Web intro: Since 2001 Oklahoma has seen a 20% increase in both Type 1 and Type 2
diabetes in children. Why this increase? We asked Dr. Jeanie Tryggestad, a pediatric
endocrinologist at OU Medicine and the Harold Hamm Diabetes Center, to answer
this and other important questions in a recent OU Medicine online chat. View her
answers here.
1. Question: Why is diabetes increasing in children in Oklahoma?
Jeanie Tryggestad, M.D./Harold Hamm Diabetes Center: There's a lot of research
going on trying to understand what's going on with Type 1. I think that's the one we can't
explain quite as well. With Type 2 the incidence of diabetes directly correlates with our
incidence of obesity. Oklahoma is also one of the most obese states in the nation. Not only
our adults but also our children.
2: What is Type 1 diabetes?
Tryggestad:Type 1 diabetes is an auto-immune process. In other words, the body has made
antibodies, has made proteins that are attacking the pancreas. The pancreas is an organ that
sits in the middle of the stomach. Its responsibility is to make several hormones, one of
those hormones being insulin. Insulin's needed by every cell in the body. Without it--and it
acts like a key--without the insulin there, there's nowhere for the glucose, or the sugar that
you eat, to get inside of the cells for energy. When that glucose can't get in, it basically
starts to build up in the blood. Our kidneys do a pretty good job of holding onto that sugar
for us, until we get a blood sugar level of 180. Once we get over that, kidneys can't handle
it any more, so we get rid of it.
3: Can you be born with diabetes?
Tryggestad: There are children born with diabetes, but this is usually a genetic problem.
The immune system develops over time, so usually it's--the earliest you see it is in the
eighteenth month--there's occasionally been a child that's nine months old. But usually
they're the eighteen to two years that you can really start to see the autoimmune process.
And really Type 1 diabetes has a peek in early childhood around the age of eight or nine
and then has another peak during the teenage years. Used to we thought of type 1 diabetes
as juvenile diabetes. That name is changing because we know that older people can
develop Type 1 diabetes, but it's actually more common to develop during childhood.
4:What is Type 2 diabetes and how is it different from Type 1? [4:46]
Tryggestad:It's still diabetes. It's still an abnormal way the body processes glucose. But
this is more due to the tissues of the body, all of them being resistant to the effect of
insulin. Kind of like there's a wall being built up, and it gets higher and higher. It takes
more and more insulin to get over that wall, to get in and be used. Usually, while in Type 1
there's no insulin production, it's very low, in Type 2 usually the insulin levels are very
high. There is insulin production, it's just like the tissues in the body don't see it.
5: Which is worse--Type 1 or Type 2?
Tryggestad: I don't know that we can say which one is worse. I think that some people
perceive Type 1 as worse because you have to do the injections. But occasionally in Type
2 your disease progresses to the point that you don't respond to medicine anymore and you
have to take insulin.
6: What's the best way to manage Type 2 diabetes?
Tryggestad: Getting exercise. Getting at least 60 minutes of exercise every day, enough to
get your heart rate up. Again, watching your diet, watching your portions, your intake, and
trying to match that the best we can. If that doesn't work, and if that isn't enough to control
the diabetes, we occasionally add a medication.
7: Can you cure diabetes in children?
Tryggestad:Type 1, no. There's a lot of debate on Type 2. Is, if you really do lose the
weight, and if you really do get to the lifestyle modification, can it be to where you're not
taking the medications anymore? Potentially, but you still if you let your control decline it
will come back?
8: Can you prevent diabetes?
Tryggestad: Type 1, no. Type 1, that's genetic potential. You genetically inherit the
tendency toward that. We don't have a way to prevent type 1 right now. Type 2--the best
prevention is managing the weight, controlling the diet, getting exercise, living a healthy
lifestyle.
9: What factors predispose someone to Type 2 diabetes? [post 10:01]
Tryggestad:When we look at what is four things that kind of predispose us to Type 2
diabetes, some of them we can't control. Family history. A family history of type 2
diabetes--there's nothing we can change about that.
(dissolve)
The other thing that predisposes us to Type 2 diabetes is our ethnic background. Type 2
diabetes is very prevalent in the Native American population. It's also prevalent in people
with Hispanic descent. We can't change our ethnic makeup. The other two things are, one,
being obese, which we do have some control over. Kind of controlling our weight. And the
last kind of risk factor is this:acanthuses. Having that darkening of the skin. It can be at the
neck. It can be under the armpits. That again is the sign that the insulin is high.
10:Should concerned parents limit their child's sugar intake, or their fat intake--or
both?
Tryggestad: It's really a combination of both. You want to look at overall calories, and
calories depend on the age of the child, how many they would need. So you have to take
that into account. Talk to their primary doctor about what their intake should be. We have
a nutritionist to help us out to about what are good vats, what are good carbohydrates,
because everybody needs carbohydrates. We have to have it, but it's the excess and the
same thing with the fat. It's trying to avoid the excess.
11: What are some other warning signs of diabetes in children?[15:09]
Tryggestad: The things that we look for, for the development of diabetes, this is usually
related to the fact that we're losing that sugar as I mentioned through the urine. Because
we're doing that we're losing water too, so we become very thirsty. So we start drinking a
lot. One of the other signs is that we're more hungry, so we're eating more and that's
because we're losing a lot of these calories with the urine. losing the calories, you tend to
lose weight especially in kids who aren't trying to actively lose weight. It's seeing the
weight loss. So those are signs that you would look for. And also because we're losing
both water and sugar, you're going to the bathroom a lot.
(dissolve)
You notice a child has never gotten up at night, and all of a sudden they're having to get up
two and three times during the night to go to the bathroom. Maybe in our, especially, Type
1 children, the preteens are maybe all of a sudden wetting the bed again. That's kind of a
sign that we need to look for.
12. What is gestational diabetes? [post 19:52]
Tryggestad: This is diabetes that develops during pregnancy. We know that mothers with
gestational diabetes, they're at higher risk at developing diabetes later on.
(dissolve)
The child is not born with diabetes, but it does create a risk factor.