It's no surprise that, with the growing number of obese children in the United States, type 2 diabetes is also on the rise. In fact, the American Diabetes Association estimates that 2 million children, that's one out of every six, has pre-diabetes-a collection of risk factors that can lead to the chronic illness.
Also in conjunction with obesity is the rise in high cholesterol levels among children. At present, the American Academy of Pediatrics (APP) does not specify routine cholesterol screening for all children whose parents have a history of high cholesterol levels or early heart attacks (before age 50). However, a study released at the end of 2011 by the National Heart, Lung and Blood Institute (NHLBI)-part of the National Institutes of Health and endorsed by the AAP-recommends that all children be screened for high cholesterol at least once between the ages of 9 and 11 and again between ages 17 and 21.
So as a parent, how do you know when your child is at risk for these illnesses and should be tested? Pulse spoke with pediatrician
Elaine Gutierrez, MD, to answer some of your pressing questions about what testing entails and how to assist your child in building healthy habits.
Who should be tested for diabetes?
EG:Dr. Elaine Gutierrez (EG): When kids come in for a routine physical and I notice that the patient is significantly overweight, the issue is addressed. If the child is at the 85th or 90th percentile for body mass index, I will do an initial screening by sending the patient to the lab for bloodwork. I will usually check an insulin level and Hemoglobin A1c. (Note: Type 2 diabetes is a disorder in which the body can't use insulin to control and process glucose [sugars] in the blood the way it should.)
Besides being overweight, what are the signs you look for that may indicate high insulin levels?
EG:EG:Sometimes it's physical findings, like dark pigmentation under the neck and in the folds of their skin. Sometimes I find the information from the medical history I've collected. Urinating and drinking a lot more can present. From the time the patient comes in as a small child, I am asking about the family history, so I'm always screening for what I may need to look for down the line.
When do you recommend a child get a cholesterol test?
EG: If a child is overweight, I do the insulin and cholesterol test at the same time. If testing for cholesterol alone, doctors can order a non-fasting cholesterol test, and if the results come back abnormally high, a follow-up fasting test can be done.
What does a diabetes test entail?
EG: It is a simple blood test. I will order the Hemoglobin Alc, blood sugar and insulin first. If the results are not clear and my suspicion is high, I will order a two-hour glucose tolerance test.
Is the two-hour glucose tolerance test more accurate?
EG: Let's just say they have the physical findings for insulin resistance. A fasting sugar test might come back normal. The two-hour test involves checking three samples. The first is fasting. The patient is then given a sugar drink, and the next sample is taken one hour later. The last sample is drawn two hours after the drink. This shows us how the patient handles the sugar load. If the two-hour test is high, the diagnosis can be made.
What's the next step if someone is diagnosed as diabetic?
EG: I send them to a dietician and endocrinologist. The parents and the child receive counseling regarding eating and exercising. Both parents should go to the meetings with the dietitian/endocrinologist so the parents can work as a team.
What role do parents play in childhood diabetes?
EG: When you look at our culture, lots of couples are divorced. Families that are together often have two working parents and very busy schedules. It is a major challenge to stay away from convenience foods that are typically unhealthy. It is important for parents to plan ahead and try to support a healthy lifestyle.
What advice do you have for parents to avoid high cholesterol and diabetes in their children?
EG: Parents can engage their children so they're not isolated-alone on a computer or watching TV. It is really helpful to do things as a family, like eating family meals or going out and walking together. It's important for parents to set healthy limits for their kids. Discipline can be the hard part. Most people understand that obesity isn't just about food, but there is often an emotional component and this needs to be addressed as well. Staying emotionally connected to their kids can help avoid needing to seek comfort from food, especially the wrong kind of food.
Dangerous Glucose Levels In Children and Adolescents, according to the APP:
||Results Confirming Diabetes
|Fasting Blood Glucose
||126 mg/ml or higher
|Random Blood Glucose
||200 mg/ml or higher,
accompanied by diabetic symptoms
|Two-Hour Blood Glucose
||200 mg/ml or higher
Cholesterol Levels in Children and Adolescents, according to the APP:
||Low Density Lipoprotein (LDL)
||Less than 170
||Less than 100
||Greater than 200
||Greater than 130