Treatments and drugs

By Mayo Clinic Staff

Treatment for type 2 diabetes is a lifelong commitment of blood sugar monitoring, healthy eating, regular exercise and, sometimes, insulin or other medications — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan.

If managing your child's diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your child's diabetes treatment team — doctor, certified diabetes educator and dietitian — to keep your child's blood sugar level as close to normal as possible.

Blood sugar monitoring

Depending on what type of medication (if any) your child needs, you may need to check and record your child's blood sugar at least daily, possibly more often. This usually requires finger sticks, though some blood glucose meters allow for testing at other sites. Children who need insulin therapy will need to check their blood sugar levels at least three times a day. Ask your doctor how often your child needs to test his or her blood sugar.

Testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is. The doctor may ask you to keep a log of your child's blood glucose readings, or he or she may download that information from your blood glucose meter.

Even if your child eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to:

  • Food. What and how much your child eats will affect your child's blood sugar level.
  • Physical activity. Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level.
  • Medication. Any medications your child takes may affect his or her blood sugar level, sometimes requiring changes in your child's diabetes treatment plan.
  • Illness. During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level.

Healthy eating

Contrary to popular perception, there's no diabetes diet. Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories. A healthy diet also limits sodas, juices, sweets and has fewer foods containing animal fats. This type of diet is generally the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your child's meal plan.

Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle. If your child is overweight or obese, gradual weight reduction will be a goal.

Physical activity

Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. The AAP recommends children and adolescents with type 2 diabetes get at least 60 minutes of moderate-to-vigorous activity daily and limit nonacademic-related time in front of televisions, computers and handheld devices to less than two hours a day. Sign up for a sports team or dance lessons. Better yet, get in the act together. Play catch in the backyard. Take a walk or run through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine.

Physical activity lowers blood sugar. If your child needs insulin treatment, check your child's blood sugar level before any activity. He or she might need a snack before exercising to help prevent low blood sugar.

Medication and insulin

A healthy diet and exercise are key parts of controlling blood sugar in children who have type 2 diabetes, but oral medication and, sometimes, insulin treatment also play an important role.

Medication. The AAP recommends metformin (Glucophage) for all children who have type 2 diabetes. Metformin reduces the amount of sugar a child's liver releases into the bloodstream between meals. Side effects may include nausea, upset stomach, diarrhea, headaches and, rarely, a harmful buildup of lactic acid (lactic acidosis). Metformin isn't safe for anyone who has liver failure, kidney failure or heart failure.

Insulin. The AAP also recommends insulin therapy if your child:

  • Has random blood glucose levels of 250 mg/dL (13.9 mmol/L) or higher
  • Has A1C levels of greater than 9 percent
  • Has excess ketones (toxic acids) in his or her urine (diabetic ketoacidosis)
  • May have type 1 diabetes

Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Therefore, if insulin is necessary, it has to be delivered under the skin. Insulin delivery options include:

  • Injections. Usually, insulin delivery means injections using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.
  • Insulin pump. An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. A wireless pump that uses small pods filled with insulin is another option that's now available. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. The decision about which treatment is best depends on the child, his or her blood sugar level, and the presence of any other health problems. Initially, children whose blood sugar is above 200 mg/dL (11.1 mmol/L) or who have an A1C above 8.5 percent will likely be started on insulin therapy to stabilize the blood sugar. Once blood sugar levels are normalized, your child may be weaned off insulin and placed on metformin alone.

However, if blood sugar isn't well controlled with metformin and lifestyle changes, insulin will have to be given again. A long-acting insulin, such as insulin glargine (Lantus), is often used for type 2 diabetes in children.

Signs of trouble

Short-term complications of type 2 diabetes require immediate care, including:

Low blood sugar (hypoglycemia). If your child's blood sugar level drops below the normal range, it's known as low blood sugar. Your child's blood sugar level can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin.

Watch for:

  • Sweating
  • Shakiness
  • Drowsiness
  • Hunger
  • Dizziness
  • Irritability
  • Headaches
  • Dramatic behavior changes
  • Confusion
  • Loss of consciousness

Treating low blood sugar

If your child has signs or symptoms of low blood sugar, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar equivalent to 15 grams of carbohydrate, and then recheck the blood sugar levels in 15 minutes. If the blood sugar reading is still low, give your child another fast-acting source of sugar, and retest again in 15 minutes. Once the blood sugar reaches a normal level, give your child a mixed food snack, such as peanut butter and crackers, to stabilize the blood sugar levels.

If your child loses consciousness, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. This is a medical emergency.

High blood sugar (hyperglycemia). Likewise, your child's blood sugar can rise for many reasons, including eating too much, not taking enough insulin or illness.

Watch for:

  • Frequent urination
  • Increased thirst
  • Dry mouth
  • Blurred vision
  • Fatigue
  • Nausea

Treating high blood sugar

If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is persistently above the target range set by your child's doctor, call your child's doctor right away or seek emergency care.

Increased ketones in your child's urine (diabetic ketoacidosis). If your child's cells are starved for energy, your child's body may begin to break down fat — producing toxic acids known as ketones. Although this condition is more common in children with type 1 diabetes, it can occur in children with type 2 diabetes.

Watch for:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Fever
  • Abdominal pain
  • A sweet, fruity smell on your child's breath
  • Confusion
  • Difficulty breathing
  • Exhaustion

Treating increased ketones

If you suspect ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit. If your child has excess ketones in his or her urine, call your child's doctor right away or seek emergency care.

Mar. 09, 2013