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Don't Sugarcoat It: Diabetes and Children
Amit Lahoti, MBBS discusses diabetes diagnoses and some of the innovative ways that Le Bonheur is working to treat children with diabetes.
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Learn more about Amit Lahoti, MBBS
Amit Lahoti, MBBS
Amit Lahoti, MBBS is an Endocrinologist and Assistant Professor at the University of Tennessee Health Science Center.Learn more about Amit Lahoti, MBBS
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Don't Sugarcoat It: Diabetes and Children
Bill Klaproth (Host): When people talk about diabetes, you don’t often think of children, but diabetes in children is on the rise, especially type 2 diabetes. So, let’s learn more with Dr. Amit Lahoti, a Pediatric Endocrinologist and Associate Professor at the University of Tennessee Health Science Center.
This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Lahoti, thank you for your time. So, what is diabetes and how common is it in children?
Amit Lahoti, MBBS (Guest): Diabetes is a disease in which a person develops high blood sugar levels in blood due to his or her inability to regulate it. Now we all get sugar levels up in our blood by eating food and a lot of our food has things called starches or carbohydrates which our body eventually digest to break down into small particles called the sugar particles. For our body to be able to use these sugar particles, our body needs to transfer them from blood to our different parts of the body including our muscles, our brain, everything needs energy. And we need a sort of a bridge called insulin to make these sugar particles move from our blood inside these cells.
Now there are broadly speaking, or the common types of diabetes are what we know as type 1 and type 2 diabetes. There are some rarer forms of diabetes also. Patient with type 1 diabetes, essentially lack these bridges or they actually do not make any insulin so the blood sugar once it is absorbed from our intestines after the food that we ate, remains high because it has no where to go because we do not have these insulin bridges. On the other hand, patients who have type 2 diabetes have a primary problem with these bridges where the insulin is working. So, sugar stays in the blood because these bridges that you can kind of think about in practical terms are not working quite right. So, we can see both type 1 and type 2 diabetes in children.
And approximately 210,000 Americans under the age of 20 are estimated to have diagnosed diabetes which is about 0.25% of all population in this age group. In a one year period, and between 2014 and 2015, there were about 18,000 new children diagnosed with type 1 diabetes and close to 6000 children who were diagnosed with type 2 diabetes.
Host: So, we often hear about diabetes in adults. It seems like we are hearing more and more about it in children. How is diabetes care different in children versus adults?
Dr. Lahoti: There are several forms in which diabetes in kids and adults are different. The one major difference is that the majority of diabetes cases in children are type 1 which is what we used to call childhood onset diabetes in the past, but it is essentially insulin dependent diabetes. And while type 1 diabetes can also be diagnosed as an adult, the overwhelming majority of diabetes in adults is type 2 which is what we used to call adult onset diabetes. But it is essentially an insulin resistant kind of diabetes.
Secondly, I think the other important factor is that children are growing, and their body’s insulin needs, or their medication needs vary a lot as they go through different phases of their growth. Specifically puberty, is a period of increased needs of insulin in patients with type 1 diabetes. It is also a challenging phase because children are going through puberty and trying to fit in with the rest of their peers, so diabetes care tasks are overall harder sometimes during that period. And there are two other major points which is they are very dependent on adults for a lot of their diabetes care needs so they are not – a lot of things that they have to do for the diabetes is out of their control, buying medications, taking medications sometimes. And they have a long life ahead of them. So, blood control earlier in the childhood can have really long term effects and the complications can start rather at an early age.
Host: Okay. So, then how is diabetes diagnosed and treated in children?
Dr. Lahoti: Final diagnosis what I believe is based on their blood sugar levels which is a lab testing. So, if the fasting blood sugar basically after you have not eaten for eight hours, if your blood sugar is greater than 126 milligrams per deciliter or higher or two hours after a meal or with a formal glucose tolerance test, your blood sugar is 400 milligrams per deciliter or higher. That is consistent with diabetes. However, the symptoms are the key. And if there is one take home message for all the listeners here, I would like to pass on is that they should be aware of what are the symptoms of diabetes so that they can pick them up if they see that in their child or a friend. And those are an excessive thirst or increased frequency of going to the bathroom to pee or a new onset frequency of going to the bathroom at night or waking up at night to drink or pee which is unusual for the person. And unexplained weightloss especially even if they are very hungry and they often eat more and still they end up losing weight. An overall loss of energy. Those are kind of early symptoms of diabetes that should make a person seek medical attention or take their children to the doctor’s office to kind of make sure that they do not have diabetes.
Host: Well it’s good to know those symptoms. Let’s go over those again. Excessive thirst, more trips to the bathroom especially at night, unexplained weightloss, overall fatigue, and then potentially blurry vision. Earlier, you said the majority of kids have type 1 diabetes. We hear about type 2 diabetes more so in an older population; however, type 2 diabetes is on the rise and type 2 diabetes is becoming more common in children, is that right?
Dr. Lahoti: Yes. Very much so. So, approximately one in every four to five patients with diabetes under the age of 20 have type 2 diabetes. And in our hospital, we kind of see approximately two to three patients per week with new diabetes and in an entire month, we can have one or two of those as type 2 diabetes.
Host: Wow, so you are seeing that more and more often then.
Dr. Lahoti: That’s correct.
Host: So, then can diabetes be prevented?
Dr. Lahoti: That’s an interesting question. For type 1 diabetes, it will be about 100 years since we first discovered insulin and the treatment for type 1 diabetes. However, we still do not have very good understanding of what essentially causes it. Because by the time the children come to medical attention, they already have had 90 to 95% of their pancreas which makes insulin stop working to make insulin. So, it is really hard to determine what caused it that late in the game. So, more and more research is still focusing on trying to take some of these patients before the reach full blown diabetes and unfortunately the answer to that as of now is yes, I cannot tell you do this or not to do this to prevent type 1 diabetes.
On the other hand, we have a somewhat better understanding for type 2 diabetes though still more research is needed in this field as well. There are some known factors of type 2 diabetes and the prominent among those are being obese or overweight, having a family history of type 2 diabetes, certain racial or ethnic groups like Native Americans, African Americans, Asian Americans, Hispanics or it the patient already has hypertension or high levels of cholesterol, will if they are not physically active or have other some physical exam findings of insulin resistance. These patients can do some things to decrease their risk of type 2 diabetes and specifically among those; increasing their activity levels and potentially losing some weight to get a healthy body mass index are potential ways to prevent type 2 diabetes.
Host: So, for type 1 diabetes, the picture is a little unclear, but certainly with type 2 diabetes, with lifestyle management; you can help prevent the disease. So, what are the greatest risks of diabetes in children if it goes unchecked?
Dr. Lahoti: So, most of the complications are due to uncontrolled diabetes. So, the risks can be to a large part negated or minimized by managing diabetes well and trying to keep the blood glucose levels in the target range. And that is not even needed for 100% of the time even a 50 to 70% of the time blood sugars are in the target range, you can minimize the complications. The complications can be either immediate or short term, things like increased risk of infections especially bacterial or yeast infections. You can have serial high blood sugars or what we call diabetes ketoacidosis. It’s a term in which refers to having high blood sugars, having high acid level in the blood which often requires hospitalizations and serial low blood sugars or seizures because of low blood sugars.
In addition, there could be also long term complications of diabetes which we have probably heard much more. Things like heart attacks, things like strokes, increased risk of loss of vision, kidney failure, developing nerve problems which includes including loss of sensation to limbs, extremities, increased risk of dental caries or early teeth loss. Some of these can start even unfortunately before kids graduate from our practice. So, it’s really important to take good care of diabetes to prevent these complications hopefully for a really long time.
Host: Yeah, this is a problem that seems to be increasing and growing. So, what are some of the innovative ways that Le Bonheur is working to treat children with diabetes?
Dr. Lahoti: Similar to a lot of children’s hospitals, we do have very well rounded and multidisciplinary program for managing and helping patients with type 1 and type 2 diabetes and some of the other rarer forms of diabetes also to be managed by a team of physicians, nurse practitioners, diabetes educators, registered dieticians, social workers and psychologists. However, we also have specific programs to meet needs of certain subpopulations in this group of diabetes patients that we see. One of the clinics that we do run is called A Fresh Start Clinic. This clinic focuses on a small group of patients with type 1 diabetes who have had recurrent episodes of what I had just mentioned diabetic ketoacidosis in the preceding 12 months with the primary goal of preventing any further hospitalizations. The clinic sees these patients every four to six weeks but in a multidisciplinary team set up and they have a goal of essentially leaving no stone unturned to bring the change in these patient’s lives.
A second clinic that we run is called EMPOWER Clinic which is an acronym for exercise, medications, psychosocial health, optimizing blood sugar, weight management, eating right and reducing risks. So, as the name suggests, this kind of is a multipronged approach and especially targeted to our patients with type 2 diabetes to improve their care and management. Ensuring they have access to newer medications as well as have options to participate in newer research studies for type 2 diabetes. We do also conduct an annual conference for school nurses and providers by training educators and other caregivers in the schools who take care of our children with diabetes. And we are also at the front line to provide research opportunities for our patients with diabetes to hopefully improve our understanding of the diabetes causes itself and improving our treatment for these patients.
Host: Wow, really comprehensive and good to know that Le Bonheur has a plan on working to treat children with diabetes as this problem is growing. Dr. Lahoti, thank you so much for your time. This has really been informative. Thank you.
Dr. Lahoti: Thank you Bill.
Host: That’s Dr. Amit Lahoti and to learn more, visit www.lebonheur.org/podcast and be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out www.lebonheur.org/podcast to view the full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening.
Don't Sugarcoat It: Diabetes and Children
Bill Klaproth (Host): When people talk about diabetes, you don’t often think of children, but diabetes in children is on the rise, especially type 2 diabetes. So, let’s learn more with Dr. Amit Lahoti, a Pediatric Endocrinologist and Associate Professor at the University of Tennessee Health Science Center.
This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Lahoti, thank you for your time. So, what is diabetes and how common is it in children?
Amit Lahoti, MBBS (Guest): Diabetes is a disease in which a person develops high blood sugar levels in blood due to his or her inability to regulate it. Now we all get sugar levels up in our blood by eating food and a lot of our food has things called starches or carbohydrates which our body eventually digest to break down into small particles called the sugar particles. For our body to be able to use these sugar particles, our body needs to transfer them from blood to our different parts of the body including our muscles, our brain, everything needs energy. And we need a sort of a bridge called insulin to make these sugar particles move from our blood inside these cells.
Now there are broadly speaking, or the common types of diabetes are what we know as type 1 and type 2 diabetes. There are some rarer forms of diabetes also. Patient with type 1 diabetes, essentially lack these bridges or they actually do not make any insulin so the blood sugar once it is absorbed from our intestines after the food that we ate, remains high because it has no where to go because we do not have these insulin bridges. On the other hand, patients who have type 2 diabetes have a primary problem with these bridges where the insulin is working. So, sugar stays in the blood because these bridges that you can kind of think about in practical terms are not working quite right. So, we can see both type 1 and type 2 diabetes in children.
And approximately 210,000 Americans under the age of 20 are estimated to have diagnosed diabetes which is about 0.25% of all population in this age group. In a one year period, and between 2014 and 2015, there were about 18,000 new children diagnosed with type 1 diabetes and close to 6000 children who were diagnosed with type 2 diabetes.
Host: So, we often hear about diabetes in adults. It seems like we are hearing more and more about it in children. How is diabetes care different in children versus adults?
Dr. Lahoti: There are several forms in which diabetes in kids and adults are different. The one major difference is that the majority of diabetes cases in children are type 1 which is what we used to call childhood onset diabetes in the past, but it is essentially insulin dependent diabetes. And while type 1 diabetes can also be diagnosed as an adult, the overwhelming majority of diabetes in adults is type 2 which is what we used to call adult onset diabetes. But it is essentially an insulin resistant kind of diabetes.
Secondly, I think the other important factor is that children are growing, and their body’s insulin needs, or their medication needs vary a lot as they go through different phases of their growth. Specifically puberty, is a period of increased needs of insulin in patients with type 1 diabetes. It is also a challenging phase because children are going through puberty and trying to fit in with the rest of their peers, so diabetes care tasks are overall harder sometimes during that period. And there are two other major points which is they are very dependent on adults for a lot of their diabetes care needs so they are not – a lot of things that they have to do for the diabetes is out of their control, buying medications, taking medications sometimes. And they have a long life ahead of them. So, blood control earlier in the childhood can have really long term effects and the complications can start rather at an early age.
Host: Okay. So, then how is diabetes diagnosed and treated in children?
Dr. Lahoti: Final diagnosis what I believe is based on their blood sugar levels which is a lab testing. So, if the fasting blood sugar basically after you have not eaten for eight hours, if your blood sugar is greater than 126 milligrams per deciliter or higher or two hours after a meal or with a formal glucose tolerance test, your blood sugar is 400 milligrams per deciliter or higher. That is consistent with diabetes. However, the symptoms are the key. And if there is one take home message for all the listeners here, I would like to pass on is that they should be aware of what are the symptoms of diabetes so that they can pick them up if they see that in their child or a friend. And those are an excessive thirst or increased frequency of going to the bathroom to pee or a new onset frequency of going to the bathroom at night or waking up at night to drink or pee which is unusual for the person. And unexplained weightloss especially even if they are very hungry and they often eat more and still they end up losing weight. An overall loss of energy. Those are kind of early symptoms of diabetes that should make a person seek medical attention or take their children to the doctor’s office to kind of make sure that they do not have diabetes.
Host: Well it’s good to know those symptoms. Let’s go over those again. Excessive thirst, more trips to the bathroom especially at night, unexplained weightloss, overall fatigue, and then potentially blurry vision. Earlier, you said the majority of kids have type 1 diabetes. We hear about type 2 diabetes more so in an older population; however, type 2 diabetes is on the rise and type 2 diabetes is becoming more common in children, is that right?
Dr. Lahoti: Yes. Very much so. So, approximately one in every four to five patients with diabetes under the age of 20 have type 2 diabetes. And in our hospital, we kind of see approximately two to three patients per week with new diabetes and in an entire month, we can have one or two of those as type 2 diabetes.
Host: Wow, so you are seeing that more and more often then.
Dr. Lahoti: That’s correct.
Host: So, then can diabetes be prevented?
Dr. Lahoti: That’s an interesting question. For type 1 diabetes, it will be about 100 years since we first discovered insulin and the treatment for type 1 diabetes. However, we still do not have very good understanding of what essentially causes it. Because by the time the children come to medical attention, they already have had 90 to 95% of their pancreas which makes insulin stop working to make insulin. So, it is really hard to determine what caused it that late in the game. So, more and more research is still focusing on trying to take some of these patients before the reach full blown diabetes and unfortunately the answer to that as of now is yes, I cannot tell you do this or not to do this to prevent type 1 diabetes.
On the other hand, we have a somewhat better understanding for type 2 diabetes though still more research is needed in this field as well. There are some known factors of type 2 diabetes and the prominent among those are being obese or overweight, having a family history of type 2 diabetes, certain racial or ethnic groups like Native Americans, African Americans, Asian Americans, Hispanics or it the patient already has hypertension or high levels of cholesterol, will if they are not physically active or have other some physical exam findings of insulin resistance. These patients can do some things to decrease their risk of type 2 diabetes and specifically among those; increasing their activity levels and potentially losing some weight to get a healthy body mass index are potential ways to prevent type 2 diabetes.
Host: So, for type 1 diabetes, the picture is a little unclear, but certainly with type 2 diabetes, with lifestyle management; you can help prevent the disease. So, what are the greatest risks of diabetes in children if it goes unchecked?
Dr. Lahoti: So, most of the complications are due to uncontrolled diabetes. So, the risks can be to a large part negated or minimized by managing diabetes well and trying to keep the blood glucose levels in the target range. And that is not even needed for 100% of the time even a 50 to 70% of the time blood sugars are in the target range, you can minimize the complications. The complications can be either immediate or short term, things like increased risk of infections especially bacterial or yeast infections. You can have serial high blood sugars or what we call diabetes ketoacidosis. It’s a term in which refers to having high blood sugars, having high acid level in the blood which often requires hospitalizations and serial low blood sugars or seizures because of low blood sugars.
In addition, there could be also long term complications of diabetes which we have probably heard much more. Things like heart attacks, things like strokes, increased risk of loss of vision, kidney failure, developing nerve problems which includes including loss of sensation to limbs, extremities, increased risk of dental caries or early teeth loss. Some of these can start even unfortunately before kids graduate from our practice. So, it’s really important to take good care of diabetes to prevent these complications hopefully for a really long time.
Host: Yeah, this is a problem that seems to be increasing and growing. So, what are some of the innovative ways that Le Bonheur is working to treat children with diabetes?
Dr. Lahoti: Similar to a lot of children’s hospitals, we do have very well rounded and multidisciplinary program for managing and helping patients with type 1 and type 2 diabetes and some of the other rarer forms of diabetes also to be managed by a team of physicians, nurse practitioners, diabetes educators, registered dieticians, social workers and psychologists. However, we also have specific programs to meet needs of certain subpopulations in this group of diabetes patients that we see. One of the clinics that we do run is called A Fresh Start Clinic. This clinic focuses on a small group of patients with type 1 diabetes who have had recurrent episodes of what I had just mentioned diabetic ketoacidosis in the preceding 12 months with the primary goal of preventing any further hospitalizations. The clinic sees these patients every four to six weeks but in a multidisciplinary team set up and they have a goal of essentially leaving no stone unturned to bring the change in these patient’s lives.
A second clinic that we run is called EMPOWER Clinic which is an acronym for exercise, medications, psychosocial health, optimizing blood sugar, weight management, eating right and reducing risks. So, as the name suggests, this kind of is a multipronged approach and especially targeted to our patients with type 2 diabetes to improve their care and management. Ensuring they have access to newer medications as well as have options to participate in newer research studies for type 2 diabetes. We do also conduct an annual conference for school nurses and providers by training educators and other caregivers in the schools who take care of our children with diabetes. And we are also at the front line to provide research opportunities for our patients with diabetes to hopefully improve our understanding of the diabetes causes itself and improving our treatment for these patients.
Host: Wow, really comprehensive and good to know that Le Bonheur has a plan on working to treat children with diabetes as this problem is growing. Dr. Lahoti, thank you so much for your time. This has really been informative. Thank you.
Dr. Lahoti: Thank you Bill.
Host: That’s Dr. Amit Lahoti and to learn more, visit www.lebonheur.org/podcast and be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out www.lebonheur.org/podcast to view the full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening.