Type 2 Diabetes in Children – Diagnosis and Treatment
Diagnosis
Healthcare teams diagnose type 2 diabetes in children by performing several blood tests to check blood sugar levels at random times and after fasting. Each test helps them identify if diabetes is present and determine its type.
Key Blood Tests for Diagnosing Type 2 Diabetes in Children
| Test Name | Description | Diagnostic Value |
|---|---|---|
| Random blood sugar test | Blood sample taken at any time, regardless of meals. | 200 mg/dL (11.1 mmol/L) or higher points to diabetes. |
| Fasting blood sugar test | Blood drawn after at least 8 hours without food or drink (except water). | 126 mg/dL (7.0 mmol/L) or higher suggests diabetes. |
| Glycated hemoglobin (A1C) test | Measures average blood sugar over the past 3 months. | An A1C level of 6.5% or above indicates diabetes. |
| Oral glucose tolerance test | Fasting followed by a sugary drink; sugar levels measured over 2 hours. | 200 mg/dL (11.1 mmol/L) or more confirms diabetes. |
Providers test children showing signs like increased thirst, frequent urination, and tiredness using one or more of these methods. Healthcare often combines tests to confirm the diagnosis.
Further Testing Options
Sometimes, health care teams order additional tests to determine whether a child has type 1 or type 2 diabetes.
Providers may also check for specific markers or antibodies in the blood that are typical of type 1 diabetes but not type 2.
This distinction matters because each type requires different treatments, and these extra steps guide the team in choosing the best care plan for each child.
Treatment
Nutritious Food Choices
Healthy eating plays a key role in managing type 2 diabetes. Balanced meals help keep blood sugar steady and support a healthy weight.
Families are encouraged to choose a variety of foods such as fruits, vegetables, nuts, whole grains, and healthy oils like olive oil.
These foods are generally higher in fiber and nutrients while staying lower in fat and calories.
Some useful eating habits include:
- Reducing portion sizes to avoid overeating.
- Swapping high-calorie foods with fruits or vegetables.
- Drinking water instead of sugary drinks or soda.
- Preparing meals at home more often.
- Taking part in meal prep and eating together at the table, not in front of the TV.
A meal plan should match the child’s preferences, encourage whole-family involvement, and allow for occasional treats. A registered dietitian helps design safe, enjoyable meal plans that fit health goals.
Regular Movement and Exercise
Daily physical activity helps control weight and supports the body in using insulin better, which can lower blood sugar.
Children with type 2 diabetes should get about 60 minutes of activity each day, which can be split up into smaller sessions.
Good activities include:
- Walking or biking
- Playing sports
- Dancing
- Swimming
- Games or playtime that makes the body move
Exercise works best when it becomes a regular habit. Families can join in activities for support and teamwork.
Diabetes Medicines and Insulin
Some children with type 2 diabetes need medicine to reach blood sugar goals. Three main medicines are approved:
- Biguanide: An oral medication that helps prevent the liver from releasing too much sugar and helps cells use insulin better. It can sometimes cause upset stomach or diarrhea.
- GLP-1 Receptor Agonist: An injection that helps the pancreas make more insulin after eating. It may lead to nausea or digestive issues.
- Insulin injections: Used when blood sugar levels are very high or other treatments do not control blood sugar. Insulin can be delivered by a shot or an insulin pen. Types include long-acting insulin used once per day and fast-acting insulin at mealtimes.
Providers may change medicine plans over time. Some children may reduce or stop insulin with healthy habits and other medicines.
| Medication | How It’s Taken | Main Use | Common Side Effects |
|---|---|---|---|
| Biguanide | Oral (pill) | Lowers liver sugar output, helps insulin | Upset stomach, diarrhea |
| GLP-1 Receptor Agonist | Injection | Boosts insulin after meals | Nausea, digestive issues |
| Insulin | Injection/pen | Lowers blood sugar quickly | Low blood sugar risk |
Checking Blood Sugar
Regular monitoring helps the care team and family see how well the treatment works. Most children taking insulin check blood sugar several times a day using a finger-prick blood test or a continuous glucose monitor (CGM).
The care plan determines how often to check. Tracking results shows how food, activity, and medicines affect blood sugar and helps doctors adjust the plan.
Sample Blood Sugar Monitoring Log Table:
| Time of Day | Blood Sugar Reading (mg/dL) |
|---|---|
| Before breakfast | |
| Before lunch | |
| Before dinner | |
| Before bedtime snack | |
| Extra checks (if needed) |
Surgery for Weight Loss
Doctors may recommend surgery to help teens with serious obesity reduce weight and improve blood sugar control if their body mass index (BMI) is 35 or higher and other steps have not worked.
Weight loss surgery is not for everyone. Providers generally offer it only after careful evaluation and when lifestyle changes and medicines do not bring enough improvement.
Regular Health Checkups
Children with type 2 diabetes need ongoing care, with regular visits to their care team. Checkups track progress, find problems early, and allow for plan adjustments as the child grows.
Routine checks may include:
- Viewing blood sugar logs and A1C results (goal is usually 7% or below).
- Measuring growth and watching for healthy changes in weight and height.
- Measuring blood pressure and checking cholesterol.
- Testing kidney and liver function.
- Eye exams once a year to watch for changes.
- Foot checks to find any problems early.
- Checking for other health conditions like polycystic ovary syndrome or sleep apnea.
Providers may also update vaccines, such as the yearly flu shot and possibly shots for pneumonia or COVID-19, depending on age and other risks.
Managing Low Blood Sugar
Low blood sugar, or hypoglycemia, occurs when blood sugar drops below the healthy range. This can happen if a child skips meals, eats less than planned, exercises more than usual, or takes more medicine or insulin than needed.
Children with type 2 diabetes do not get low blood sugar as often as those with type 1, but it can still happen.
Signs of Low Blood Sugar Include:
- Feeling shaky, dizzy, or weak
- Being pale
- Being very hungry
- Sweating or clammy skin
- Mood changes, like being grouchy
- Trouble paying attention or confusion
- Slurred speech
- Trouble moving or loss of coordination
- Passing out or having a seizure (in severe cases)
How to Treat Low Blood Sugar:
- Give 15-20 grams of quick sugar. Juice, regular soda (not diet), glucose tablets, or hard candy work well. Foods with lots of fat, like chocolate or ice cream, work too slowly and should not be used.
- Check blood sugar after 15 minutes.
- If still low, give more sugar and check again. Repeat as needed.
- Once better, eat a snack or meal to keep blood sugar up.
Every child should learn how low blood sugar feels and what to do. When unsure, treat first and test as soon as possible.
Sample Fast-Acting Carbohydrate Table:
| Food or Drink | Amount for 15g Sugar |
|---|---|
| Orange juice | ~1/2 cup |
| Regular (non-diet) soda | ~1/2 cup |
| Glucose tablets | 3-4 tablets |
| Hard candy | 3-5 pieces |
Dealing With High Blood Sugar
High blood sugar, or hyperglycemia, can occur if a child eats too much, misses their medicine, or is sick. Signs include:
- Needing to urinate often
- Having dry mouth or being very thirsty
- Blurry vision
- Feeling tired
- Feeling sick or queasy
If you suspect high blood sugar, check the blood sugar level right away. If the reading is high, follow the care plan, which may include adjusting medicine, drinking water, and calling the doctor for advice.
Diabetic Ketoacidosis (DKA) Awareness
Diabetic ketoacidosis occurs when blood sugar stays very high and the body does not have enough insulin. The body starts using fat for energy, which makes acids called ketones. DKA is very serious and requires emergency care.
DKA Warning Signs:
- Fast breathing
- Stomach pain or feeling sick
- Vomiting
- Fruity-smelling breath
- Tiredness or confusion
If these signs appear, seek medical care fast. The care team can test for ketones at home using urine or blood test strips.
Hyperosmolar Hyperglycemic State (HHS) Information
Hyperosmolar hyperglycemic state is a rare but dangerous problem that develops if blood sugar becomes extremely high over time but without the acidity seen in DKA. Older children and teens who have not been diagnosed yet are more likely to develop HHS.
Typical Signs and Symptoms:
- Very thirsty and dry mouth
- Needing to pee a lot, or later not peeing at all
- Weakness and confusion
- Trouble walking or even coma, in very serious cases
HHS requires urgent medical attention to bring blood sugar back down and rehydrate the body.
Summary Table:
| Problem | Early Signs | Immediate Steps |
|---|---|---|
| Low blood sugar | Shakiness, hunger, sweating | Eat/drink fast sugar, retest in 15min |
| High blood sugar | Thirst, urination, tiredness | Check blood sugar, follow action plan |
| DKA | Vomiting, fast breathing | Emergency care, test for ketones |
| HHS | Extreme thirst, confusion | Emergency care, hydration |
Everyday Habits and Home Strategies
Diabetes Management at School
Parents and caregivers should inform teachers and school nurses about the signs and symptoms of both high and low blood sugar. A written care plan guides staff on what to do in different situations.
It is helpful to create a checklist for school, including:
- A list of symptoms for high and low blood sugar.
- Emergency contacts.
- Instructions for giving insulin or other medicine.
- The child’s meal and snack schedule.
Federal regulations require that students with diabetes receive the support they need to stay healthy and achieve in school. Open communication between parents, the care team, and the school helps meet each child’s needs.
Reaching Out to the Diabetes Support Team
Families should provide regular updates to the diabetes care team for proper management.
If a child’s blood sugar readings are often outside of the recommended range, caregivers should contact a health care provider, a certified diabetes care and education specialist, or a registered dietitian.
Some possible reasons to call the team include:
- Not knowing how to handle certain situations.
- Changes in eating or exercise habits.
- Questions about medicines or insulin doses.
Coping and support
Managing type 2 diabetes in children involves more than medicine and meals—it is also about feelings and changes in daily life. Support can help kids adjust to new routines.
Family members can encourage open talks about emotions. Letting children know it is okay to feel upset or frustrated plays an important role.
Ways to Offer Emotional Support:
- Listen Carefully: Give children space to talk about what bothers them.
- Be Patient: Adjusting may take time.
- Seek Help: Professional counselors or therapists can provide coping tools.
- Watch for Warning Signs: Changes in sleep, mood, or problems at school might signal something more serious, like depression.
Older children and teens sometimes resist diabetes management or experiment with things that are not safe, such as drugs or alcohol. Honest conversations and education can help address these issues.
Accessing support groups or resources online, including sites like the American Diabetes Association, can provide extra advice and community.
Regular diabetes education helps families build skills and confidence for diabetes care. Working closely with the diabetes care team gives ongoing support.
Getting Ready for Your Child’s Visit
Steps You Can Take Before the Visit
Preparing for a child’s diabetes appointment helps make the most of the visit. Families can take several steps:
- Look for Any Rules Before Testing: Sometimes, a blood sugar test requires a child to avoid food or drink for several hours. Ask if your child needs to fast before coming in.
- Note Down Any Symptoms: Write a list of physical or emotional changes your child has noticed. Include symptoms like increased thirst, frequent urination, tiredness, unexplained weight change, or anything that feels different.
- Family Medical History: Record if any relatives have type 2 diabetes. The health team may want to discuss family risk.
- Bring Support: Invite a trusted person to attend if possible. Having an extra listener can help remember the details.
-
Prepare Questions: Write questions ahead of time, such as:
- How often should we check blood sugar at home?
- What are healthy blood sugar ranges for kids?
- What changes to meals do we need?
- Does my child need medicine, and how does it work?
- How much exercise is best for my child?
- What warning signs should we watch for?
- What happens if my child has another medical problem?
- How often will we visit diabetes specialists?
- List All Medications and Allergies: List any medicines and known allergies. This helps doctors give safer requests for treatment.
Don’t be afraid to ask more questions during the meeting. Taking notes can help you remember instructions and advice.
| Helpful Reminders | Example |
|---|---|
| Bring snacks if fasting. | To eat after a blood draw. |
| Notebook for notes. | Record advice, instructions, and next steps. |
| Review symptoms in advance. | Know what to discuss. |
What the Healthcare Team May Discuss
During the appointment, the health provider will likely ask about:
- How the family is managing diabetes.
- Typical foods and meal patterns for the child.
- The child’s activity level and daily exercise.
- Whether the child is showing any new symptoms related to diabetes.
- How your child handles treatment routines, both emotionally and physically.
- Any risk factors like family history or previous symptoms.
The care team may also introduce the members you’ll work with, such as a pediatric endocrinologist, a certified diabetes educator, or a dietitian.
Answer honestly about daily routines. The health team can better manage or adjust care when they have more details.
