Kids at Risk For Diabetes

Registered Nurse, Diabetes Educator, CDE, Obesity, Children, Youth, Lifestyle

Prediabetes

Children at Risk for Adult Diabetes

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Children at risk type 2 diabetes due to obesity

In previous generations, the medical profession had few occasions to monitor children for adult health issues. Today, children are experiencing increasing problems with high blood pressure, high cholesterol and other health problems related to obesity. Although obesity is ever increasing in children, many times our health care system is lagging behind in identification and approved treatment.   

Obesity is the main cause for kids being at risk for Type 2 diabetes and heart disease. Children are classified as overweight who are above the 85th percentile for age and sex. To be classified as obese, a child’s BMI will be over the 95th percentile for age and sex or their weight is greater than 120% over ideal for height(1). But being at risk for diabetes is much more than just a weight issue.

First: If one or both parents have been diagnosed with diabetes, then the child has the genetics putting them at risk for diabetes.

According to the SEARCH study, at least 75% of youth diagnosed with type 2 have at least one close family member who has diabetes. (Close family members include mother father sisters or brothers.)  (searchfordiabetes.org)

Second: If the child’s BMI (body mass index) is over 28, it indicates that their life-style places them at additional risk. 

BMI can be misleading on its own. You should also consider waist circumference. (http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html)

(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851850/) 

Third: If they have high blood pressure. This one is tricky because blood pressure can be affected by many things including anxiety. If you or your child become anxious about going to the doctor, then chances are your blood pressure will be elevated. Taking several deep breaths before taking the blood pressure can help. It is important to get an accurate reading. 

If you would like to monitor a child’s blood pressure, there are automatic machines available at most pharmacies and many department stores. I recommend using one of these machines because they are more reliable (ensure accurate readings) as compared to home monitors. Doctors are wanting blood pressure reading less than the 90th percentile on at least three measurements.(2) You can refer to the CDC guidelines for these recommended values.

(http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module3/text/bloodpressure.htm)

The rule of thumb for children age 7-15 years old is: multiple 2 times your child’s age and add 90. This gives you the median for systolic pressure (the upper number). For the diastolic (lower number) subtract 30-45 from your systolic number. This is just an average number, the number you get can be higher or lower (for more information see: http://www.fpnotebook.com/CV/Exam/PdtrcVtlSgns.htm)

Fourth: Dyslipidemia. Now that is a big word! It means high cholesterol or high triglycerides. You need a fasting blood test to check for these conditions. Ask your doctor for this information.

Fifth: High Blood Sugar. Teens with a fasting blood glucose (FBG) 100 – 125 mg/dL or a random blood test greater than 199 mg/dL are at risk. For children younger than their teens, you should consult your pediatrician for this information. A1C is a non-fasting blood test. The results will vary with the age of your child. 

A1C is not recommended to use to diagnose diabetes in children so it may not be covered by insurance. It is a good indicator if your teen’s tolerance to sugar is a problem. Younger children run higher blood sugars and the A1C test is not recommended for them. The readings for A1C are determined by the age of the child and industry standards have NOT be determined (as of this writing).

American Diabetes Association recommends testing asymptomatic youth for Type 2 if they are overweight plus any 2 of the following risk factors:  

  • Diabetes screening should be repeated every three years.
  • Family history of Type 2 in first or second degree relatives
  • Native American, Latino, African American, Asian or Pacific Islander ethnicity
  • Mother with a history of gestational diabetes during the child’s gestation
  • Signs of insulin resistance or conditions associated with insulin resistance including acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome or small for gestational age birth weight(3)

Symptoms of high blood sugar include:

  • Unusual Thirst (they can’t drink enough)
  • Frequent urination (going to the bathroom more than once in the night)
  • Headaches, especially after eating sugary foods
  • Tired, no energy; especially after a meal
  • Unusually hungry; (I have seen these kids start eating two full lunches – this indicates a hormone imbalance)
  • Anxious (there are times when they want food NOW)

For more information about how to teach your kids and your family good habits for a healthy future, check out my healthy kids and family 30 day virtual program.

1) American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care. 2013;36 (suppl 1): S11-S66.

2) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report. Pediatrics. 2011;128 (suppl 5):S213-S256.

3) American Diabetes Association. Diabetes Care. 2013;36 (suppl 1) S11-S66

 

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Alcohol and Diabetes a Deadly Combination

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I know alcohol is never recommended in children under the legal age. But teens often have access to alcohol, so it is important for them to understand the effects on their blood sugar. This is particularly important when parents are preparing their children for college. I worked in a college town and many students end up in the ER with blood sugar problems.

So many people with prediabetes are in denial. This is especially true in teens. But that doesn’t mean they are exempt from the side effects of uncontrolled blood sugars. Parents need to take an active role in educating their young adults in the problems of alcohol before they head to college…..

Alcohol Can Adversely Effect The Body’s Ability To Regulate Energy

As you know, excess alcohol effects your liver functions. Your body’s energy regulation actually starts in the liver. That is the reason doctors use Metformin as the first medication with prediabetes. Improving the function of the liver by 20% will improve blood sugars by 80%.

Initially alcohol could raise your blood sugar (particularly with beer), but alcohol works in the liver to prevent stored sugars from being released. So it can actually cause low blood sugars during the night while you sleep. It is important to eat a snack of protein and carbs before going to sleep. It is even more important to not sleep in late in the morning (like most college student tend to do).

What You Should Do

Set an alarm, and if you can, check your blood sugar and eat breakfast! Then if you want to go back to bed, no problem. The main problem is that your blood sugar could go too low while you’re “sleeping it off”. That feeling of being hung-over may actually be low blood sugar.

Also, please feel free to email me if you have questions that aren’t answered here!

How Alcohol Affects Blood Sugar

Low Blood Sugar Symptoms

The side effects from low blood sugar looks similar to drunkenness. This is a dangerous situation. Symptoms of low blood sugar without diabetes include:

  • Paleness
  • Headaches
  • Shakiness or trembling
  • Blurred vision or Dizziness
  • Lack of energy or fatigue
  • Poor Coordination
  • Irritability, anxiety, agitation
  • Nausea or vomiting
  • Excess sweating or perspiration
  • Problems concentrating, confusion
  • Decreased consciousness or loss of consciousness

This is really important with kids that are going to college. They will drink alcohol. So educate them about it.

Any questions, send me a message at Julie@kidsatriskfordiabetes.com.

http://www.healthclop.mailto:Julie@kidsatriskfordiabetes.comcom/low-blood-sugar-without-diabete

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Help for Diabetes During Pregnancy

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Your Gestational Diabetes Diagnosis can be Traumatic

When you are pregnant, being diagnosed with gestational diabetes is the last thing you want to hear. You are given a crash course on how to manage your blood sugar with diet and exercise. You are so stressed out, you probably don’t remember one tenth of what was said.  Your stress continues as you try to “manage” your blood sugar by testing multiple times each day. You feel like your body has betrayed you. All you want to do is have a healthy baby. I know what you’re going through.

Fasting Blood Sugar Test

The American College of Obstetrics and Gynecology (ACOG) is now requiring new clients to have a fasting blood sugar test during early pregnancy to determine un-diagnosed Type 2 and prediabetes in their patients.  Due to the average woman waiting to have their first child later in life and the increasing weight problems they face with age, pregnant women are at increased risk for developing sugar problems. (Get my free gift to evaluate your risk for gestational diabetes.)

How Does Gestational Diabetes Affect You and Your Baby?

At about 12 weeks gestation, your baby starts growing rapidly. This requires increasing amounts of energy, and insulin requirements increase accordingly. Around week 24, your body’s insulin production cannot keep up with your baby’s growth.

Typically, the fasting blood test for gestational diabetes happens between weeks 24-28. The ACOG is allowing your blood sugars to increase enough during the day so that your body can not recover through the night. At that time a random blood sugar test over 200 is a positive result for gestational diabetes.

Your baby continues to grow until about 36 weeks gestation. At delivery, the hormonal effects of the pregnancy disappear and the demand for insulin drops dramatically. Postpartum, your body’s requirement for insulin can go below normal. Many women are placed on IV insulin during labor and they need to be monitored carefully during postpartum.

After Gestational Diabetes Delivery

Because your baby has developed in a blood supply rich in sugar, your baby’s pancreas will also go through an adjustment after delivery. You will see the nursing staff taking blood samples from your baby. Don’t get excited. They will monitor your baby’s blood sugar as needed to keep them safe.

Since insulin requirements shift dramatically during pregnancy, true diabetics need to be monitored carefully for adjustments in their medications. Type 1 diabetics need to be under the care of an endocrinologist throughout their pregnancy. Type 2 diabetes should expect to be placed on insulin during pregnancy. They should also expect to have weekly insulin adjustments.

What to do Before You Get Pregnant

To have a successful pregnancy without complications, all diabetics need to have their blood sugars under good control for six months before conception. The success of their ability to control their blood sugar is often determined by an A1C test.

If you need support in controlling your blood sugars before pregnancy, consider my 1:1 phone consultation program. For a free evaluation please schedule a FREE call with me.

Wishing you a happy pregnancy and a healthy baby!

Julie

P.S. Remember to get my list to evaluate your risk for gestational diabetes.

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Childhood Obesity: 1st in a Series

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Part 1:  If you wait until they are diagnosed, it is too late.

This is the beginning. We call it obesity; children measuring over the 85th percentile for weight given their age and height. We used to call it morbid obesity because it triggers chronic health conditions that can threaten your life. Weight problems in children can affect their future health, either more immediately or as they become young adults.

The difference between adult and childhood diabetes

When an adult is diagnosed with type 2 diabetes, they are told to lose 10% of their body weight and it may revert to prediabetes. This is not true in children! Type 2 diabetes progresses so quickly in children, many of them are put on insulin within two years.

Prediabetes in adults can last ten years or more. In children, prediabetes progresses into type 2 within 12 months. Plus, by the time they are diagnosed with type 2, their beta cells are already dying off. Type 2 in children, the beta cells can die up to 37% per year. This cannot be reversed with current medications. Hospitals can test to determine if the child has type 1 or type 2. But many of them need insulin as soon as they are diagnosed.

Puberty causes many changes

Weight problems accelerate during puberty. Children who may be above normal weight before puberty can quickly change during puberty due to human growth hormone. Their body grows and develops quickly during this time. Parents should monitor their child’s BMI (Body Mass Index) during this phase. (Note: I recommend parents use the CDC charts for BMI including waist circumference for a more accurate evaluation.) https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

If you see significant changes in their BMI, talk to your child about what they are doing.

  • Have they increased junk foods?
  • Are they eating out more?
  • Are they playing more computer games?
  • How has their daily life changed?

Daily choices now will affect their future

Encourage them to be mindful of how their daily choices are affecting their future.

Healthy living today will be the key to minimizing future health problems. Children’s weight over the 85th percentile can cause problems like high blood pressure, which over time triggers other problems like heart disease and strokes. (Narasimhan, 2015)

Severely obese children (the 95th percentile or more for weight) are at risk for serious health conditions like fatty liver disease. Fatty liver disease in children is linked to early-onset type 2 diabetes and multiple complications from insulin resistance. (Narasimhan, 2015)

Summary

It’s sad but true: research proves that if the parent waits until the child is diagnosed, the damage is already done. Please don’t wait!

Resources

For more information about how weight gain can affect your child’s overall health, check out this article I recently published.

For more information on healthy lifestyle habits in children, part 2 in this series talks about lifestyle changes!

For information about my program Kids at Risk for Diabetes, please check out my course for the whole family.

If you always want to be notified when I publish a new article or blog post, please join my mailing list using the form below!

References

Narasimhan, S. a. (2015, Jun 1). HS Public Access. Retrieved from Youth-Onset Type 2 Diabetes: Lessons Learned from the Today Study: https://www.ncbi.nim.nih.gov/pmc/articles/PMC4319667/

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Munchies with Marijuana

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Munchies with Marijuana

Many states are passing laws to legalize marijuana for medical uses. Sometimes diabetics use this to treat diabetes related complications like pain from neuropathy. But beware – we all know marijuana increases your cravings (gives the munchies) and it usually is toward sweets…. This is because marijuana can temporarily lower your blood sugar.

Marijuana Effects Blood Sugar

Please check your blood sugar before you start eating. After all, pain can make your blood sugars too high. You don’t know if you have low or high blood sugar. Be careful of the snacks you consume. You will probably be craving sweets or salty snacks like popcorn or potato chips. Limited portions is important. Remember it takes 20 minutes for your stomach to communicate with your brain concerning feeling full. You should not be continuously eating for 20 minutes. If you are on insulin, you will need to take additional insulin to cover your snacks. This will enable your body to use the carbohydrates. If you don’t take extra insulin, you may continue to crave sweets.

If you want to contact me with more questions, email me at Julie@kidsatriskfordiabetes.com.

 

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What Schools Need to Know: Children with Type 2

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Back to School with Type 2 Diabetes

Each new school year brings new challenges, particularly with diabetic students. Back to School Preparations are different when your child has diabetes. A parent’s ultimate responsibility is to teach their children to be independent, no matter what the situation. My experience with parents of school age children with diabetes varies widely.

Many times, school officials do not know if diabetic students are type 1 or type 2. Although the difference between the two conditions is like night and day, students are treated much the same way. It is unfortunate at this time in the USA, that approved medications for Type 2 in children are limited to Metformin and insulin. Insulin is a serious medication with significant side effects if not administered properly. I understand why parents are fearful for unfamiliar staff to give insulin to their child. For this reason, parents need to teach their child about insulin dosing so that the child will be self-assured and assertive to ask questions of adults when needed.

Kids can learn amazing things. While I was medical staff at a Type 1 diabetes camp, I had some amazing experiences. I worked with the youngest group ages 6-8 years old. Danny (fictitious name), was diagnosed at age 2 years and had an older sister who was also Type 1. Although he was 7 years old, he could already feel his blood sugars dropping when he was outside playing and he knew how to appropriately treat his low. He could “guestimate” what he was eating at each meal and calculate his insulin correctly. He had to be supervised, but at a very young age he had learned how to live with his “organ failure” and still be as normal as possible. Kids can learn with parental support.

Diabetes Priorities Vary with Age

According to the American Association of Diabetes Educators (AADE) diabetes priorities vary with age. (BC-ADM, 2014)

*Preschool and early elementary school students (ages 3-7 years) need to develop self-confidence. They need to learn to trust school staff to take care of their unique needs. Parents have the responsibility to educate other caregivers about their child’s specific needs. Many times blood glucose readings are seen as “good” or “bad”. Children have a strong desire to please parents. Fear of failure can cause children to falsify their numbers. Parents need to teach their children that blood glucose readings are just used to monitor their medication needs and never meant to evaluate their child’s behavior. Developing trust with your child is very important in this phase. (BC-ADM, 2014)

*Older elementary school ages 8-11 years need to develop self-esteem with respect to friends and peer groups. Diabetes management needs to center around a flexible regiment to allow participation in many activities. Their education needs to include how to avoid and treat hypoglycemic events. Parents need to observe blood glucose testing. Parents also need to progress in teaching their children about insulin dosing and self-administration. It is also important to teach their children how to participate in special occasions (example: birthday parties particularly at school). (BC-ADM, 2014)

*Early adolescents (ages 12-15 years old) can be very challenging. Normal hormone changes during puberty will cause blood sugars to be unpredictable. Parents need to be cautious about blaming their child of eating extra foods. Although they may be very hungry due to growth hormone, other hormone shifts will cause major troubles with blood sugars. It is important for parents and children to communicate honestly to avoid emotional problems. Diabetes priorities in addition to blood glucose control include monitoring for body image distortion, eating disorders, risky behaviors and depression. Although students may learn maintaining high blood sugars can create weigh lose, they also need to be taught the dangers of complications from uncontrolled diabetes like blindness, strokes and heart disease.

Family conflicts need to be intervened possibly with a professional family counseling. Turmoil between parent and child is very common at this phase. Children want more independence while parents are very fearful of the results. There is a high divorce rate in families with diabetic kids. Counseling may be beneficial for the whole family. (BC-ADM, 2014)

*Young adults (ages 16-19) Diabetes priorities include integrating diabetes into their lifestyle after high school. Young adults need to learn good coping skills for self-management. Teen and parent conflicts are common even without diabetes. There is a normal separation of the child from the family unit. Teens begin planning for their future independence. It is the parent’s responsibility to transition their teen into independent living. This includes developmentally challenged young adults. (BC-ADM, 2014)

When appropriate, it is very important for parents to educate their child about the effects of alcohol on blood sugars. I have seen so many diabetic college students in the emergency room. If you don’t know the dangers of alcohol abuse with diabetes, I encourage you to educate yourself and your child. For more information, see my blog post on alcohol and blood sugars.

 

BC-ADM, C.B. (2014). Type1 diabetes throughout the life span. IN S.C. Carole Mensing RN, The Art and Science of Diabetes Self-Management Education Desk Reference (pp. 393-400)

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