TWIN FALLS — Not so long ago, doctors diagnosed type 2 diabetes in people of middle age and older. They still do. But nowadays pediatricians are also finding it in some of their young patients.

Twin Falls pediatrician Dr. Barton Adrian emphasized that he had never seen a type 2 diabetic or insulin resistant child until about five years ago.

“We have at least 12 kids in our practice — between myself and the other people here,” he said. “There’s a couple of us who see most of the diabetics, but there’s six pediatricians here. That’s about two kids per pediatrician.“

Adrian said traditionally a person might get type 2 diabetes in his 50s. Now people can already have insulin resistance and some of the signs of type 2 diabetes at 15 and start needing insulin or oral agents at 20. With this goes the possibility of developing consequences like amputation and blindness.

“I would think if you’re going to have diabetes from the time you’re, say, 15 to 60 — that’s 45 years,” he said. “Eventually you’re going to lose all your small blood vessels — that’s your eyes, your kidneys and your extremities.“

Contributing factors

Adrian places the blame for the youthful trend to type 2 diabetes on widespread childhood obesity. He said kids eat more calories than they spend, and they pack it in as fat. Then as they become overweight, they can develop insulin resistance — it takes more insulin to make the sugar go into the muscle cells when they are fat.

“And so people who have type 2 diabetes actually have normal or even elevated insulin levels, but they don’t have enough for what they need,” he said. “We’ve known that for years with adults with type 2.“

Although not all people who have the disease are obese, he said, most are. It may be that whatever insulin resistance there is worsens when a person becomes overweight.

Poor diet, junk food and lack of exercise play a role in type 2 diabetes. Adrian said he thinks inactivity plays the major role. Adrian said a lot of things keep kids from getting exercise, such as television and video and computer games. In large cities it is dangerous to play in the streets, so parents keep kids inside.

Certified diabetes educator Ann Bybee, a registered nurse, said that even in Magic Valley there is an inclination to keep kids off the street. In her childhood she rode her bicycle three or four miles to her nearest friend’s house.

“And yet, I wouldn’t have allowed my children to do the same thing, because of the safety issue that we deal with, or are fearful of, now with our children,” Bybee said. “We used to, when we were kids, go out and play on the school grounds and everywhere, and now they have fences and now they have rules. They’ve taken away the monkey bars and all of these things that we used to play with frequently, because of safety and liability.“

Bybee said there is a correlation between the fat in fast foods and obesity, and soda is loaded with sugar and high-fructose corn syrup. She advocates removing pop from schools, as long as it isn’t replaced with drinks equally high in sugar.

Elva McNurlin, a Hansen dietician and diabetes educator, said it is better to eat fruit than to drink the juice. Liquid calories are usually a bigger calorie source in our diet than we’d like to admit.

“We don’t always recognize those as making us feel less hungry or making us feel full,” she said. ”It’s easier to get a lot of calories in liquids, and forget that we did it.“

Diet for diabetics

McNurlin said kids need to be taught about healthy foods, good choices and portion sizes.

“Some of their struggles are based on things like school activities and activities after school; plus they have to live a normal life as much as they can,” she said. “We try to help their families make that work for them.“

She said the reality is that kids with type 2 diabetes are going to eat normal food, so they have to know how to make that work.

They can learn to make healthier choices, such as a grilled chicken sandwich instead of deep fried chicken or a hamburger. They need to choose lower-fat meats and eat more fruits and vegetables — especially the vegetables. Salad is a better choice than fries.

It helps to count carbohydrates and set per-meal limits.

“Diet for diabetics is just basically a healthy diet,” McNurlin said. “For the person who has diabetes, then controlling the amounts of those foods they eat more closely is the biggest factor.“

Detecting the disease

With type 1 diabetes there is an autoimmune attack on the cells that make insulin, Bybee said, and those cells are destroyed.

Symptoms are the same for type 1 or type 2 diabetes, Bybee said. First you have fatigue, then you start urinating more, have more thirst, have trouble thinking clearly and sometimes have blurred vision, sometimes foot pain or numbness and tingling in the feet.

A marker for some people with type 2 diabetes is acanthosis, a darkening and thickening of skin in the groin, under the arms and behind the neck.

Adrian said sometimes he notices this in a child he is examining, or parents might comment that they scrubbed and scrubbed, but couldn’t get that sunburn mark off.

“That is actually a sign of insulin resistance,” he said. “They’re pre-diabetic in that they may have the insulin resistance, they may have elevated cholesterol or triglycerides on their lipid panel, and they have acanthosis. But if you check their glucose, it’s actually normal.“

Type 2 diabetes comes on over years, and you gradually develop trouble after eating meals. Probably the first thing that happens: You eat and then instead of your body keeping your blood sugar under, say, 180, it will shoot up to maybe 220, 250 or 280 about an hour after eating. And then by two to three hours after eating it will come back to normal. Technically you don’t have diabetes.

But if a glucose tolerance test shows that your glucose rises too high after eating, then you’re pre-diabetic — you have impaired glucose tolerance, and you’re well on your way to becoming a diabetic.

“In the initial part of this If you lose weight, your insulin sensitivity will return and acanthosis will go away and your blood sugar will return to normal,” Adrian said.

“I haven’t seen it in kids, but I know that in adults, even if they are on insulin, if they turn their life around and exercise and lose weight, they can come off insulin, because they make normal amounts of insulin.“

Study: Millions of U.S. teens on verge of developing diabetes By Warren King Knight Ridder News Service SEATTLE — Nearly 2.8 million teenagers in the U.S. could be on the brink of developing type 2 diabetes — a disease that used to be almost exclusive to adults — and another 39,000 teens may already have the disease, a University of Washington scientist has estimated in a new analysis of the growing prevalence of diabetes. The findings support growing concerns among public-health authorities nationwide over the increasing number of kids who are overweight, a major factor in the development of type 2 diabetes. The disease can eventually lead to kidney failure, limb amputations, blindness, heart disease, strokes and high blood pressure. “What we’re seeing is a reduction in physical activity and an increase in the prevalence of overweight kids,” said Glen Duncan, the University of Washington assistant professor of nutrition who conducted the study. “These things go hand in hand with diabetes, so this (the findings) is no surprise to me at all.“ About 18.2 million people in the U.S. have diabetes, including 210,000 people under 20, according to the Centers for Disease Control and Prevention. Another 1.3 million new cases a year are being diagnosed, and the vast majority are type 2, the agency said. The disease formerly was almost exclusive to people older than 40. Patients with type 2 diabetes are not able to use the insulin made by their bodies to metabolize glucose in the body. Those with type 1, formerly called juvenile diabetes, are not able to make insulin; more than 1 million Americans have that form of the disease. Duncan’s research, reported in the May edition of Archives of Pediatrics & Adolescent Medicine, echoes previous findings from the National Institutes of Health that showed a growth of type 2 diabetes in younger people. Duncan used data from extensive national health and nutrition surveys from 1999 to 2002 to reach his findings. Among a sample of 4,370 youths aged 12 to 19, only 18 had been told by a physician they had any type of diabetes. But blood samples from 1,496 who said they didn’t have the disease showed that about 11 percent had impaired glucose tolerance levels, or were “pre-diabetic.“ The findings indicated that 39,000 U.S. teens have type 2 diabetes and nearly 2.8 million are pre-diabetic.