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Wednesday, November 19th, 2008

| CWK Producer

Keith Gonyea is one of a growing number of adolescent diabetics. His body doesn’t produce insulin, a hormone needed to regulate blood sugar levels.

“You wake up every morning, you do your blood sugars. You eat, do your blood sugars before lunch and dinner and every other time you eat and it just gets really old,” says Keith.

“Really old,” but necessary for kids learning they have this disease. New statistics show the number of diabetics rose 33-percent over the past decade. Keith was diagnosed on a ski vacation when he was 10-years-old.

“He couldn’t go more than 10, 15 minutes skiing down the slopes without having to eat snow because he was thirsty, or going into the woods to go to the bathroom,” says his mother, Jill Gonyea.

Now 14, Keith wears an insulin pump to regulate his blood sugar levels, and that has eliminated those symptoms.  He must also remain vigilant about his diet and exercise, two factors that experts point to as principal reasons why there are so many diabetic children today.

“What has changed is the lifestyle and the level of obesity and some of the physical activity and dietary habits we have,” says Dr. Michael Engelgau, a researcher with the Centers for Disease Control and Prevention.

But some children may be genetically predisposed to the disease, in which case, living with diabetes is all about attitude.

Keith says, “Don’t stop any activities or any sports, anything you did before you were diagnosed. If you have to make any changes look at them positively.”

“You also have to heed that there are long term issues that a diabetic has to deal with so those things loom heavy on your mind. But you can’t let them control you,” says Jill Gonyea.

And with the life expectancy of a diabetic 15 to 20 years shorter, the Gonyea family says its focus is all about living healthy.

Tips for Parents

Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action or both. According to experts at the Centers for Disease Control and Prevention, there are four types of diabetes:

• Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for 5 to 10 percent of all diagnosed cases of diabetes. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic and environmental factors are involved in the development of this type of diabetes.
• Type 2 diabetes was previously called non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90 to 95 percent of all diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African-Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risks for type 2 diabetes.
• Gestational diabetes develops in 2 to 5 percent of all pregnancies but disappears when a pregnancy is over. Gestational diabetes occurs more frequently in African-Americans, Hispanic/Latino Americans, American Indians and persons with a family history of diabetes. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40 percent of women with a history of gestational diabetes developed diabetes in the future.
• "Other specific types" of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections and other illnesses. Such types of diabetes may account for 1 to 2 percent of all diagnosed cases of diabetes.

Diabetes may not be considered by many to be a serious disease, but statistics from the Juvenile Diabetes Research Foundation suggest otherwise. Consider the following:

• Diabetes kills one American every three minutes.
• 23.6 million Americans have the disease.  That is 8 percent of the population.
• Diabetes afflicts 120 million people worldwide, and the World Health Organization (WHO) estimates that number will skyrocket to 300 million by 2025.
• A new case of diabetes is diagnosed every 40 seconds.
• Diabetes is the leading cause of kidney failure, adult blindness and non-traumatic amputations. It is a leading cause of nerve damage.
• People with diabetes are two to four times more likely to have a heart attack or stroke than someone without the disease.
• Life expectancy of people with diabetes averages 15 years less than people without the disease.
• Diabetes accounts for more than $105 billion of annual U.S. healthcare costs.
• One of every four Medicare dollar goes to pay for the health care of people with diabetes.

Type 2 diabetes is a serious and costly disease affecting more than 15 million adult Americans. The chronic complications of diabetes include accelerated development of cardiovascular disease, end-stage renal disease, loss of visual acuity, and limb amputations. All of these complications contribute to the excess morbidity and mortality in individuals with diabetes. Moreover, the prevalence of type 2 diabetes in adults is increasing. Superimposed on this disturbing picture in adults are the recent reports of the emerging problem of type 2 diabetes in children and adolescents.

Currently, children with type 2 diabetes are usually diagnosed over the age of 10 and are in middle to late puberty. As the childhood population becomes increasingly overweight, type 2 diabetes may be expected to occur in younger pre-pubertal children. There is evidence suggesting that type 2 diabetes is increasing in children and adolescents in the United States. One possible explanation for its emergence in children is the increase in obesity and decrease in physical activity in children.

Obesity is now reaching epidemic proportions all over the world, and specifically in the United States. It is a very common finding in children with type 2 diabetes. According to the American Diabetes Association (ADA), other risk factors include the following:

• Family history of diabetes – The frequency of a history of type 2 diabetes in a first- or second-degree relative has ranged from 74 to 100 percent.
• Sex and puberty – In the adult U.S. population, the prevalence of diagnosed type 2 diabetes is slightly higher in women than in men. Most of the studies in children, including those that are population-based, indicate a higher frequency in females. Reported cases of type 2 diabetes in children show a peak age of diagnosis during the usual pubertal age period, although there have been individuals described who were diagnosed pre-pubertally. The mean age of diagnosis was between 12 and 16.

There are a number of pharmacological treatment combinations for the treatment of diabetes, most of which include some level of insulin utilization. However, there are a number of lifestyle-oriented modifications that can also have a significant impact on the health and wellbeing of individuals dealing with diabetes. According to the ADA, the goal of lifestyle-oriented treatment is to lower your blood sugar and improve your body’s use of insulin. Components of this goal include:

• Meal planning – When an individual eats, his/her body changes food into blood sugar, making his/her blood sugar go up. A good meal plan slows this rise. A dietitian can help your child create a meal plan just for him/her, but make sure the following hold true:
  • It is low in fat.
  • It has moderate amounts of protein.
  • It contains starches, like those in beans, vegetables and grains (such as breads, cereals, noodles and rice).
• Exercise - Being active helps the cells in your child’s body take in blood sugar, so exercise plays a major role in the treatment plan. Tell your child’s doctor about the kinds of exercise he/she does now. His/her healthcare provider will help your child fit them to his/her new lifestyle. If your child doesn’t exercise, you may want to encourage him/her to become more active. It would be great if he/she could be active on most days of the week for a total of 30 minutes, which can be broken down into short sessions. If your child isn’t used to exercising, encourage him/her to start slow. Even a five-minute walk can help.
• Weight loss – Losing weight is another big part of diabetes treatment. It will help your child’s body use insulin better. The best way to lose weight is to exercise and follow a healthy meal plan. With a healthy meal plan, your child will consume fewer calories because he/she will fill up on low-fat foods, not fatty foods. Your child’s healthcare provider can help determine how much weight (if any) your child should lose. Sometimes, just 10 or 20 pounds is enough to bring diabetes under control. Your child should then decide how much to lose per week, keeping in mind that one pound per week should be the maximum. Slow weight loss is healthier and easier.
• Blood sugar checks – Once your child understands that eating healthy, losing weight and keeping fit help keep blood sugar levels normal, he/she can check his/her blood sugar levels at home to keep track of how he/she is doing.

References

• Centers For Disease Control and Prevention
• The Juvenile Diabetes Research Foundation
• American Diabetes Association
• Pediatric Research Institute at St. Louis University
• The Kansas Health Institute

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