Treatment for type 2 diabetes is lifelong and includes blood sugar monitoring, healthy eating, regular exercise, and sometimes insulin or other medications. As your child grows and changes, so will his or her diabetes treatment plan. The goal is to maintain healthy blood sugar levels, improve your child's sensitivity to insulin and prevent complications of type 2 diabetes.
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.
Although many alternative therapies have been touted as possible ways to treat or prevent type 2 diabetes, there's no definitive evidence that any of these alternative therapies are effective.
Talk to your child's doctor about dietary supplements or other alternative therapies to treat or prevent type 2 diabetes. Some of these supplements or alternative therapies might be harmful if combined with certain prescription medications. Your child's doctor can help you weigh the pros and cons of specific alternative therapies.
Blood sugar monitoring
You will need to check and record your child's blood sugar at least daily, possibly more often. This usually requires finger sticks, although some blood glucose meters allow for testing at other sites. 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.
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.
Your child won't be restricted to a lifetime "diabetes diet" of boring, bland foods. Instead, your child needs plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories. Ideally, your child's intake of carbohydrates should be consistent.
Your child's dietitian will likely suggest that your child — and the rest of the family — consume fewer animal products and sweets. This eating plan is the best for the whole family. Sugary foods are OK once in a while, as long as they're included in your child's meal plan.
Your dietitian is also likely to recommend that you:
- Decrease portion sizes
- Substitute a fruit or vegetable for a carbohydrate-rich food
- Replace high-calorie beverages, such as soft drinks or fruit juices, with water
- Eat at home more frequently instead of eating at restaurants
Physical activity lowers blood sugar. Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. Encourage your child to get regular physical activity for at least an hour a day and, better yet, exercise with your child.
Your child might need a medication to help control blood sugar. Metformin (Fortamet, Glucophage, Glumetza) reduces the amount of sugar a child's liver releases into the bloodstream between meals. Metformin might also help your child lose weight.
Side effects may include nausea, upset stomach, diarrhea and headaches. Metformin isn't safe for anyone who has liver failure, kidney failure or heart failure.
Insulin is generally recommended at the time of diagnosis for children with:
- Blood sugar above 250 mg/dL (13.9 mmol/L)
- A1C above 9 percent
Once your child's blood sugar levels fall to normal, your child might be weaned off insulin. Your child will need to take metformin and maintain lifestyle changes to control blood sugar.
If blood sugar isn't well-controlled with metformin and lifestyle changes, insulin will have to be given again. Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options.
Your doctor's recommendation will depend on your child's blood sugar level and the presence of any other health problems. A long-acting insulin, such as insulin glargine (Lantus), is often used for type 2 diabetes in children.
Insulin delivery options include:
- Injections. Insulin can be injected using a fine needle and syringe or an insulin pen ¾ a device that looks like an ink pen, except the cartridge is filled with insulin.
- Insulin pump. The pump is a device about the size of a cellphone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. A pump that is programmed to dispense specific amounts of insulin automatically might be an option.
Signs of trouble
Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 2 diabetes — such as low blood sugar, high blood sugar and ketoacidosis — require immediate care.
Hypoglycemia is a blood sugar level below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin.
Teach your child the symptoms of low blood sugar. When in doubt, he or she should always do a blood sugar test. Early signs and symptoms of low blood sugar include:
- Pale complexion
- Nervousness or anxiety
If your child has a low blood sugar reading:
- Give your child fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar
- Retest the blood sugar in about 15 minutes to make sure it has gone up into the normal range
- If the blood sugar is still low, re-treat with more sugar and then retest in another 15 minutes
Left untreated, low blood sugar will cause your child to lose consciousness. If this occurs, the child may need an emergency injection of a hormone that stimulates the release of sugar into the blood (glucagon). Make sure your child always carries a source of fast-acting sugar.
Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating the wrong types of foods and not taking enough insulin.
Signs and symptoms of high blood sugar include:
- Frequent urination
- Increased thirst or dry mouth
- Blurred vision
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 his or her target range, call your child's doctor or seek emergency care.
Severe lack of insulin causes your child's body to produce certain toxic acids (ketones). Excess ketones build up in your child's blood and are spilled in the urine, a condition known as diabetic ketoacidosis (DKA).
DKA is more common in children with type 1 diabetes, but can sometimes occur in children with type 2 diabetes. Untreated DKA can be life-threatening.
Signs and symptoms of DKA include:
- Thirst or very dry mouth
- Increased urination
- Dry or flushed skin
- Nausea, vomiting or abdominal pain
- A sweet, fruity smell on your child's breath
If you suspect DKA, check your child's urine for excess ketones. If the ketone levels are high, call your child's doctor or seek emergency care.