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How To Prevent Diabetes

November is National Diabetes Month. According to the Centers for Disease Control & Prevention (CDC), 1 in 10 Americans has diabetes (keep in mind that most of those numbers are adults with Type 2 diabetes). With the aging and fattening of America, the number of adults diagnosed with diabetes has more than tripled in the last 20 years. In my own practice, it used to be a rare that I would see an overweight child with Type 2 diabetes (classically, an adult problem). I am now seeing quite a few overweight teens (I had a 9-year-old the other day), with Type 2 diabetes. The question is, “Is there anything I can do to help prevent it in my children (and myself)?”

Type 1 diabetes (classically, the childhood, insulin dependent form) is believed to be an autoimmune problem. This means the body’s own immune system attacks itself. We generally believe there isn’t anything anyone can do to necessarily prevent Type 1 diabetes. Type 2 diabetes (classically, the diabetes associated with older, overweight people who have burned out their pancreas) is a different story. If we prevent an individual from becoming overweight, we can often prevent the onset of Type 2 diabetes.

Type 2 Diabetes:

Risk factors that you can change:

  1. Being overweight
  2. Not being physically active (at least 3 times a week).
  3. Poor diet

Risk factors you can’t change:

  1. Age, older than 45 years
  2. Immediate family with Type 2 diabetes
  3. African American, Hispanic or Latino, American Indian or Alaskan Native, Pacific Islander
  4. Ever having gestational diabetes (or a baby who weighed more than 9 lbs.) puts you at higher risk of Type 2 diabetes later in life.

Should I have my kid tested?

During every well-child check, we are supposed to screen your child for signs/risks of diabetes. Your pediatrician may not come right out and say he or she is “screening for diabetes,” but a few simple questions and examination findings can help a doctor identify patients who need further workup. If the answer is “yes” to any of these questions, your pediatrician will likely suggest some blood work to investigate further. Your pediatrician will look at:

  1. Your child’s BMI (body mass index). Is the BMI elevated? This tells a doctor if your child is overweight/obese.
  2. Your child’s diet. Does your child have a poor diet and/or eat too much? How is your child’s fluid intake? (if it’s excessive, it may be a sign of Type 1 diabetes.)
  3. Is there a family history of diabetes (especially first-degree relatives)?
  4. Does your child have other medical conditions that increase his or her risk of diabetes (e.g., cystic fibrosis, polycystic ovarian syndrome, hypercholesterolemia)?
  5. Is your child’s blood pressure elevated?
  6. Does your child have any physical symptoms (e.g., acanthosis nigricans—patches of dark, thick skin especially in areas like the neck and arm pits).

As always, if you are concerned about your child, make sure and talk to your doctor about it. For additional, specific information on diabetes, see the previously posted articles:



Candy, Candy, Candy! What To Do With Halloween Candy

I love candy. I loved it as a kid and still do. It’s my nutritional Achilles heel. But it’s not good for you or your kids. The problem is that there is an entire holiday surrounding it and what to do with it. So what should you do? My advice, come up with a plan. Know the recommendations, know the risks, then decide what’s best for you and your family.

Official recommendations on how much sugar

The American Heart Association (with the AAP supporting the guidelines) says that children should not have more than 6 teaspoons (25 gms) of sugar a day. That’s not much (think 16 candy corns, 5 suckers, 2.5 Reeses Peanut Butter cups, 1.5 Snickers, 0.5 bag of Skittles). The average kid consumes  more than 3 times that amount (on regular days, not Halloween and the days following). It’s no secret that too much sugar can lead to obesity, elevated blood pressure, and type 2 diabetes. So despite my love for candy, it’s something I need to address (both for me and my kids) with a plan.

Halloween day plan

  1. Eat dinner before trick or treating (fuller bellies will be less inclined to eat too much candy).
  2. Only allow candy to be eaten at home (where you can monitor what and how much) not on the trick or treat trail.
  3. Make your child walk, don’t chauffer them to houses. The exercise is good for them and will reduce the total number of houses your child can get to.
  4. Limit your trick or treating to neighborhoods you know.
  5. Set an ending time.
  6. Make children trick or treat with someone else. (In our case, one parent takes the all the children…and being told “wait for your sister,” slows the process down so we end up with less candy).
  7. Support the cause by giving out something other than candy (This year I’m giving out glow-in-the-dark bouncy balls and punch balloons that I got for a deal online).
  8. Set a limit ahead of time on the total number of pieces of candy on Halloween day (I’ve done everywhere from 5-15 in years past).

What to do with the post Halloween haul

I’ve heard all sorts of good ideas over the years. Here’s a few you can choose from.

  1. Daily limit. Slowly dole out the candy with a daily limit (e.g., the child is allowed to have 1-5 candies a day).
  2. Donate extra candy. Depending on where you live, there are all sorts of different options. Some dentists have a donation or buy back program. Many shelters will take extra candy (you can have your children help separate them into little bags that make distributing it easier). I’ve also heard of programs that send candy to troops overseas.
  3. Bake goodies. Many candies can be frozen and used later in cookies, brownies, and cake recipes.
  4. Candy art. Have a family night competition where everyone gets to use the candy and toothpicks to make artistic creations (you could even chose a competition theme like best candy house, funniest monster, etc.).Give out awards. Take pics, then pitch the art (candy) later.
  5. The Switch Witchery. I once read in Parents magazine an article about the “Switch Witch” (like a tooth fairy) who comes on her broom stick in the night and takes the entire bag candy, but leaves a toy or prizes in return. I’ve never tried it, but it sounds interesting. Apparently it works best when the child is prepped days in advance. In theory, the child is happy with the new toy and voila, the candy problem is gone.
  6. Reuse the candy. I’m almost embarrassed to admit that I have used my kids Halloween candy to fill a piñata and grab bags for my son’s birthday (which happens to be just after Halloween). It solves two problems, I don’t have to buy more candy and it gets rids of all of the extra Halloween candy.
  7. Parent Tax. Last, but not least, my self-serving favorite (did I mention I love candy), the parent tax. I use some lame reasoning like, “I bought your costume, paid for treats to hand out, and took you around,” so that entitles me to whatever candy of yours I want to eat at any time. I say it ‘tongue in cheek,’ my kids put up a fake fight, and they consent to sharing. It’s a win-win scenario.

Have a safe and healthy Halloween!

Type 2 Diabetes: An Adult Problem Showing Up In Kids

In follow up to Monday’s post, I’m addressing type 2 diabetes today. It used to be that the people who got type 1 diabetes were skinny kids and type 2 diabetes happened to fat adults. The picture isn’t quite so clear cut anymore, especially with the fattening of American kids. Now with that said, there are adults who get diagnosed with type 1 diabetes as adults and thin teens with type 2 diabetes, but those are the exception, not the rule. So what is type 2 diabetes?

Type 2 diabetes: The Overview

Like type 1 diabetes, type 2 diabetes is also a problem of blood sugar (or glucose). The cause is just a little different. The body has an organ in the abdomen called the pancreas. The pancreas has little cells called beta cells that make insulin. Insulin is the hormone your body needs to take sugar from the blood and put it into the cells to make it usable. In type 1 diabetes, those beta cells don’t work right (so they don’t make insulin). In type 2 diabetes, those beta cells work, but have essentially been overworked and are getting burned out. Think about it, really fat people, eat too much and too often. Those little beta cells try to keep up and kick out more insulin, but eventually get out paced. Type 2 diabetes is far and away the more common of the two types, making up about 90% of cases of diabetes. Type 2 diabetes is considered “noninsulin dependent” because the beta cells can work and often treatment with an oral medication can jump start the cells into working better. With that said, there are many cases where type 2 diabetics require insulin to help control sugars (so it’s a bit of misnomer).

Signs and Symptoms

Type 2 diabetes can present similarly to type 1 diabetes (since both have problems of the sugar being too high). Since it’s a slow burn out of the cells, the symptoms are often unnoticed since they come on slowly.

  1. Increased thirst (polydipsia)
  2. Increased urination (polyuria)
  3. Weight loss (if the body can’t put any of the sugar into the cells)
  4. Feeling tired
  5. Hunger (again, if the cells aren’t getting the sugar)
  6. Poor wound healing
  7. Blurry vision
  8. Recurrent yeast infections
  9. Acanthosis Nigricans (dark, velvety skin on the back of the neck)

Long-term complications

If the sugars are high chronically, there can be all sorts of problems. I am determined that if people really understood the complications, they would take better care of themselves (and prevent it in the first place).

  1. Heart disease
  2. Stroke
  3. Diabetic retinopathy which leads to blindness
  4. Kidney failure (almost all the dialysis patients I cared for in medical school had type 2 diabetes)
  5. Amputations of body parts (usually toes, feet, legs) from gangrene that develops due to poor blood flow

How is it diagnosed?

Like type 1 diabetes, type 2 diabetes is diagnosed by a blood test. Usually at hemoglobin A1c (hg A1c) is done which tests the average blood sugar over the past 3 months. It does not have to be drawn when fasting. Results greater than 6.5% are considered abnormal. Other antibody tests (also blood work) are usually done to help determine the type (if the picture isn’t clear).  Fasting blood sugar levels should be less than 126 mg/dL. Sometimes doctors will do an oral glucose tolerance test (OGTT). The OGTT tests your blood sugar before and 2 hours after drinking a super sugary drink to see how your body handles the sugar.

How is Type 2 diabetes treated?

I alluded to it above, but type 2 diabetes can often be treated with oral medications (a huge difference from type 1 diabetes which must be treated with insulin). The most common medication used is Metformin. With that said, some cases are so severe that insulin is necessary. In some situations, your pediatrician may recommend that your child see an endocrinologist (a specialist that deals with hormones in the body).

The most important part of treatment of type 2 diabetes is lifestyle modification. The medication is a band aid. If you want to really help the fix the problem, the affected person must change everything—exercise, eat right, and maintain a healthy weight. While there is technically no cure, I have seen over and over, people make drastic lifestyle changes and their type 2 diabetes miraculously resolves.

Can I prevent type 2 diabetes in myself and kids?

Gratefully, this is a resounding yes (unlike type 1 diabetes). Make sure you and your children are eating healthy: limit sweets, junk food, and sweetened drinks. Exercise, get those bodies moving. Maintain an ideal body weight-don’t be overweight. If you or your children are already overweight, resolve now to fix it. Involve your doctor if needs be. We’re here to help. Set a good example of healthy living for your children. Not only will you prevent type 2 diabetes (and so many other medical problems), but you set your children up for a more healthy, happy life.

Excessively Thirsty Child. Could Your Child Have Type 1 Diabetes?

Everyone has heard of diabetes and knows it has something to do with sugar, but do you understand the different types and potential signs to look for in your child? This past week at work, I diagnosed diabetes in two kids. One child was type 1 and one was type 2. I’m going to feature articles this week on both. Today I’m going to look at Type 1 diabetes.

Type 1 diabetes overview

The complete name for diabetes is diabetes mellitus. It is a metabolic problem where the body does not make enough insulin. Insulin is a hormone that allows the body to take sugar (or glucose) from the blood and put it into the cells of the body to be used. So if you have type 1 diabetes, your blood sugars will be high and the way to fix it is to take insulin. However, it’s easier said than done.

Why does one get diabetes?

There are lots of theories on why Type 1 diabetes happens. It is believed to be a combination of genetic and environmental factors. Having family members with diabetes increases your risk, but does not guarantee the condition. Interesting aside, in studies of affected identical twins, both twins are only affected 30-50% of the time (despite having the same genes). The environmental component is poorly understood as well. In some parts of Europe there is a 10-fold difference in rates in Caucasians depending on where they live.

In type 1 diabetes, there is also an autoimmune (meaning the body attacks itself) component to the condition. The pancreas (the organ in the left upper part of the abdomen) has cells called beta cells that make insulin. In type 1 diabetes, the body destroys those beta cells, so there isn’t insulin produced. It has been theorized that certain viruses may trigger this autoimmune response, but the science isn’t completely definitive on it. We do know that certain chemicals (e.g., pyrinuron used to kill rodents and streptozotocin use to treat cancers) are toxic to the beta cells of the pancreas. So it is a complicated picture.

What are diabetes symptoms?

Once people understand that in Type 1 diabetes, the blood sugars are really high and can’t get sugar into the cells, all the symptoms make sense. It’s the science principle we all learned in elementary school, water follows where the most solutes are to try and balance (this is why you get wrinkly swimming in the ocean).

  1. Increased thirst, aka, polydipsia (the body is driving the child to drink more water to dilute the sugars)
  2. Increased urination, aka, polyuria (if you drink a lot, you’re bound to pee a lot)
  3. Increased appetite, aka, polyphagia (the sugar can’t get into the cells, so the body is starving)
  4. Weight loss (the body can’t absorb those sugars). The typical picture of a type 1 diabetic is a thin kid.
  5. Fatigue (again, no fuel to the body)

Unfortunately, many times families miss these early signs and kids present with diabetic ketoacidosis (DKA). Diabetic ketoacidosis is serious progression/complication where there is:

  1. Drowsiness
  2. Rapid breathing
  3. Dry skin
  4. Abdominal Pain
  5. Vomiting

DKA is life threatening and is usually treated in an intensive care unit at the hospital. Rush to the emergency department if these are your child’s symptoms.

How it Type 1 diabetes diagnosed?

Blood tests are the gold standard for diagnosing type 1 diabetes. There is a specific test called a hemoglobin A1c (hg A1c) that tests your average blood sugar for 3 months. For a hemoglobin A1c, it doesn’t matter whether the child is fasting when the blood is drawn. If the value is greater than 6.5%, you usually have problems. Another helpful test is a fasting blood sugar. Generally, a fasting blood sugar shouldn’t be more than 126 mg/dl. In addition, there are follow up blood tests that are often done to test antibodies in the blood, which helps a doctor determine risk and type of diabetes. Sometimes, a doctor will have a patient give a urine sample to see if sugar and/or ketones are spilling into the urine (not normal).

 How is Type 1 diabetes treated?

As I mentioned previously, Type 1 diabetes is treated with insulin replacement. This can be done in one of 2 ways: a separate injection (with a needle) or a pump (which has a catheter that stays under the skin). Typically, a newly diagnosed diabetic learns to treat elevated sugars with injections before moving to a pump. The difficulty in treating diabetes is finding the perfect dose of insulin. If too much insulin is given, the child will have low sugars. If not enough is given, then the sugars are high. Both lows and highs have medical problems. So in the end, the child ends up getting a lot of sugar checks (finger pokes) to make sure the levels are ok).

For clarification, Type 1 diabetes cannot be treated with oral medications (that is type 2 diabetes).

If you worry that your child may be exhibiting any signs or symptoms of diabetes, I encourage you to take your child in to the doctor. This is definitely not a diagnosis that you should “wait and watch.”