Type 2 Diabetes in Children

Diagnosis

If diabetes is suspected, your child’s health care provider will usually recommend a screening test. Several blood tests can be used to diagnose type 2 diabetes in children.

Tests commonly used include:

• Random blood sugar test: A blood sample is taken at any time, regardless of when your child last ate. A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher suggests diabetes.

• Fasting blood sugar test: A blood sample is taken after your child has had nothing to eat or drink except water for at least eight hours. A reading of 126 mg/dL (7.0 mmol/L) or higher suggests diabetes.

• Glycated hemoglobin (A1C) test: This test shows your child’s average blood sugar over the past three months. An A1C of 6.5% or higher indicates diabetes.

• Oral glucose tolerance test: After fasting overnight, your child drinks a sugary liquid at a clinic or lab. Blood sugar levels are checked for two hours afterward. A reading of 200 mg/dL (11.1 mmol/L) or higher generally confirms diabetes.

Additional testing may be recommended to help distinguish between type 1 and type 2 diabetes because treatment approaches differ.

Treatment

Treatment for type 2 diabetes is ongoing and may include healthy eating, regular physical activity, medications, blood sugar monitoring and, in some cases, weight-loss surgery. Your child will work with a diabetes care team that may include a health care provider, a certified diabetes care and education specialist, a registered dietitian and other specialists. The main goal is to maintain blood sugar levels within a target range.

Your child’s provider will determine appropriate targets for blood sugar and A1C levels. These goals may change over time as your child grows and as treatment needs shift.

Healthy eating

Food plays a central role in diabetes management, but this does not mean your child must follow a rigid diet. Weight management may be recommended to help improve blood sugar levels. A dietitian can help your child create a balanced eating plan that supports overall health and fits personal food preferences. This usually focuses on foods that are high in nutritional value and low in fat and calories.

Recommendations usually include:

• Eating more fruits, vegetables, nuts, whole grains and olive oil

• Choosing foods high in fiber and lower in fat

• Reducing portion sizes

• Replacing sugary beverages with water

• Preparing meals at home more often

• Eating meals at the table instead of in front of the television

Planning occasional treats is also possible while keeping overall goals on track.

Physical activity

Daily physical activity is essential. Exercise helps manage weight, uses sugar for energy and improves the body’s ability to use insulin. Children with type 2 diabetes should aim for at least 60 minutes of movement each day, which can be divided into shorter periods. Joining your child in exercise can help encourage consistency.

Medication

Several medications are approved for treating type 2 diabetes in children.

• Metformin: A pill that reduces the amount of sugar released by the liver and helps the body use insulin more effectively.

• Liraglutide: An injectable medication that helps the pancreas release more insulin after meals. It may cause nausea or diarrhea.

• Insulin: Sometimes needed when blood sugar levels are very high. A long-acting insulin once a day combined with a rapid-acting insulin at meals is commonly used. Insulin is given through a syringe or pen.

With healthy lifestyle changes and other medications, some children may eventually discontinue insulin.

Blood sugar monitoring

Your child’s provider will advise how often blood sugar should be checked. Children taking insulin may need to test more frequently, sometimes four or more times daily. Continuous glucose monitoring may be an option depending on treatment needs. Frequent monitoring helps ensure blood sugar stays within the target range.

Weight loss surgery

For teens with severe obesity, usually defined as a body mass index (BMI) of 35 or higher, weight-loss surgery may be an option. These procedures can improve blood sugar control, but they are only appropriate in select cases.

Ongoing medical care

Regular follow-up visits are essential for managing type 2 diabetes. Appointments typically involve reviewing blood sugar patterns, daily habits, physical activity levels, weight and medications. Healthy lifestyle changes may reduce the need for medication.

Your child’s provider may monitor:

• A1C levels

• Growth and development

• Blood pressure

• Cholesterol levels

• Kidney and liver health

• Eye health

• Foot health

• Risk of polycystic ovary syndrome or obstructive sleep apnea

Vaccinations such as the yearly flu shot, and possibly pneumonia or COVID-19 vaccines, may be recommended.

Signs of trouble

Despite good management, complications can occur. Some short-term issues require immediate attention, including low blood sugar, high blood sugar, diabetic ketoacidosis and hyperosmolar hyperglycemic state.

Low blood sugar

Hypoglycemia occurs when blood sugar drops below the target range. This can happen from skipping meals, eating fewer carbohydrates than planned, extra activity or too much insulin. Though less common in type 2 diabetes, it can occur.

Possible symptoms include:

• Paleness

• Shakiness

• Hunger

• Sweating

• Irritability

• Difficulty concentrating

• Dizziness

• Loss of coordination

• Slurred speech

• Loss of consciousness or seizures

If symptoms appear, blood sugar should be checked immediately. If testing is not possible, treat for low blood sugar first, then test as soon as you can.

Steps for treatment:

• Give 15 to 20 grams of fast-acting carbohydrate such as fruit juice, glucose tablets, hard candy or regular soda.

• Recheck blood sugar after 15 minutes. Repeat if needed until it returns to the target range.

High blood sugar

Hyperglycemia occurs when blood sugar rises above the target range. This can result from illness, overeating, certain foods or inadequate medication.

Symptoms may include:

• Frequent urination

• Increased thirst

• Blurred vision

• Fatigue

• Nausea

Check your child’s blood sugar if these signs appear. If levels remain high, contact your child’s provider.

Diabetes ketoacidosis

A severe lack of insulin can lead to the buildup of ketones, causing diabetic ketoacidosis (DKA). Although more common in type 1 diabetes, it can sometimes occur in type 2.

Symptoms may include:

• Intense thirst

• Frequent urination

• Dry or flushed skin

• Nausea or vomiting

• Stomach pain

• Fruity-smelling breath

• Confusion

Check for ketones using an over-the-counter test kit. If levels are high, seek emergency care right away.

Hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic state (HHS) develops gradually, often triggered by severe infection, illness or other medical conditions. Blood sugar levels may reach 600 mg/dL or higher, leading to severe dehydration as the body tries to remove the excess sugar.

Symptoms may include:

• Minimal or no ketones

• Increased urination

• Intense thirst

• Dry mouth and warm, dry skin

• Confusion

• Seizures

• Coma