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Hills 1 Abbie Hills Mrs.

Strecker AP English 12 Block 8 5 October 2011 Type 2 Diabetes in Children: A Preventable Epidemic During the latter part of the twentieth century there was a sharp increase in the number of people below the age of twenty who were diagnosed with type 2 diabetes, a disease usually acquired by adults over age forty-five. Currently, about 151,000 people below the age of twenty have type 2 diabetes, making it the most common chronic disease in children and adolescents. Type 2 diabetes accounts for approximately eight to forty-six percent of all new cases of diabetes referred to pediatric centers, and about 3,700 adolescents are diagnosed with type 2 diabetes annually (National par. 1). Many doctors and pediatricians believe that this seemingly sudden increase of type 2 diabetes in children directly correlates to a lack of physical activity, poor diet, and family history of the disease. As more and more children and adolescents are diagnosed with type 2 diabetes every year, it is becoming increasingly apparent that there is insufficient public knowledge on how to avoid and detect this debilitating disease. Although the number of new cases of type 2 diabetes continues to increase, many people do not know that this disease is preventable and increased awareness of what the disease does inside the body, the factors that put children at risk for this disease, and pre-emptive measures can lead to the decrease of this life-threatening disease. Type 2 diabetes has been known by many misleading names such as "adult-onset diabetes", "obesity-related diabetes", "insulin-resistant diabetes", or "non-insulin-dependent diabetes. However, these names do not necessarily correlate with the nature of the disease

Hills 2 (Diabetes, Type 2 par. 1). Type 2 diabetes occurs when the beta cells in the pancreas are still producing plenty of insulin, but the cells take a longer time to release the insulin due to large amounts of glucose in the blood stream. Cells in the body need insulin to function. However, in a body with type 2 diabetes, the cells are insulin resistant due to either a lack of insulin receptors on cells, an imbalance of insulin and receptors, or flaws in the chemistry allowing insulin into the cells (Laliberte 42). When glucose starts to build up in the blood stream and does not enter the cells, the cells burn fat instead of glucose and ketones form in the blood and get into urine, which causes frequent urination and dehydration. Ketones are the result of the body burning fat for energy and, in people with type 2 diabetes, it is often the result of prolonged high blood sugar and insulin deficiency in cells (Kaufman par. 1). The symptoms of type 2 diabetes are hard to recognize due to the fact that the disease gradually increases in strength and manifests itself slowly. Often times there may be no symptoms other than obesity. Type 2 diabetes manifests itself through polydipsia (unquenchable thirst), frequent urination, and fatigue, and a random plasma glucose level that is greater than 200mg/dl (Copeland par. 9). The effects that it has on the nervous and immune systems are shown through slow wound healing, tingling in the hands and feet due to a nervous system breakdown, and frequent infections, especially in the urinary tract (Laliberte 38). Less common warning signs for the disease are hunger, flulike symptoms, blurred vision, irritability, and recurring infections of the gum or skin. Many females with the disease experience recurring vaginal infections and yeast infections along with urinary tract problems. (Collazo-Clavell 12). Despite all these warning signs, most children with type 2 diabetes are not diagnosed until the appearance of acanthosis nigricans, an epidermal condition which causes dark shiny patches to

Hills 3 appear on the skin located between fingers and toes, back of the neck, and in axillary creases (Type 2 par. 10). The biggest question about type 2 diabetes is why is occurs, and especially why it is starting to occur in children. Melinda Southern, professor of public health at Louisiana State University Health Sciences Center in New Orleans, quotes in USA Today: We have a new generation of children who are metabolically different. We [at the Louisiana State University Health Sciences Center in New Orleans] think theres been a series of genetic mutations linked to environmental and lifestyle changes over the last few generations that have led to this [epidemic] (par. 7). These lifestyle changes include an increase of high-sugar and high-fat food in the diet of many children. While eating too much sugar does not directly cause diabetes, this excess in sugar can cause weight gain, which can contribute to developing diabetes if it is not balanced with a decent amount of exercise (Diabetes Facts par 3). However, obesity alone is not the only health factor that increases a childs chance of procuring type 2 diabetes. A child may have a weight that classifies them as obese, but the way in which they carry their weight plays an important part in their risk for diabetes. In the Newswise.com article, Ethnic Background Matters for Type 2 Diabetes, it states that: BMI [body mass index, used to diagnose someone as obese] alone does not tell the whole story. The BMI calculation, which relies on weight and height only, does not account for fat distribution or the percentage of an individual's body that is lean muscle mass: two factors that may have more influence on the development of diabetes (par. 5). This rising generation also has shown and increase in a lack of physical activity, making cells more prone to insulin resistance because of the lack of muscle mass to absorb excess glucose, which then enters into the bloodstream. With the addition of excess sugars in the diet of children and the lack of exercise, obesity has become

Hills 4 increasingly more prevalent in children and adolescents. The excess body weight increases the need for insulin in the body, and the pancreas, which produces the insulin, is unable to keep up with the demand. Increased sugar and lack of exercise also contribute to the accumulation of visceral adipose tissue. This tissue, which generates around the abdominal region of the body, contributes to the development of diabetes because it increases the level of fatty acids that causes insulin resistance to cells that store glucose around the liver (Laliberte 44-45). It is storing the fat in the abdominal region that Doctor Maskarinec wrote in the Newswise article, Ethnic Background Matters for Type 2 Diabetes that, "[people with] more weight distributed to the abdomenare at high risk of diabetes [because], in the pancreas, the beta cells seem to exhaust themselves faster" (par. 8). Doctors Copeland, Becker, Gottschalk, and Hale wrote in the medical journal Clinical Diabetes: [In] a study of 32 overweight or obese Hispanic children without diabetes but with a family history of type 2 diabetes indicated that increased visceral fat was independently related to both insulin resistance and decrease insulin secretion (par. 18). This finding is important because insulin resistance and a decrease in insulin secretion are both precursors to full-blown type 2 diabetes. Another factor in the increase of type 2 diabetes in children is family history. Statistics have shown that 45-80% of all children diagnosed have at least one parent with diabetes and 74100% of these children have a first or second degree relative with diabetes (Type 2 Diabetes in Children par. 13). Also, the ethnic groups with the highest prevalence of type 2 in teens 15-19 are American Indians, followed by African Americans, Asian and Pacific Islanders, and Hispanic Americans (National Diabetes par.11). These ethnic groups also have a history of a higher prevalence of poverty and usage of government supplied food stamps. Their meager funds and

Hills 5 food stamps usually go towards processed, high-sugar, high-fat foods which indirectly contribute to obesity, which is a risk factor for type 2 diabetes. Doctor Mark Hyman wrote in the Huffington Post: Many poor people in this country are consuming an excess of nutritionallydepleted, cheap calories from sodas, processed foods, and junk food. These folks scarcely eat whole, fresh foods at all, and for good reason: We have made calories cheap, but real food expensive. Almost three hundred billion dollars of government subsidies support an agriculture industry that focuses on quantity not quality, on producing cheap sugar and fats from corn and soy that fuel both hunger and obesity. These calorie-rich, sugary, processed foods are what most people buy if they don't have enough money. You can fill up on twelve hundred calories of cookies or potato chips for one dollar, but you'll only get two hundred fifty calories from carrots for that same one dollar (par. 10). A genetic occurrence of pubertal problems also contributes to type 2 diabetes. According to the website Children with Diabetes: Puberty has been identified as important in the development of type 2 diabetes in children. Changes in hormone levels during [puberty] cause insulin resistance and decreased insulin action (par. 12). This is because puberty is an especially stressful time for adolescents and the stress makes diabetes worse. This added stress on top of handling type 2 diabetes can cause serious depression in adolescents with the disease (Teenagers par. 10). According to the Center for Disease Control About nine percent of adolescents with diabetes mellitus have moderate or severely depressed mood symptoms Depressed moods are also associated with poor glycemic control (National Diabetes par. 7). Blood glucose control is extremely difficult during puberty because the growth hormones being excreted negatively

Hills 6 affect insulin usage in the body, causing blood glucose levels to fluctuate between too high and too low. After a child has been diagnosed with type 2 diabetes, no matter what the cause, they cannot outgrow the disease. Type 2 diabetes may also cause a slew of other medical complications throughout a childs life. Pediatricians Sheila Gahagan and Janet Silverstein wrote in the medical journal Pediatrics: For pediatric patients, [diabetes] heralds earlier onset of cardiovascular disease, retinopathy, nephropathy, and neuropathy, with risks of impaired quality of life and premature death (par. 27). Eye problems are extremely common in people with type 2 diabetes, especially problems such as night blindness and light sensitivity. Diabetes also makes it hard to control blood pressure and cholesterol, causing heart attacks, strokes, and decrease in blood flow to the legs and feet, making it hard to walk. Due to nerve damage from prolonged insulin therapy, many people with type 2 diabetes have trouble with digestion and have trouble using the bathroom, along with tingling sensations in their extremities (Type 2 par. 10). Other future effects of type 2 diabetes include hypertension, kidney disease, amputations, dental disease, pregnancy complications, and more (National Diabetes par. 16). These consequences are very rarely thought of at or before the time of the diagnosis of type 2 diabetes in a child. Many men with type 2 diabetes acquire erectile dysfunction due to the prolonged insulin therapy and the nerve damage that accompanies it (Type 2 par. 10). The future goals of the female child having a family of their own can also be seriously deterred. Gahagan and Silverstein also wrote: Pregnancy should be deferred until optimal glycemic control has been achieved to decrease first-trimester risks to the fetus, including congenital heart disease, caudal regression, and neural tube defects, and third-trimester risks of

Hills 7 macrosomia, neonatal hypoglycemia, and hypocalcaemia, all of which are common in preexisting type 2 diabetes mellitus and gestational diabetes (par. 31). Which these risk factors it seems improbable that the female child or adolescent with type 2 diabetes will be able to bring a child into the world without some kind of health risk to themselves or the child. Another often overlooked result of type 2 diabetes in children is the financial and medical burden on the family at the time, and then the \burden on the child when they reach adulthood. The direct medical cost of diabetes per year is around sixteen billion dollars and the average medical expense for people with diabetes is 2.3 times higher than people without diabetes. The indirect medical cost of diabetes (for things like disability, work loss, and premature death) is about fifty-eight billion dollars per year (National Diabetes par. 18). For the average person with type 2 diabetes, the cost per year is around twenty-two thousand dollars, which is thirteen times higher than a person with no chronic health condition. Most of this expense is out-of-pocket because most insurance companies refuse to insure people with diabetes (Health par. 1). These expenditures come in the form of lancets for self-monitoring of blood glucose levels, monthly doctors visits, costly insurance copayments, and other medical necessities for controlling type 2 diabetes (Gahagan par. 12). The daily burden of simply monitoring blood glucose level on a regular basis is another stress. According to lifeclinic.com, an informative website, run by Sentry Health Monitors: Most teens want desperately to "fit in", and being different from peers may be especially stressful in these years. Having to eat meals, test blood glucose, and inject insulin "on time" all violate the desire to conform with ones peer group.

Hills 8 Having diabetes and injecting insulin can have a negative effect on self-image and self-esteem, which are fragile enough during this time (par. 5). These emotional problems can also call for psychological counseling, another added cost, to help the adolescent come to terms with the stress of their chronic disease. With all of the negative effects of type 2 diabetes on children, the saddest fact of the matter is that this disease is preventable. The most preventative of measures can be enacted before any symptoms occur. Dietary modification, increased physical activity, and decreased sedentary behaviors have proven to be beneficial in preventing children from acquiring type 2 diabetes (Gahagan par. 8). Sheila Gahagan and Janet Silverstein, both pediatricians, observed that children whose body mass index is greater than the eighty-fifth percentile for their age should receive appropriate counseling on nutrition, weight control, and physical activity (par. 11). These suggestions on eating properly, maintaining a healthy weight, and exercising regularly are all simple tasks that everyone is advised to take in order to live a healthy life. The goals of these pre-diabetes treatments are to eliminate symptoms of hyperglycemia, to maintain a reasonable body weight, decrease cardiovascular risk factors, and to achieve overall improvement in physical and emotional well-being (Gahagan par. 33). Doctors Sheila Gahagan and Janet Silverstein have also observed that preventing obesity in women of child-bearing age is another primary prevention goal, because exposure to the environment of a diabetic pregnancy places the fetus at increased risk of future onset of diabetes (par. 27). This places responsibility on families preparing for children and those that already have children to live a healthy life and to be a good example of overall health to their children. An increase in breast-feeding has also shown to be beneficial in preventing type 2 diabetes in children (Gahagan par. 41). The general consensus is that families who live healthy lifestyles are

Hills 9 less likely to have children with type 2 diabetes. However, health care professionals have also tried to promote school policies that require daily physical activity for all children and for fitness programs in communities to further promote individual well-being (Gahagan par. 29). Medical clinics have also stepped up in order to combat that increasing epidemic of children with type 2 diabetes. These health care professionals are continuing to look for ways to recognize early signs of type 2 diabetes in children and to reverse these symptoms. In a study by the Diabetes Prevention Program a large prevention study of people at high risk for diabetes, showed that lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by fifty-eight percent during a three-year period (National Diabetes par. 38). Doctors Gahagan and Silverstein wrote: Identification of disorders associated with insulin resistance, such as acanthosis nigricans, polycystic ovarian syndrome (PCOS), and family history of diabetes, should trigger education and the initiation of prevention activities (par. 43). Many of these health care professionals also believe that type 2 diabetes can be delayed or stopped with lifestyle changes, treatment for hypertension and hyperlipidemia, and frequent follow-up evaluations with the childs doctor. Also, in supplement with these lifestyle changes, a pediatrician may also prescribe Metformin, which works to combat type 2 diabetes by decreasing hepatic glucose production and enhancing insulin sensitivity in cells (Gahagan par. 47). The United States Government has also recognized the need to prevent the type 2 epidemic in children. The Center for Disease Control (CDC) holds annual workshops to discuss the potential emergence of type 2 diabetes in North American children and adolescents as an outof-control epidemic. The Center for Disease Control also sponsors SEARCH for Diabetes in Youth, a five-year study to coordinate data to develop a uniform protocol to identify children and adolescents with diabetes, which has been one of the biggest problems with the disease in the

Hills 10 past (National par. 6). In March of 2010, the United States Congress authorized the CDC to manage the National Diabetes Prevention Program. This new CDC program includes a grant for community-based diabetes prevention programs and a program for training lifestyle intervention instructors to encourage youth to live healthier lives (National par. 2). In January of 2011 President Barrack Obama signed a new bill to help schools pay for healthier foods, and encourage children and adolescents to make better dietary choices. The guidelines of the new bill state that school meals are to have a calorie limit, salt content will be cut by half over ten years, most trans fats are banned, more fruits and vegetables are included in each meal, only low-fat or nonfat milk is to be served, meals are to include more whole grain content and eventually include only whole grains, and breakfast would include both grain and protein, not one or the other (Reinberg par. 11). While the extra expenditures from these healthy meals may seem like a waste of funds to some, the increase of the nutritional value of these meals, and the increase of health in the children due to the extra nutrition, will be a wise investment in assuring that children will be able to lead productive lives as adults. Type 2 diabetes is a disease that is preventable if proper decisions about health, and if the precursors to the disease are recognized early. This disease is becoming increasingly more common in children every year. The effects of this disease on the childs life are severe and are often not taken into account when making choices about physical activity and proper diet. When families are encouraged to make healthier lifestyle choices together, there is a smaller chance of a child being diagnosed with type 2 diabetes. As the schools move towards less sugary or fattening foods to serve, adolescents will carry over those food choices into their everyday lives. Through government programs, communities and families can be rewarded in their steps towards healthier living and combating diabetes in children. This epidemic is preventable, but only if the

Hills 11 individual is willing to make the necessary lifestyle changes to be able to lead a healthier and happier life.

Hills 12 Works Cited Collazo-Clavell, Maria. Mayo Clinic on Managing Diabetes. Philadelphia, Penn.: Mason Crest, 2002. Print. Copeland, K.C., D. Becker, M. Gottschalk, and D. Hale. Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Treatment. Clinical Diabetes. 23.4 (2005): 181-85. Clinical Diabetes. American Diabetes Association, Oct. 2005.Web. 30 Aug. 2011. <http://clinical.diabetesjournals.org/content/23/4/181.full>. Diabetes Facts and Myths. Kids Health from Nemours. The Nemours Foundation, n.d. Web. 29 Aug. 2011. <http://kidshealth.org/parent/diabetes_center/diabetes_basics/diabetes _facts_myths.html>. Diabetes, Type 2 Medication | Drugs.com. Drugs.com | Prescription Drug Information, Interactions & Side Effects. Drugs.com, 2000. Web. 01 Oct. 2011. <http://www.drugs. com/condition/diabetes-mellitus-type-ii.html>. Gahagan, MD, Sheila, and Janet Silverstein, MD. Prevention and Treatment of Type 2 Diabetes Mellitus in Children, with Special Emphasis on American Indian and Alaska Native Children. Pediatrics. 112 (2003): 328. Pediatrics: Official Journal of the American Academy of Pediatrics. American Academy of Pediatrics, Oct. 2003. Web. 20 Aug. 2011. <http://pediatrics.aappublications.org/content/112/4/e328.full>. Health Insurance for Diabetes. MedSave.com. 01 July 2004. Web. 01 Oct. 2011. <http://www.medsave.com/health-insurance-articles/health-insurance-for-diabetics.htm>. Hyman, MD, Mark. The Link Between Poverty, Obesity and Diabetes. The Huffington Post. The Huffington Post, 18 Sept. 2010. Web. 01 Oct. 2011. <http://www.huffingtonpost. com/dr-mark-hyman/not-having-enough-food-ca_b_721344.html>.

Hills 13 Kaufman, MD, Francine. Ketones > Blood Sugar Highs > Blood Sugar Management > Everything Diabetes. Diabetes | Type 1 Diabetes | Type 2 Diabetes. LifeMed Media, Inc., 24 Jan. 2011. Web. 01 Oct. 2011. <http://www.dlife.com/diabetes/blood_sugar_management/blood_sugar_highs/ketones>. Laliberte, Richard. Stopping Diabetes in Its Tracks: the Definitive Take-charge Guide. Pleasantville, NY: Readers Digest, 2002. Print. Manning, Anita. Study: Diabetes Keeps Rising Among Youth. USA Today. 27 June 2007. Gannett Co. Inc., 30 Aug. 2011. <http://www.usatoday.com/news/health/2007-06-26diabetes-children_n.htm>. Maskarinec, G. "Ethnic Background Matters for Type 2 Diabetes." Newswise: News for Journalists, Press Release Distribution for Public Relations. Newswise, Inc., 20 Feb. 2009. Web. 01 Oct. 2011. <http://www.newswise.com/articles/ethnic-backgroundmatters-for-type-2-diabetes>. National Center for Chronic Disease Prevention and Health Prevention. CDC More Information Children and Diabetes Projects Diabetes DDT. Centers for Disease Control and Prevention. 20 May 2011. Web. 22 Aug. 2011. <http://www.cdc.gov/diabetes/project>. National Diabetes Statistics, 2011. National Diabetes Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases, n.d. Web. 20 Aug. 2011. <http://diabetes.niddk.nih.gov/dm/pubs/statistics/#NewCasesDDY20>. Reinberg, Steven. U.S. Aims to Make School Lunches Healthier. Healthy Kids and Pediatrics Information on Childrens Health. MedicineNet, Inc., 13 Jan. 2011. Web. 01 Oct. 2011. <http://www.medicienet.com/script/main/art.asp?articlekey=124680>.

Hills 14 Teenagers with Diabetes. Sentry Health Monitors. Sentry Health Monitors, Inc., 2011. Web. 01 Oct. 2011. <http://www.lifeclinic.com/focus/diabetes/teens_challenge.asp>. Type 2 Diabetes in Children. children with DIABETES. Children with Diabetes, Inc., 19 Oct. 2005. Web. 29 Aug. 2011. <http://childrenwithdiabetes.com/d_0n_d00.htm>. Type 2 Diabetes: MedlinePlus Medical Encyclopedia. National Library of Medicie National Institutes of Health. A.D.A.M., Inc. 29 Aug 2011. Web. 10 Sept. 2011. <http://www.nlm. nih.gov/medlineplus/ency/article/000313.htm>.