Health - Change your lifestyle;Type 2 Diabetes

DR. GAUTHAM RAO, M.D. AND DR. VIJAY VISWANATHAN


Obesity is a major cause of Type2 diabetes in children. While available treatments involve insulin, a better option is to bring in more physical activity and healthier eating habits.


A 10-year-old boy had symptoms of frequent urination, thirst and extreme hunger and tiredness. His parents noticed that he had lost five kg in one month. The child had no family members with diabetes. His family physician did a blood glucose test whi ch showed a level of 490 mg/dl. The patient was immediately treated with insulin injections and the blood glucose levels were controlled.

By contrast, a 13-year-old girl presents with fatigue. The child had a positive family history of diabetes and was obese. A routine blood glucose measurement showed 240 mg/dl. Insulin treatment was not given and the child was treated with oral medication and the blood glucose was brought under control.


Spreading epidemic

Childhood obesity is a major worldwide epidemic. The consequence of overweight and obesity among children will be the development of Type 2 diabetes in children. Type 2 diabetes, previously considered an adult disease, is now being diagnosed in children and adolescents. As we see a rise in childhood obesity, there has also been a rise in type 2 diabetes. Diabetes is not the only issue related to childhood obesity, but excess bodyweight is implicated as a risk factor for many disorders including heart disease, high blood pressure, cancer, orthopaedic problems etc. Overweight in children and adolescents is generally caused by lack of physical activity and unhealthy eating patterns.

When a child is diagnosed with diabetes it is commonly referred to as Juvenile Diabetes or type 1 diabetes. It is an auto immune disease and requires insulin injection for blood sugar control. There are usually no family members with diabetes. Children may have high blood sugar levels and show positive symptoms of diabetes such as increased urination, thirst, severe weight loss and tiredness. If someone has type 1 diabetes and is not treated with insulin immediately, he or she may have to be hospitalised.

Recent technological advances have provided new treatment options for treating type 1 diabetes. Insulin remains the main treatment in type 1 diabetes. The introduction of new and improved insulin pumps to achieve strict diabetes control provides a safe and effective alternative to multiple daily injections. A number of systems for inhaled delivery of insulin are in development, which allows the child to take bolus insulin doses before each meal.

The recently introduced continuous glucose monitoring systems provide a good view of the blood sugar fluctuations during day and night. A new islet cell transplantation technique is showing promising results which uses islet cells from the pancreas of two or more donor pancreases. The cells are transplanted into a person with diabetes and then special medications are given to prevent rejection of new cells.

Scientists are trying to develop a “vaccine” against diabetes so that it stops the destruction of pancreatic beta cells in humans. It thereby offers the possibility of preventing Type 1 diabetes in people at high risk.


Some symptoms

In recent years, an increased number of children have been diagnosed with Type 2 diabetes. This type of diabetes is related to a child’s lifestyle. The body produces insulin to keep blood sugar levels normal. At some point, the body cannot produce insulin or does not use insulin properly. When this happens, blood sugar levels will rise. Children may not have any symptoms and the diagnosis is often made during routine check up. Darkening of the skin at the back of neck, in the folds of the arms, or around the eyes are noted. Affected children are usually obese and a positive family history of diabetes is common. There may be poor performance in school by obese children. High blood sugar levels are treated with oral medicines and not insulin injections.

Attempts to prevent Type 2 diabetes in children should follow the same as that recommended for the prevention of type 2 diabetes in adults. We should promote the avoidance of obesity and ensure adequate levels of physical activity for the entire community. Children need about 60 minutes of physical activity per day. Children can avoid watching television, limit TV time to less than two hours a day. Computer and Video games contribute to children’s inactive lifestyle. Health professionals have to be involved in developing and implementing school and community-based programmes to promote improved dietary and physical activity behaviours for all children as well as their families. School programmes should promote healthy food choices and increased physical activity.

Root cause

As childhood obesity is now widely accepted as the root cause, not only of Type 2 diabetes, but also a number of other conditions including high cholesterol, sleep-related breathing problems, and high blood pressure, the question, “What can we do now to solve the problem?” naturally arises. Since childhood obesity is much more serious and widespread in the United States compared with other countries, much of the research in this area comes from that country. Two medications are currently approved to promote weight loss: Sibutramine acts on the brain to curb appetite and is approved for children aged 16 and older only. Orlistat acts on the intestines to block absorption of fat. It is approved for children 12 and older. Both are associated with significant side effects and only provide a weight loss of roughly five kg over the course of a year. Given that many obese adolescents in the U.S. weigh more than 100kg, this degree of weight loss is not all that substantial. Current research into medications is focusing upon manipulating the hormones that affect appetite including insulin, and hormones called ghrelin, adiponectin, and cholecystokinin. The first drugs to emerge based on this research are several years away.

Surgery is an option for a small number of very obese adolescents, especially those who have already developed obesity-related problems. Two procedures, gastric bypass (stomach is “bypassed”) and laparoscopic gastric banding (a ring is placed around the stomach to reduce its size) are currently being carried out. Laparoscopic banding is currently being evaluated systematically in a large American study known as TEEN-LABs.

Behavioural changes

Medications and surgery may be options for a small number of children, but most experts accept that the greatest impact on this problem will come from positive changes in our man-made or “built” environment, and through education and behaviour change among families through promotion by physicians, other health professionals, and teachers. The built environment in the United States is one in which food is very inexpensive in relation to incomes and widely available to all children.

This is also a common circumstance among middle class families in India. Public policy and public education to avoid over-consumption of unhealthy foods such as sweet drinks (fruit juices, soda pop, etc), fast food (pizza, deep fried Indian snacks), and sweets will be instrumental in reversing this epidemic. In the United States, regular soft drinks have recently been banned from schools. This is already having a positive impact upon children. Physicians, teachers, parents, and even children themselves, should serve as advocates for these types of changes. Around the world, India is seen as an emerging power and one in which prosperity is coming quickly. Let’s make sure our children and theirs are healthy and able to enjoy this bright future.

Dr. Gautham Rao is with the University of Pittsburgh.

Dr. Vijay Viswanathan is with the WHO Collaborating Centre for Research, Education and Training in Diabetes.

This type of diabetes is related to a child’s lifestyle. The body produces insulin to keep blood sugar levels normal. At some point, the body cannot produce insulin or does not use insulin properly.

School programmes should promote healthy food choices and increased physical activity.


Dr. Gautham Rao is with the University of Pittsburgh.

Dr. Vijay Viswanathan is with the WHO Collaborating Centre for Research, Education and Training in Diabetes.