Atkins Diabetes Revolution (47 page)

Chapter 25

TYPE 2 DIABETES AND YOUR CHILD

Not many years ago, Type 2 diabetes was an old people’s disease. The only children with diabetes Dr.Atkins saw in his medical practice were those who had Type 1. But by the 1990s, a very disturbing trend had taken root. A virtual stream of overweight youngsters, most in their early teens, began showing up at The Atkins Center for weight loss. After doing blood work, Dr. Atkins ended up diagnosing all too many of them with the metabolic syndrome or Type 2 diabetes. It was as shocking as it was depressing: A few of these kids hadn’t even hit puberty yet!

IT’S AN EPIDEMIC

It’s a small step from having the metabolic syndrome or impaired glucose tolerance when you’re only 10 (in some cases, even younger) to having Type 2 diabetes by the time you’re 14. And it’s a progression that far too many children are now experiencing. The diabetes problem among juveniles isn’t just in this country. In Japan, for instance, the incidence has been rising almost as fast. The same is true in Europe, Australia, Asia—and around the globe.
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We can say that the epidemic of Type 2 diabetes in kids was born back in the early 1980s, when researchers noticed a surge in reported cases among Native American populations. The surge soon became a tidal wave. Before 1994, Type 2 diabetes was found in only 5 percent of youngsters newly diagnosed with diabetes; the rest had Type 1 diabetes,which almost always occurs in childhood.Although we don’t yet have accurate statistics, today some estimates say that 45 percent or more of all new cases of diabetes in children are Type 2.
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In one study of children in Cincinnati, the incidence of diabetes rose ten times in a little more than a decade, from less than 1 case per 100,000 kids in 1982 to 7.2 cases per 100,000 kids in 1994.
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The diabetes epidemic hits minority communities especially hard. Research has shown that more than 4 out of 1,000 Native American teenagers have diabetes. In one study of African American and Caucasian children aged 10 to 19,Type 2 diabetes accounted for 33 percent of all cases of diabetes.
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And just as so many adults with Type 2 diabetes go undiagnosed for years,so do many kids.The real numbers are probably higher.

GETTING HARD TO TELL

The fasting blood sugar (FBS) cutoff level for either kind of diabetes in children is the same as for adults:a fasting blood sugar of 126 mg/dL or higher,or a postprandial blood sugar of 200 mg/dL or higher.That’s almost the only thing the two types of diabetes have in common.
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Type 1 diabetes is a very serious autoimmune disease caused by the failure of the pancreas to produce insulin. It usually comes on suddenly, and the treatment is lifelong insulin administration and careful dietary management. Type 2 diabetes is no less serious but at the start the pancreas still produces insulin and symptoms develop gradually. Type 2 diabetes in kids is almost always preventable and can usually be stopped or reversed with weight loss and dietary changes. Sometimes, though, it’s hard for a doctor to tell whether a child has Type 1 or Type 2 diabetes. (Although the focus of this book is Type 2, because in children it can be harder to differentiate,some discussion of Type 1 is necessary.) Recently, it has gotten harder to make the diagnosis.

It used to be that if a child was overweight, the chances were very good that he or she had Type 2 diabetes. Today, however, kids with Type 1 diabetes are just as likely to be overweight as youngsters in the general population—as many as 24 percent may be overweight when they start showing symptoms.
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Being overweight may be an accelerating factor for developing Type 1 diabetes, because heavy kids develop the disease at an earlier age than those who aren’t overweight. This could be at least part of the explanation for the increased incidence of Type 1 diabetes over the past several decades.
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Particularly if there is a family history of Type 1 diabetes, parents must not be complacent about their children’s weight gain. Of course, a family history of Type 2 means parents should
also
be concerned about preventing obesity.

On top of that, if a child with Type 1 diabetes is also obese, he or she could have “double diabetes”—insulin resistance from being obese as well as an inability to produce insulin from having Type 1.
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This can cause some confusion, but in almost all cases, children with Type 1 diabetes have the classic symptoms of excessive thirst, hunger, and urination along with weight loss and sugar in the urine. If further confirmation is needed, blood tests can provide it. Kids with Type 1 diabetes also usually show specific types of autoimmune antibodies in their blood. In addition, testing for the presence of c-peptide in the blood reveals how much, if any, insulin the pancreas is producing. If the level is very low, indicating little or no insulin production, the diagnosis is usually Type 1. (It’s necessary to run all the tests, however, because in some cases, children with Type 2 diabetes also have very little insulin production.)
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For youngsters with diabetes, Dr.Atkins usually did a two-hour postprandial (after a meal) test of insulin and glucose to get a better idea of how well they could still produce insulin.

When the diagnosis in a child or teenager is Type 2 diabetes, the Atkins approach to evaluating the problem is very similar to that for adults. He did the same blood tests discussed in Chapter 6. However, depending on the child’s age and ability to cooperate with testing, the five-hour glucose tolerance test might be terminated early. He always attempted to get the FBS (fasting blood sugar) and insulin as well as one-hour and two-hour blood sugar and insulin values.If the FBS was already high, he found that the two-hour postprandial test was sufficient to determine how much insulin the child was producing and his or her degree of hyperinsulinemia.

THE FACTS ON TYPE 1

Type 1 diabetes is the most common severe chronic disease of childhood. In the United States, about 1.7 out of every 1,000 kids under the age of 19 have it.
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The symptoms are generally pretty clear: The child is suddenly very hungry and thirsty, has to urinate a lot, and may lose weight even though he or she is eating a lot of food. When the child’s urine is tested at the doctor’s office, it usually contains sugar and ke- tones. Most children who develop Type 1 get it as they reach puberty, generally around age 10 to 12 in girls and age 12 to 14 in boys. The disease can strike at any age, however, and even very young children can get it. Type 1 diabetes tends to run in families—siblings of someone with Type 1 diabetes may have a 30 times greater risk of getting Type 1 than the general population.
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The identical twin of a child with Type 1 has a 35 percent higher risk of developing the disease.
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TYPE 1 DIABETES AND DOING ATKINS

Youngsters who have Type 1 diabetes have a lifelong condition that requires very careful management. The Atkins Blood Sugar Control Program (ABSCP) can help, particularly in one very important way: A controlled-carb food plan can assist in preventing dangerous episodes of both hypoglycemia and hyperglycemia. The Atkins approach helps keep the entry of glucose into the bloodstream steady, avoiding glucose spikes and sharp drops. Although kids with Type 1 must continue to take their life-saving insulin, on the ABSCP they can often achieve good blood sugar control with less insulin.

It is mandatory, however, that children with Type 1 who are following the Atkins approach do it only under the close supervision of a doctor experienced in its use. The program can be so effective in quickly lowering blood sugar and insulin requirements that accidental insulin overdose could occur.

HOW TO KNOW IF IT’S TYPE 2

The signs and symptoms of Type 2 diabetes are less clear-cut than those of Type 1, and they develop more slowly. The primary sign is obesity—80 percent or more of kids with diabetes are seriously over- weight or obese at the time of diagnosis.
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Unlike those with Type 1 diabetes, they usually haven’t lost weight. They commonly don’t experience increased thirst,increased hunger,or increased urination.Often the first hint that they have a problem comes from a routine urine test that shows a lot of spilled glucose, or when they see a physician for another problem.

Another common indicator, found in 67 percent of kids with Type 2 diabetes, is acanthosis nigricans (uh-kan-THO-sis NIH-grihkans).
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These are patches of dark, velvety skin that are usually found on the neck, in the armpit region, and in other areas where the skin folds or rubs together. Acanthosis nigricans, which can occur at any age, can be a sign of hyperinsulinemia, the precursor to diabetes.
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Although very young children can get full-blown Type 2 diabetes, most are older than age 10 and are in middle to late puberty when they develop the disease. This is partly because insulin resistance naturally increases during puberty.
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When insulin resistance from obesity amplifies puberty’s natural increase in insulin resistance,the result can be Type 2 diabetes, especially if there’s also a family history of the disease. Almost all kids with Type 2 have at least one parent or close relative who became diabetic as an adult—and often the family history of diabetes goes back two or even three generations. Ethnicity plays a big role as well. Kids whose heritage is African American, Hispanic, Asian American, Pacific Islander, or Native American are all at much greater risk of Type 2 diabetes. For this reason, if you have a family history of Type 2 diabetes, it is crucial to keep your children’s insulin levels in check with carbohydrate control prior to puberty if possible.
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TYPE 2’S GREATER DANGERS

One of the most distressing things about Type 2 diabetes in young people is that it so quickly leads to serious complications—even more so than Type 1. Because of this, it is essential that we recognize the warning signs leading to diabetes at the earliest stage possible and intervene swiftly.

One recent Swedish study of kidney disease in young people with diabetes was especially chilling. The study looked at 469 people who were diagnosed with diabetes between the ages of 15 and 34. Of the group, most had Type 1; only 43 had Type 2. Over a nine-year period,5.6 percent of the people with Type 1 diabetes and 16 percent of the people with Type 2 diabetes developed kidney disease.
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Another study of the same group of patients showed a similar situation with diabetic retinopathy, an eye disease that can lead to blindness. Fifteen percent of the people with Type 2 diabetes had severe retinopathy, while only 5 percent of the people with Type 1 diabetes had retinopathy, and most of those with Type 1 had a milder form.
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Both these studies show how dire the consequences of Type 2 diabetes are when it occurs in young people. In most cases of chronic disease, being young provides some protection. Overall, in cases of early-onset Type 2 diabetes, this protection is simply lost. Compared with people who develop diabetes in later middle age, young people with diabetes are 80 percent more likely to end up needing insulin.
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The risk of having a heart attack is also much higher.Older adults with diabetes have just under four times the risk of having a heart attack as someone their age without diabetes; young people with diabetes have 14 times the risk of having a heart attack as someone their age without diabetes.
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The complications don’t stop there. A long-term follow-up study of First Nations (native Canadians) children looked at a group of 51 patients who were diagnosed with Type 2 diabetes in 1986; at the time, all were under age 17. When they were contacted 15 years later, two had died while on kidney dialysis, three were currently on dialysis (one of them had become blind), and another had had a toe amputation. Of 56 pregnancies among the patients, only 35 resulted in live births.
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Kids with Type 2 diabetes often end up taking the sorts of medications we usually associate with older adults.It’s not uncommon to find 15-year-olds taking metformin (Glucophage) for their blood sugar, along with one or more drugs for high blood pressure and a statin drug for high cholesterol. Although metformin may be helpful for some kids and is probably safe for them—on occasion, Dr. Atkins did prescribe it—most of the other drugs these kids are taking have never been tested on children. (Some statins are FDA-approved for children beginning at age 12. Dr. Atkins never used these.) Diet, exercise, and supplements (if needed) may preclude the use of medications. Lifestyle changes are always a better approach.

TREATING KIDS THE ATKINS WAY

The ABSCP is particularly effective for treating kids and teens with diabetes. They—and their parents—don’t have to follow a complicated exchange system. There’s no calorie counting, portion measuring, or anxiety about the fat content of a food. Moreover, youngsters never have to feel hungry or stigmatized. They do have to learn to live without the junk food they’ve grown accustomed to—even “addicted” to—but this turns out to be a fairly easy transition. By making sure that kids get adequate protein and dietary fat, and by substituting better carb foods, such as low-carb bread with sugar-free peanut butter instead of potato chips,for example,the junk food habit can be tamed. And once these kids start eating the Atkins way,they simply stop being hungry all the time.

HOW MANY CARBS?

In general, kids with Type 2 diabetes will get their blood sugar under control,stabilize their weight,and even start to lose weight by controlling the quality and quantity of carbohydrates and by exercising more. But because Type 2 diabetes is a serious disease,you must discuss these changes with your child’s doctor first.Work closely with him or her to track the child’s progress and to be sure that your son or daughter is achieving normal growth and development milestones.