Transcription:
Diabetes Awareness Month

Scott Webb: Welcome to UK HealthCast from UK I'm Scott Webb, and since November is Diabetes Awareness Month, it seems like a good time to talk about childhood diabetes with Andrea Francis. She's a registered dietician and licensed diabetes educator at the Barnes Stable Brown Diabetes Center. Andrea, thanks so much for your time today. We're gonna talk about diabetes, childhood diabetes, and all that that implies. But before we get rolling here, just to have a quick definition of what diabetes is?

Andrea Francis: Sure. So diabetes is a condition where the body has trouble regulating its blood glucose, or you might hear that referred to as blood sugar. So there's multiple types of diabetes and it affects all ages.

Scott Webb: Yeah, it really does. And our focus today, of course, is gonna be on children. So what types of diabetes really affect children?

Andrea Francis: So there's multiple types of diabetes that we see in kids. The most common types of diabetes in children are type one and type two diabetes. Those make up the majority. Type one diabetes is actually one of the most common chronic conditions for children in the United States. So, to give you a little bit more detail there's Type one diabetes is an autoimmune disease. So normally the pancreas makes insulin to convert the food we eat into energy, and then type one diabetes. The body mistakenly destroys those insulin producing cells. So the No longer makes that insulin.

The only treatment is to take multiple daily doses of insulin either using an insulin pin or an insulin pump, along with counting carbohydrates that the child eats, monitoring blood glucose levels multiple times a day, and. All of those steps can help keep the blood glucose levels in a healthy range. To give you a picture, the annual incidents of children diagnosed with type one diabetes is 18,200 kids per year according to the CDC. Type two diabetes is the other one that we see most commonly. If you ever hear of prediabetes, that's the precursor to type two.

But type two diabetes is more of a metabolic disorder, s o the person's body still makes insulin, but the body is resistant to using that insulin that it makes, so it's not as effective or efficient. If interventions are started early, type two diabetes can be managed when nutrition, exercise perhaps oral medication like metformin. But type two diabetes is a progressive condition. And type one diabetes insulin is not made anymore. And type two diabetes as that person has insulin resistance.

And as that increases, the pancreas tries to keep up with that demand. And so eventually the amount of insulin won't be enough and the person may need insulin injection. So this is why early intervention is so important in type two diabetes so that we can make those changes to delay the progression of the condition and also delay any comorbidities associated with it. I know I talked about the annual incidents for type one diabetes and kids. The annual incidents for children diagnosed with type two diabetes is 5,800 children per year.

And both of those statistics are according to the CDC. There are a couple of other types of diabetes that are less popular. They don't happen as much. There's neonatal diabetes that occurs within the six months of life, like one in a hundred thousand births. And then Modi or maturity onset diabetes of the young is something we see as well. It's an inherited form of diabetes. It's a genetic mutation and accounts for about one to 5% of diabetes cases. We still see. So that's why I talk about those. But the majority of our cases are type one and type two diabetes.

Scott Webb: Yeah, Type one and type two. And I've heard this before about type one that it's a bit of a misnomer to think of people, children being born with type one diabetes, that because it's an autoimmune disease. It's sort of there in the background and then something sort of triggers it and maybe we don't even know what triggers it. Do I have that?

Andrea Francis: Great question. Type one diabetes, we're not a hundred percent sure why it happens. There are antibody tests that can tell us a person's risk or can confirm type one diabetes, for the child. But where it's an autoimmune condition, yeah, there's a genetic component, but usually there's something that switches that trigger. And so we can't predict when it will happen. We can't predict if it will happen. It's one of those things that just creeps up. And so that's a conversation I have with parents a lot is we couldn't prevent it. We couldn't know it was going to happen. Now we just have to treat it.

Scott Webb: Yeah, I'm sure that some parents wonder, well, did we do something wrong? You know, is this our fault? And of course the answer is no but certainly all of us parents sort of understand that feeling. Well then I must have. Something wrong. I must have failed them somehow, but that's not really the case. Right?

Andrea Francis: Correct. Absolutely. And that's with diabetes in general is we really couldn't predict exactly when it was going to happen. And with type one diabetes, you're exactly right. We don't know, and we couldn't prevent it.

Scott Webb: Right, and you did mention that early diagnosis, especially for type two. So what, It's nice to catch it when it's in that pre-diabetes phase, but you know, somewhere in there if we can help to, uh, treat it. Slow it down, there's no cure per se, but there's lots of interventions. But, let's talk at least about the signs and symptoms. What should we, as parents be on the lookout for pre-diabetes or type two in our children? And When these signs and symptoms appear, what do we do? Like how quickly should we reach out to a provider?

Andrea Francis: Yeah, so I'll go over type one and type two just because I feel like type one diabetes, sometimes the symptoms are missed or they're misdiagnosed for something else. So let's go into both of them. So signs of type one diabetes include increased thirst, increased hunger, increased need to urinate. So they're gonna be peeing a lot. Weight loss, blurry vision, extreme fatigue, those are really common signs. And then when we're at the point of DKA or diabetic ketoacidosis, that's at a point where the child is very sick. And we see that a lot when children are first diagnosed with type one, and that includes fruity smelling breath, abdominal pain, vomiting, trouble breathing.

DKA is a life threatening event, and that's when I tell parents and caregivers, you should seek treatment or seek care immediately. Those are severe signs, so if you can catch those other ones first, like the increased thirst, increased hunger. Increase, need to urinate. We call it the three Ps. Polyuria, polydipsia, and polyphagia. When you see, yeah, when you see those, it's good to go ahead and reach out to a provider, the pediatrician and say, Hey, this is going on. We're concerned. Type two diabetes. The symptoms are similar. So the three P's, the polyuria, polyphagia, polydypsia, we do see that with type two diabetes as well.

I would also include the fatigue as well, but we can also see with type two diabetes if the child's having an increased number of infections, or if they have really dry skin or darkened areas of skin, like around the neck or the arm pits. We call that acanthosis or significant weight changes, gains or losses. If those are happening, I definitely recommend that a parent or caregiver, uh, reaches out to the pediatrician and the pediatrician can provide a referral to a pediatric endocrinology provider.

Scott Webb: Yeah, and you mentioned that parents and caregivers, caretakers, like we can't prevent diabetes per se, but I'm sure there maybe are some tips, some things that maybe sort of like we don't know that these work exactly or how they might work, but we think these are good ideas. Maybe you can share some of those tips.

Andrea Francis: Sure. So for type one diabete s there's not really anything we can do to prevent it, and there's really no cure. However, if there's a family history you can always look into Antibody testing. There's a couple of different programs out there where you have the opportunity to enroll in studies like TrialNet or t1, detect. There's a couple of different things out there now. Type two diabetes though, there are a couple things we can do to prevent this from coming on or delay the progression.

Scott Webb: Yeah, Delay, right.

Andrea Francis: Big, big part there. So type two Diabetes and children. It does have a genetic component. A lot of times if family members, there's type two diabetes all throughout the family history, there's a pretty good chance the child may eventually develop it sometime in their lifetime. So first, knowing that but also lifestyle habits can play a huge part to preventing or delaying type two diabetes. So a couple of different things. These are the. Kind of top things I share with families of what we can do to delay or prevent type two diabetes. First, encourage your child to be physically active.

All experts in pediatric care recommend at least 60 minutes of physical activity per day, whether or not they have diabetes. So this is all children. This can help maintain a healthy weight and also keep the body really sensitive to the insulin they're already making. A second thing would be serving healthy meals and snacks. So eating a balance of vegetables, fruit, lean proteins, whole grains, low fat dairy in the right portions. Those allow us to fuel the child's body the right way, while also maintaining a healthy weight, .

Avoiding regular sodas, fruit juices, sugar sweetened drinks. These items are really high in sugar that our body doesn't actually need. So getting rid of those can be a huge game changer. Also, limiting the amount of processed foods can play a role in preventing diabetes as well. The last thing that can really help prevent type two diabetes is maintaining a healthy weight. So I always recommend talking to your child's pediatrician provider about what a normal weight looks like for your child. Weight kind of varies across the board. So what is perfect for your child? Children are still growing.

So if they are overweight, typically the goal is to slow down that weight gain while also allowing for normal growth and development. Especially in pediatric endocrinology, we can provide guidance on how to achieve this. And so wrap that all up, I do say that my best recommendation to parents and caregivers is don't expect the child to make these changes alone. Healthy changes can become a habit when the whole family is participating together, Of course, involve the child in picking out new recipes or choosing how to exercise, like if they like to dance, let's do Zumba.

If they like lifting weights. Cool. Make sure we're doing it safely. But when the whole family tries the new recipe or completes the activity together, it's more likely for everyone to make changes for the whole family to be healthy. And it also doesn't single the child out.

Scott Webb: Yeah, exactly. Like your child doesn't feel like, Oh, this is my special. Prevent diabetes meal, like we're all trying to eat healthier because we would all benefit from better choices, probably behavior, lifestyle, watching our weight, eating less processed foods. Like it's all good stuff for all of us, but especially, as you said, nearly 25,000 children are diagnosed roughly with diabetes every year. So everything that we can do in terms of prevention, delaying early diagnosis.

It's all good stuff, as has been this conversation today. This has been really educational and fun. Wanna give you a chance here we think about education. What sort of options are available for kids at Barn Stable Brown?

Andrea Francis: So we offer a variety of classes and appointments. Or pediatric patients and their families. Usually after patients are initially diagnosed, they'll come to an education class where we build on these survival skills. The family learned, like how to give insulin or how to check a blood sugar. We then talk about day to day experiences and tips and tricks to manage diabetes. Including how to manage diabetes at school, using diabetes technology, what to do when the child is sick, how to help keep blood sugars in range when kids are playing sports.

These are really big things that families need to know so they can be successful. We also offer training on using diabetes technology like continuous glucose monitors and insulin pumps. Those have made such strides in the last couple years that we are so lucky to have these and we want to use them as effectively as possible. Lastly, we're also in the works of creating a class for teenagers and young adults that would provide tips on managing diabetes during that new season of independence and new life experiences.

Overall diabetes educators are very essential part of this team in diabetes Education is an essential part of being able to navigate the ins and outs of diabetes care. So as pediatric diabetes educators, we are in the trenches with families. We provide support and assistance wherever we can. Sometimes it's finding solutions with prescriptions and insurance. Sometimes it's troubleshooting. Diabetes technology issues or a brand new life situation pops up and we problem solve how to manage diabetes while the child explores a new school sport or new activity.

We really try to individualize care and education at Bard, Stable Brown because each person with diabetes has different needs. So we really want all of our patients and their families to be successful with diabetes. And we believe that a child can still be a child and diabetes shouldn't hold them back.

Scott Webb: Absolutely. My daughter is a freshman in high school and one of her friends was recently diagnosed with type two. And to your point about just how far things have come in managing diabetes, the technology, the wearables, the smartphones, and watches and all of that, it's been really interesting to hear about how her friend has dealt with this, and how impressed my daughter has been with the technology as well. Not that anybody wants type two diabetes, and our point here today is we can try to prevent this and slow this down, but if we can't and we don't, things have come so far and especially all the education you're doing there. So, this has been really educational for me today. You're just so compassionate and knowledgeable. Really good stuff. Thank you so much.

Andrea Francis: No problem. Thank you so much for your time.

Scott Webb: And for more information, go to UK Healthcare.uky.edu/barnstable-brown-diabetes-center. And that wraps up another episode of UK HealthCast from UK please remember to subscribe, rate and review this podcast and all of the other University of Kentucky Healthcare podcasts. I'm Scott Webb. Stay well.