Type 2 in Kids
The grim realities children with this disease face.
By Wil Dubois
I need to apologize in advance. Even my classic black humor and warped approach to education can't do much to temper this subject. Pour yourself a strong one, get out a box of Kleenex to dry your eyes, and prepare to be depressed.
It's Autumn. Backpacks, pencils, and notebook paper fill the aisles at Wal-Mart. Yep. It's back-to-school time, and our thoughts turn to young people. And when you think of kids and diabetes, you'll be forgiven for thinking about the more than 15,000 kids a year who develop type 1 diabetes. But when it comes to kids and diabetes, they may prove to be the lucky ones.
Because while type 1 is terrifying, dangerous, and difficult — it's a lamb compared to its evil twin: type 2 diabetes in children. Unheard of before the early 90's, type 2 diabetes in kids is a rising tide. It normally strikes between 10 and 19 years of age, but cases of children as young as five years old with full-blown type 2 diabetes are documented. Right now it's "only" devouring an estimated 3,600 kids a year, but as you'll soon see, that government statistic is almost guaranteed to underestimate the horrifying reality.
Not your grandfather's type 2 diabetes
When type 2 strikes the young, it shows us a different face. It's faster: progressing more rapidly than it does in adults. It's more aggressive: complications appear much sooner than you'd expect. It's harder to treat: the oral drugs that keep type 2 in adults tame for years fail in kids with mind-numbing speed. In fact, in the most recent clinical study of ways to treat type 2 kids, all three study arms had high failure rates, an unexpectedly grim outcome.
Frankly, the doctors and clinicians who study type 2 in children are scared.
What the hell is happening?
What's going on? Why are children getting this flavor of diabetes, a chronic illness that, because it affects a full quarter of people over the age of 65, has long been viewed as a disease of the elderly?
Consider the traditional recipe for type 2 diabetes: equal parts genes, age, and weight. A few short decades ago, type 2 often hit between 40 and 50 years of age, when people were starting to get old enough and fat enough. Now we, as a society, are getting fatter younger and younger, and type 2 is rearing its ugly head earlier and earlier.
And when it comes to kids, according to the Centers for Disease Control, childhood obesity has more than tripled over the last 30 years. Now a full third of our kids are fat. Never have so many been so fat so young. If you'll pardon the pun, it's an obesity epidemic of unprecedented portions.
And the rise of type 2 in children may be as simple as that. Or it might not. Kids with type 2 are also generally much less active than other kids, even other heavy kids. So it may prove that the driving force that awakens the genes for type 2 decades before their normal time is the combination of too much weight and too little activity.
The roots of the obesity epidemic in kids
How did so many kids get so dangerously overweight? Four things: screen time, fast food, soda, and absent parents.
OK, that might be overly simplified, but new research shows us that kids who develop type 2 are obese, inactive, and have a family history of type 2 diabetes. They are also more likely to be minorities, and from low-income, single-parent families. Does that make diabetes a social disease?
I wouldn't go that far, but there's no question that social factors play a part in this diabetes explosion. TV and computers have replaced the classic outdoors activities of childhood. Single-parent households have kids eating on their own, and this age group isn't well known for making good food choices. Plus, over the last few decades, portion sizes have ballooned in size. The standard dinner plate has inflated from 9 inches in diameter to 12 inches. Sodas from 8 ounces to 32 ounces (and sometimes even more).
Environmental factors also play a role, from the existence of urban "grocery deserts" where corner quickie marts and fast-food joints are the only source of food, to neighborhoods so dangerous that parents literally lock their kids inside for their safety.
These social and environmental factors have changed the face of youth. Its face is chubbier than in times past.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...