered dietitian, and other specialists as needed.

The goal of treatment is to keep your child's blood sugar within a target range. This target range helps to keep your child's blood sugar level as close to the standard range as possible.

Your child's healthcare professional tells you what your child's blood sugar target range is and may also set an A1C target. These numbers may change as your child grows. So may your child's diabetes treatment plan.

Healthy eating

Food is a big part of any diabetes treatment plan, but that doesn't mean your child has to follow a strict "diabetes diet." Your healthcare professional may suggest weight loss so your child can get to a healthy weight. Blood sugar levels can improve with weight loss.

Your child's dietitian can help your child and the rest of the family follow a healthy-eating plan that suits your family's culture and tastes. Healthy eating includes fruits, vegetables, nuts, whole grains and olive oil. Choose foods low in fat and calories and high in fiber. Give your child many healthy food choices.

Your child's dietitian can help you make a meal plan that fits your child's health goals and includes foods your child likes. You can plan to include treats at times. Your dietitian also may suggest that your child:

• Cut portion sizes and not feel a need to eat all the food on the plate.
• Choose fruits or vegetables instead of carbohydrate-rich foods.
• Drink water instead of sugary soft drinks or fruit juices.
• Eat at home more often instead of eating at restaurants or getting food to carry out from them.
• Help make meals.
• Eat at the dinner table instead of in front of the TV.

Physical activity

Moving more helps children manage their weight, use up sugar for energy and make the body use insulin better. This can lower blood sugar.

Make physical activity part of your child's daily life. Activity time doesn't have to be all at once. It's OK to break it down into smaller chunks of time. Try to have your child get at least 60 minutes of physical activity daily. Even better, exercise with your child.

Medicines

In the U.S., the Food and Drug Administration has approved three medicines for treating type 2 diabetes in children.

• Metformin. This pill cuts the amount of sugar a child's liver puts into the bloodstream between meals. It helps the body's cells use insulin better.

• Semaglutide (Ozempic, Rybelsus, Wegovy). Children 10 and older take this medicine as a shot. It helps the pancreas put more insulin into the body after meals. This is when blood sugar levels are higher. This medicine may cause stomach upset and loose stools.

  Other medicines in this class include liraglutide (Saxenda, Victoza), dulaglutide (Trulicity), exenatide (Byetta) and lixisenatide (Adlyxin).

• Insulin. Some children whose blood sugar levels are very high need insulin. So do some children for whom lifestyle changes don't do enough. Insulin lets sugar into the cells for energy, cutting the amount of sugar in the bloodstream.

  There are different insulins. Children with type 2 diabetes often take a long-acting insulin once a day and a short- or fast-acting insulin with meals. They most often take insulin with a syringe or an insulin pen. With lifestyle changes and other medicines, your child may be able to stop taking insulin.

Blood sugar monitoring

Your healthcare professional tells you how often you or your child need to check and record your child's blood sugar. Children who take insulin need to test more often, maybe four times a day or more.

Some children use continuous glucose monitoring. This uses a sensor placed under the skin to measure blood sugar levels. Testing often is the only way to make sure that your child's blood sugar level stays within the target range.

Weight-loss surgery

This surgery isn't for everyone. But for teens who have a body mass index (BMI) at or above 35, weight-loss surgery may help them manage their type 2 diabetes.

Continuing medical care

Children need regular appointments to manage their diabetes. Visits with your child's healthcare professional can include a review of your child's blood sugar patterns, eating habits, physical activity, weight and medicine, if taken.

Your healthcare professional may check your child's A1C levels. An A1C of less than 7% is standard for children and teens with diabetes.

Sometimes your healthcare professional also checks your child's:

• Growth.
• Blood pressure.
• Cholesterol levels.
• How the child's kidneys and liver work.
• Eyes. This test is most often yearly.
• Feet.
• Risk of polycystic ovary syndrome and obstructive sleep apnea.

Your child's healthcare professional may suggest a flu shot for your child every year. Vaccines for children age 5 and older may include the pneumonia vaccine and the COVID-19 vaccine.

Signs of trouble

Even with your best efforts, issues may come up. For some short-term complications of type 2 diabetes, your child needs medical care right away. These include low blood sugar, high blood sugar, diabetic ketoacidosis and hyperosmolar hyperglycemic state (HHS). These may be life-threatening.

Low blood sugar

A blood sugar level below your child's target range is called hypoglycemia. Blood sugar levels can drop for many reasons, including skipping a meal, eating fewer carbohydrates than planned, getting more physical activity than typical or using too much insulin. Children with type 2 diabetes have less risk of low blood sugar than do kids with type 1 diabetes.

Symptoms of low blood sugar include:

• Being pale and sweaty. Being pale may be harder to see on Black or brown skin.
• Being shaky and hungry.
• Being fussy or having other mood changes.
• Having trouble thinking or feeling dizzy or lightheaded.
• Being less able to move your body well.
• Slurring speech.
• Passing out or having seizures.

Teach your child the symptoms of low blood sugar. When your child isn't sure, the child should always do a blood sugar test. If your child has symptoms of low blood sugar and doesn't have a blood glucose meter nearby, treat for low blood sugar. Then test as soon as possible.

If your child has a low blood sugar reading:

• Give a fast-acting carbohydrate. Give your child 15 grams of something that raises blood sugar fast. This may be fruit juice, glucose tablets, hard candy, sugary soda or another source of sugar. Foods with added fat, such as chocolate or ice cream, don't raise blood sugar as fast. Fat slows the sugar from being taken in.
• Retest blood sugar. Retest your child's blood sugar in 15 minutes to make sure it's back in the target range. If it's not, repeat giving a fast-acting carbohydrate and testing in 15 minutes as needed until you get a reading in your child's target range.

High blood sugar

High blood sugar, also called hyperglycemia, is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating certain types of foods, and not taking enough diabetes medicine or insulin.

Symptoms of high blood sugar include:

• Urinating often.
• More thirst or dry mouth.
• Blurred vision.
• Tiredness.
• Upset stomach.

If you think your child has hyperglycemia, check the blood sugar. You might need to change your child's meal plan or medicines. Contact your child's healthcare professional if your child's blood sugar is out of the target range often.

Diabetic ketoacidosis

A serious lack of insulin causes your child's body to make certain toxic acids called ketones. If ketones build up, your child may have a life-threatening condition called diabetic ketoacidosis (DKA). DKA is more common in children with type 1 diabetes but can happen in children with type 2 diabetes.

Symptoms of DKA include:

• Thirst or very dry mouth.
• More urinating.
• Dry or flushed skin.
• Upset stomach, vomiting or stomach pain.
• A sweet, fruity smell on your child's breath.
• Not thinking clearly.

If you suspect DKA, check your child's urine for too many ketones using a ketone test kit you can buy without a prescription. If the ketone levels are high, call your child's healthcare professional or seek medical care right away.

Hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic state (HHS) may come on over a few days in children with type 2 diabetes. Blood sugar levels may be 600 mg/dL or higher. There may be bad infections, illness or other medical conditions.

The body tries to get rid of the sugar by passing it in the urine. This can cause a serious loss of body fluids called dehydration.

Symptoms of HHS include:

• No or few ketones in the urine.
• More urinating.
• More thirst.
• Dry mouth and warm, dry skin.
• Not thinking clearly or wanting to fight.
• Seizures.
• Coma.

HHS can be life-threatening. Your child needs care right away.

Helping your child follow the diabetes treatment plan takes effort. But managing type 2 diabetes can lower your child's risk of serious complications.

As your child gets older:

• Get your child more involved in diabetes management.
• Stress the need for lifelong diabetes care.
• Teach your child how to test blood sugar levels and to take medicine, including insulin, if needed.
• Help your child make healthy food choices.
• Urge your child to move more. Limit screen time.
• Help your child have a good relationship with the diabetes treatment team.
• Make sure your child wears a medical alert tag.

School and diabetes

Work with your child's school nurse and teachers to make sure they know the symptoms of high and low blood sugar levels. The school nurse might need to give insulin or check your child's blood sugar.

The Americans With Disabilities Act protects children with diabetes. Schools must do what they can to ensure that all children get an education.

When to contact your diabetes care team

If your child's blood sugar often is higher or lower than the target range, contact your child's diabetes care team between appointments. Also contact the care team any time you're not sure what to do.

Living with type 2 diabetes isn't easy for you or for your child. Good diabetes management means a lot of changes. That's why some diabetes specialists include a social worker or psychologist in their diabetes care teams. You're not alone. Your diabetes treatment team is there to support you and your child.

If you see that your child or teen often is sad or has big changes in sleeping habits, friends or schoolwork, ask your diabetes care team about having your child screened for depression.

Your child also may rebel. Children who have been good about their diabetes self-care may rebel as teens and stop caring for themselves. Also, using drugs or alcohol or smoking can be a great danger for people with diabetes.

Talking with a counselor or therapist may help you and your child cope with the big lifestyle changes that come with a diagnosis of type 2 diabetes. Websites that offer support include the American Diabetes Association.

Your child's main healthcare professional or pediatrician may be the one to diagnose diabetes. But you then might take your child to a specialist in metabolic disorders in children, called a pediatric endocrinologist.

Your child's healthcare team also may include a certified diabetes care and education specialist and a registered dietitian.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment:

• Ask about anything your child needs to do before the appointment. For instance, your child may need to fast before a blood sugar test.
• List your child's symptoms, including any that don't seem linked to the reason for your appointment, and when they began.
• Ask a family member or friend to go with you, if you can. Someone who's with you can help you remember the information you get.
• Make a list of questions to ask your healthcare professional.

Some basic questions to ask include:

• How often do I need to check my child's blood sugar?
• What should my child's blood sugar levels be during the day and before bedtime?
• What changes do we need to make in the family eating plan?
• How much exercise does my child need each day?
• Does my child need medicine? If so, what kind and how much?
• What symptoms of complications should I look for?
• My child has another health condition. How can we best manage them together?
• Who needs to be on my child's diabetes care team?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare team is likely to ask questions, such as:

• How do you feel about managing your child's diabetes?
• What does your child most often eat in a day?
• Does your child exercise? How much?
• How well is your child coping with diabetes and its treatment?