Transcription:
The Facts About Diabetes in Children

Prakash Chandran (Host):  Hello and welcome to Children’s Health Checkup where we answer parents’ most common questions about raising healthy and happy kids. I’m your host Prakash Chandran. We’ve all heard about type one and type two diabetes before but what exactly are the differences between the two and as a parent, what symptoms should we be on the lookout for? Today, we’ll be discussing the facts about diabetes in children and joining us is our expert Dr. Abha Choudhary, a Pediatric Endocrinologist at Children’s Health and Assistant Professor at UT Southwestern. Dr. Choudhary, it’s a pleasure to have you here today. So, let’s start with the basics around what exactly is diabetes and what are the different types that exist?

Abha Choudhary, MD (Guest):  So, diabetes mellitus is caused by a lack of hormone called insulin. This hormone is made by a group of cells called the beta cells in the pancreas. The two most common types of diabetes are type one and type two diabetes. Type one diabetes often known as juvenile diabetes is a chronic condition in which the pancreas produces little or no insulin. Now insulin is a hormone which is needed to allow the sugar or glucose to enter the cells to produce energy. Type one diabetes is not caused by eating too much sugar, staying up too late or poor parenting. The exact cause of type one diabetes is not known but there are a few factors which are considered. One is genetics, autoimmunity and environment, things like viruses, chemical and stress.  Despite active research, type one diabetes has no cure, but it can be managed with insulin.

On the other hand, type two diabetes once also known as adult onset diabetes; is a chronic condition that affects the way your body metabolizes the sugar or the glucose. With type two diabetes, your body is either resistant to the effects of insulin or does not produce enough insulin to make a normal glucose level. Type two diabetes is related to genetics and lifestyle. Many people with type two diabetes are able to manage it with healthy diet, and daily exercise. There are medications such as pills and or insulin which are needed depending on the blood glucose levels to manage type two diabetes.

Host:  I’m really glad that you broke down the differences between type one and type two. If I’m understanding it correctly, type one diabetes if your child gets it, it’s really not your fault as a parent. This is something that’s potentially genetic. You don’t really understand the true reasons around why a child might get it and there’s no real cure for it except to manage it with insulin. Is that correct?

Dr. Choudhary:  That is absolutely right. So, when parents when kids come in for the first time and they are diagnosed with type one diabetes; our parents tend to blame themselves for not bringing them in too quickly or it being their fault. But that is not true.

Host:  Yeah, that makes sense. And so, for type two diabetes, I think you mentioned that it was often called adult-onset diabetes, but this is also something that can also manifest in children if they have certain risk factors, like obesity, is that also correct?

Dr. Choudhary:  That is correct. So, it was previously known as adult onset, but we are seeing younger and younger kids with the epidemic of pediatric obesity being diagnosed with type two diabetes.

Host:  Before we get into some of the causes of type two and adjusting that lifestyle; I want to understand how you know when your children might have either type one or type two diabetes. Like what are some of the symptoms that might express in their everyday lives?

Dr. Choudhary:  So, some symptoms which are very common are increased thirst, increased urination, and some of these kids even start bedwetting at night and previously they were not bedwetting. Some of the other symptoms of fatigue. They are very tired all the time. And weightloss. So, these are some of the main symptoms of diabetes. Symptoms are common between type one and type two diabetes. The only difference is kids who have type two diabetes are overweight whereas kids who have type one diabetes are on the skinny side. So, based on symptoms and clinical presentation, it is always not clear what type of diabetes the child has, and the diagnosis is mainly based on the antibody testing which are the set of labs we send when a child comes in with these symptoms. And these antibodies take a couple of weeks to come back. So, that’s kind of when we know what type of diabetes it is. But if you have a skinny kid with these symptoms, it’s most commonly type one diabetes. If there is a overweight obese kid with these symptoms, we think of type two diabetes.

Host:  Okay and is there a certain age that these symptoms might start to express themselves? I’m sure it’s different between type one and type two but when is the earliest that you start seeing it?

Dr. Choudhary:  Very good question. So, type one diabetes, the youngest kid I’ve seen is five months old. And those kids, it’s hard to diagnose at that age but parents have noticed that kids are losing weight and they are drinking a lot and peeing a lot. Type two diabetes on the other hand, we are seeing kids as young as seven to eight years of age who are extremely overweight, and they are diagnosed with type two diabetes.

Host:  Before we get a little bit into lifestyle management and prevention; I want to understand how it is diagnosed. So, you mentioned that there are certain symptoms that express themselves, your child is potentially very thirsty, they are wetting the bed. Do you go into the pediatrician when this is happening and when you go into the pediatrician, how does it actually get diagnosed?

Dr. Choudhary:  So, the first step is to go to the pediatrician. But most often times these signs are missed and this is the diabetes awareness month and yesterday was world diabetes day. So, definitely want to raise awareness to signs and symptoms of diabetes. Especially in the summer months if your child has symptoms of increased thirst, you are probably thinking oh it’s hot or they are very active and that’s why they are drinking more. But I would want the parents to be very vigilant and if you notice these signs, take the child to the pediatrician. So the tests they do, the simple test they do are checking a fingerstick blood sugar where they prick your child’s finger, get a blood glucose value and also check urine for glucose and ketones. So, those are the basic two tests which will help us diagnose diabetes.

The other tests which are down are hemoglobin A1C which is a lab test and that will tell me how the sugar control has been in the previous three months. So, if that is high, again, that is suggestive of diabetes. So, those are the three basic tests and to confirm which type of diabetes this is, type one versus type two; the pancreatic antibodies are sent at presentation and those will give us a better clue of which type of diabetes this is.

Host:  Yeah and one thing that you said there, it’s important for the parents to be really vigilant because I had a friend whose child had diabetes and the child was actually embarrassed to really talk about it because they were wetting the bed, they had a pack of water underneath the bed. I think it’s something that is an embarrassing thing for them, and they don’t really know how to talk about it. So, do you have any tips for parents around either recognizing some of these symptoms earlier or just making their child feel comfortable talking about it?

Dr. Choudhary:  I think just talking to the child helps but if you start noticing that your child’s clearly losing weight and reaching out to water be vigilant about these signs. And I would say just talk to your child to explain these symptoms.

Host:  So let’s talk specifically about type two diabetes and prevention as it relates to lifestyle as it relates to diet. Maybe talk about some of the things that they should potentially avoid and then some of the things that they might do on a frequent basis like exercise.

Dr. Choudhary:  Type two diabetes is preventable. And ways to prevent it is healthy eating and exercise. So, exercise recommendations are about 30 to 40 minutes of exercise on a daily basis. If they do it even four to five times a week, I think that is good enough. So, definitely encourage my kids to exercise. Healthy eating, you want to avoid sugary foods, sodas, sweet tea, Gatorade, Kool-Aid and those other sugary beverages because those have a lot of sugar. Carbohydrates definitely stay away from those. So, a healthy diet consists of a good amount of proteins and vegetables, fruits, and limited amounts of carbohydrates and sweetened beverages.

Host:  Daily exercise is what you are talking about here and that can include running around with your friends and potentially even walking around the block, does that count as well?

Dr. Choudhary:  Absolutely. Anything, anything. Even turning on if it’s cold outside, walking up and down the stairs, turning on the music and do a little dance, just to sort of help with increasing the activity level. Doing little chores in the house. So, the goal is to stay active.

Host:  So, if a parent is listening to this and their child has diabetes already; I’m sure the biggest question is what can we do to help either mitigate or reverse diabetes entirely. So, you might have alluded to this a little bit before, but maybe talk about either some of the research that’s being done or if it’s even a possibility to reverse this disease.

Dr. Choudhary:  So, type one is not reversible. Unfortunately they have to be on insulin for the rest of their life. There are people looking for a cure. There are researchers who are working day and night to find a cure. But at this time, there is no cure for type one diabetes. However, the treatment for type one diabetes is getting savvier and savvier each day. There is technology. There are glucose sensors, insulin pumps which help with the management of type one diabetes.

Type two diabetes on the other hand, there are ways to reverse it. I’ve had kids who have come in with high glucoses, high A1Cs and with diet and exercise; we have been able to reverse type two diabetes. Type two diabetes kids initially are started on insulin and once their sugars are better controlled, we start them on a pill which is called metformin and gradually wean the doses of insulin. And overtime, over six to nine months, if they follow lifestyle changes and healthy eating; we are able to come off insulin in these kids.

Host:  Okay, understood and so let’s talk about living with diabetes. I have friends with children who have diabetes and it seems like they have the smallest little insulin pumps just under their shirts, you would never even know but it seems very reasonable to be able to live a manageable lifestyle even if you have diabetes. Is that correct?

Dr. Choudhary:  That is correct. However, type one diabetes is 24/7. I mean you don’t get a break. You are living with this all the time but with the current technology with insulin pumps and glucose sensors; it is a total game changer. So, with the glucose sensor, these children and adults they do not have to do fingerstick checks. They have a glucose sensor which is attached to their body and that checks glucoses or sugars every five minutes and they are able to get that data on their phone or watch or iPad. If your child is in school, the parents can see the glucose data from their house if they are in another – if they are on the west coast or east coast wherever they are, they can see their child’s data all the time. So, it is definitely life changing and helps parents track the blood sugars easily.

That is glucose monitoring. In terms of insulin; the insulin available now is definitely better than what it was many, many years ago. And there are insulin shots, insulin pens, and more recently we have insulin pumps which the site is changed every three days. So, instead of four to six shots a day, the child gets one shot every three days. And insulin pump is something which constantly delivers insulin to the body.

Host:  Yeah, it’s truly amazing to hear how far technology has come. So, Dr. Choudhary, I really appreciate your time today. that’s Dr. Abha Choudhary, a Pediatric Endocrinologist at Children’s Health and Assistant Professor at UT Southwestern. Thank you for listening to Children’s Health Checkup. Head to www.childrens.com/diabetes for more information. If you found this podcast helpful, please rate, review or share the episode and please follow Children’s Health on your social channels. Thanks and we’ll talk next time.