Maggie McKay (Host): Type 2 diabetes. With children, what are the signs and what are the ways to prevent it or treat it?

Today we'll get the answers from Dr. Sarah Allan, Pediatric Endocrinologist at Le Bonheur Children's Hospital. Welcome to the Peds Pod by Le Bonheur Children's Hospital. I'm your host, Maggie McKay. Thank you so much for joining us, Dr. Allan.

Sarah Allan, MD: Thank you for having me.

Host: So would you please give us a brief overview of what Type 2 diabetes is and how it differs from Type 1 diabetes?

Sarah Allan, MD: Of course. So in both Type 1 and Type 2 diabetes, you have high blood sugars. But in Type 1 diabetes, the high sugars are due to the body not being able to make insulin, and in people with Type 2 diabetes, your body can make insulin, but it doesn't respond normally to the insulin you're making, and that also leads to high blood sugars.

Whenever I'm talking to my families, I do like to emphasize that neither Type 1 nor Type 2 diabetes are your fault and actually in Type 2 diabetes, there's a little bit more genetic risk compared to Type 1. So that means you may have more people in your family affected by Type 2 diabetes.

Host: So, what are the main risk factors in children for developing Type 2 diabetes?

Sarah Allan, MD: So if you think about our population here in the U. S. and here in Memphis, a lot of kids are at risk, probably about a quarter of kids who are 10 or older. The recommendations for screening are based on these risk factors and really anyone with a body mass index at or above the 85th percentile for their age with any one of the following risk factors, should have screening. Because they're at high risk of developing either pre-diabetes or Type 2 diabetes in the future. Those risk factors are maternal gestational diabetes during mom's pregnancy with the child, a first or second degree relative with Type 2 diabetes, which if you think about really affects a lot of people we know, probably even many of us in our families, certain ethnicities like Native American, Latino, Asian, Pacific Islander, African American, or any signs or symptoms of insulin resistance. And we'll get into those a little bit more later. 

Host: So, how can lifestyle and diet changes help prevent Type 2 diabetes?

Sarah Allan, MD: Lifestyle and diet changes are actually the most important change that we talk to in children diagnosed either with sort of the earlier stages, not quite at Type 2 diabetes or Type 2 diabetes, because they have the greatest impact on whether or not you'll need to go on insulin in the future.

There are changes that I like to say are simple, but actually really difficult to put into practice for a lot of us. The main ones would be a 7 to 10 percent weight loss or, you know, if the child is still growing in height, it might be more trying to slow down the rate of weight gain as the height increases.

Implementing exercise in the diet. And that's really about an hour a day is what has been shown to be the most beneficial. But adding any amount of exercise to your day is a positive change. And then limiting screens to less than two hours a day, which is really challenging and not how a lot of teenagers and adults live.

Host: For sure. That probably might be even harder than getting them to exercise an hour a day, right?

Sarah Allan, MD: Absolutely, a lot of the teens I see may have spent two hours on their phone by the end of the school day.

Host: Exactly. Any more? Or those are the main ones?

Sarah Allan, MD: Those are the main ones. Other diet recommendations include emphasizing whole foods in the diet, like whole grains, fruits, vegetables, lean proteins, trying to limit the processed snack foods, so things like chips and crackers, and then trying to really eliminate any drinks that are sweetened, either with sugar or even 100 percent fruit juice.

Host: Wow. Dr. Allan, what are the early warning signs of Type 2 diabetes? Is it easy to overlook some symptoms?

Sarah Allan, MD: So it's very easy to overlook. The majority of people with early Type 2 diabetes don't have any symptoms. And that's why the recommendations for screening include so many children. But some symptoms could include, you might notice darkening of the skin, typically occurring on the neck, under the arms or the groin.

And then signs of insulin resistance can be things like elevated cholesterol, which every child should be having a cholesterol screening once during childhood. That's often done around age 10. Or in girls who have started having periods, symptoms of polycystic ovary syndrome. So irregular periods often associated with acne or some unwanted hair growth.

Host: And what tests are used to diagnose Type 2 diabetes? How often should my child be screened? 

Sarah Allan, MD: The two best tests are actually pretty simple and can be done in your pediatrician's office, either a hemoglobin A1c, which is a measurement of average glucose over about a three month time frame, or even just a fasting glucose done first thing in the morning. 

For kids who are at risk of Type 2 diabetes, we recommend screening at age 10 or the onset of puberty, whichever is earlier. And then if that first screening test is normal, re-screen every three years, and sooner if there's a significant change in weight.

Host: And when it comes to managing Type 2 diabetes, what helps in that? If a parent suspects their child might be at risk, what steps should they take?

Sarah Allan, MD: If they suspect their child is at risk, it's important to talk to their pediatrician early, because the level of the average blood sugars does impact how we treat Type 2 diabetes. But those lifestyle changes that we talked about are really important for everyone affected with Type 2 diabetes and are honestly probably changes that would improve anyone's health.

So going ahead and working on adding exercise to the day, limiting screens, working towards a healthier diet are good changes to focus on.

Host: Is there anything else in closing that you'd like to add that maybe we didn't cover?

Sarah Allan, MD: I've had a lot of families ask how exercise can impact blood sugars in patients with diabetes. And since that is one of the lifestyle recommendations, I will just mention that it's actually important to incorporate both kind of cardiovascular exercise and strength training because the cardiovascular exercise helps lower blood sugars sort of in the moment, but strength training actually helps improve how the body responds to insulin. So you can imagine how both would benefit people either at risk for or with Type 2 diabetes.

Host: Well, that's good to know. So you're saying basically whatever PE classes they get at school is probably not enough.

Sarah Allan, MD: It's probably not enough. And our best recommendation is for about 60 minutes a day. So for most people, that's going to require activity outside of PE.

Host: Right. Well, thank you so much for sharing your expertise. This has been such useful information and so educational. We really appreciate it.

Sarah Allan, MD: Thanks so much for having me. 

Host: Again, that's Dr. Sarah Allan, and if you'd like to find out more, please visit lebonheur.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thank you for listening to the Peds Pod by Le Bonheur Children's Hospital.