Prompted by a post over at Living With Diabetes, I realized that very few people know what’s involved in diagnosing and treating kids with type 2 diabetes. These are not just miniature versions of adults with type 2. As growing children, they have very special needs.

I live and practice pediatric endocrinology about 400 miles south of Dallas, Texas. We serve all of South Texas (overall, an area the size of South Carolina). As of August 31st of this year, 47% of ALL new cases of children’s diabetes seen in my practice and at my children’s hospital were due to type 2 diabetes. We have extensive experience with managing type 2 diabetes in children. I’ve written and spoken frequently about this epidemic and its management over the years.

I can tell you two things here:

1) About 15% of cases of what appear on the surface to be type 2 diabetes actually have evidence of the same process that causes type 1 diabetes (autoimmunity directed towards the beta cells).

The implication of this finding is that we may be talking about a blended disease process: that is, insulin resistance (the inciting cause of type 2 diabetes in most persons) combined with a destructive process driven by the patient’s own immune system (the underlying cause of type 1 diabetes in most persons). Ironically, the government funded study investigating the best management of type 2 diabetes in children excludes these children from study.

2) There are good oral medications that can work.

Metformin (also called Glucophage) is remarkably safe and I have hundreds of children with type 2 diabetes using this medicine both safely and effectively. However, at diabetes onset, some children with type 2 diabetes need insulin to stabilize their blood sugar control until the metformin can begin to help them. This is a common scenario and in these cases, the insulin may be weaned off rather quickly without ill effects to the child. Furthermore, insulin therapy may be associated with an unwanted side effect of additonal weight gain: the one thing most of these children don’t need.

However, each case is in many ways unique and factors other than medicine will steer the course of their disease. I now see entire families with type 2 diabetes (parents and children), so the role of the family is never to be underestimated. Also, financial issues will influence the clinical course since many of our children with type 2 diabetes are on public assistance programs (Medicaid or SCHIP) and one of these is on the cusp of disappearing!

Last 5 posts by Steve

• Day 15 - Sixtieth Camp Blog Entry - August 3rd, 2008
• Day 13 - Fifty-Ninth Camp Blog Entry - August 1st, 2008
• Day 12 - Fifty-Eighth Camp Blog Entry - July 31st, 2008
• Day 11 - Fifty-Seventh Camp Blog Entry - July 30th, 2008
• Day 11 - Fifty-Sixth Camp Blog Entry - July 30th, 2008

This entry was posted on Monday, September 24th, 2007 at 9:59 am and is filed under Clinical, type 2. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.