Kids and Blood Sugar Dysregulation: The Next Epidemic is Here

By Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

July 12, 2021

Kids and Blood Sugar Dysregulation: The Next Epidemic is Here
Recent news headlines have caught the attention of many. CNN reported “Cases of type 2 diabetes among children more than doubled during the coronavirus pandemic, research finds”. Medscape, a medical news site, reported, "Staggering’ Doubling of Type 2 Diabetes in Kids During Pandemic” Similar headlines were found throughout major news sites.

Twenty years ago, researchers and health care providers sounded the alarm about a new epidemic in children and adolescents with type 2 diabetes. The alarm resounds now with greater urgency and distress. Diabetes rates in kids and teens have worsened during the COVID-19 Pandemic. Kids with type 2 diabetes (T2D) have greater health problems and more complicated treatment programs than just a few years ago. Unfortunately, fighting T2D has had limited success with many failures or stalled out progress in recent decades.

Type 2 Diabetes: The Basics

Type 1 diabetes is the most common form of diabetes in youth, but the rate of type 2 diabetes continues to increase and occurs in about 33 percent of all newly diagnosed childhood type 1 and type 2 diabetes cases. Statistics from 2011-12, showed 12.5 cases per 100,000 youth. There is a time lag between obesity onset and diabetes, which means we will see more kids with type 2 diabetes in the coming decades. Indeed, recent reports show the Pandemic has accelerated the type 2 diabetes pediatric epidemic.

Children (up to age 18) develop type 2 diabetes for similar reasons as adults. Risk factors include sedentary lifestyle, obesity, ethnicity, family history like a relative with diabetes, low birth weight, female sex, and mother with gestational diabetes. Higher risk ethnic groups include African Americans, Asian Americans, Hispanics, Native Americans, and Pacific Islanders.

Symptoms of poorly managed diabetes are similar to adults, which include increased thirst, urination, hunger, and weight loss. Electrolyte imbalances may occur. Skin folds in the arm pits and neck may have a dark velvety rash appearance. In girls, there may be concerns of polycystic ovary syndrome (PCOS).

Type 2 diabetes is considered a preventable disease in all ages of life as it is directly affected by lifestyle and dietary choices. Obesity with visceral fat accumulation in children is considered the main underlying issue for type 2 diabetes. Overweight status in children is defined as a BMI of ≥85th percentile and < 95th percentile. Obesity is defined as a BMI of ≥95th percentile. Childhood type 2 diabetes parallels the rate of obesity trends.

More Disease Complications in the Young

Pediatric type 2 diabetes can be more aggressive, is harder to manage, and has greater risk of long-term complications compared to adult onset T2D. Researchers have seen a faster functional decline in insulin-producing cells (beta-cells) in the pancreas, but the process is different than type 1 diabetes.

T2D complications in children include peripheral neuropathy (nerve), retinopathy (eye), cardiovascular disease, and atherosclerosis. Kids also have a higher rate of end-stage kidney disease leading to death with T2D.

Approximately 90% of obese children and adolescents have at least one marker of metabolic syndrome, i.e. central obesity, high blood pressure, elevated triglycerides, low HDL, and elevated blood sugar. These concerns increase the risk for heart disease, stroke, cancer, degenerative joint disease, and Alzheimer’s diabetes as well as diabetes.

Testing Recommendations

The American Diabetes Association and the Center for Disease Control (CDC) now recommend children at 10 years of age (or younger if indicated) be tested for diabetes, heart disease, and hypertension. Children who are overweight or obese are to be screened for fatty liver disease starting at age 10. Type 2 diabetes used to be considered a disorder/disease of old age but now affects elementary age children.

Children should be thinking more about playing ball, riding their bikes, building forts, sleepovers with friends and other fun things rather than blood sugar levels, medications, and potential disease complications like kidney failure and need of dialysis. What happened?

Treatment Recommendations

The American Academy of Pediatrics recommends lifestyle changes and the prescription drug Metformin as the first treatment for choice for kids with T2D. Lifestyle changes include “encouragement of healthy eating, 30-60 minutes of moderate or vigorous physical activity five or more days per week, and strength training three or more days per week. It also includes limiting screen time to less than two hours per day and dietary counseling.

Other powerful pharmaceutical drugs like insulin and Victoza are also prescribed to elementary age children with type 2 diabetes. They face a lifetime of prescription usage and side effects unless diet and lifestyle changes are made.

Many drugs affect nutrient levels. Check out the article: Common Medications That Rob the Body of Nutrients

Food Choices and Meal Planning: What are Children Learning from You?

Kids learn by watching you. Your behavior affects their choices and actions. Think about different ways that your behavior impacts their thoughts and choices. Do you have a bad day or difficult event and choose to eat a bag of chips, ice cream, or other treat to calm the stress? Do you complete a project and decide to reward yourself with an empty calorie treat? Do you have soda pop and sugary drinks in the house? Are sweets and snacks readily available in the home? Do you pass by your favorite fast-food place or treat section in the store and can’t pass up the opportunity, even if you’re not hungry?

How about meal timing? Are you mindful about your meal times or do you graze and snack, or fast and then overeat? How about attitudes and thoughts about food preparation and cooking, recipe choices, meal planning, and having meals together? What messages are you sending your kids?

The time that you spend with your kids on meal planning affects them as they leave the nest into their adult life. Studies proved that meal planning is associated with a healthier diet and less obesity. Research showed that first-year college students who had established healthy cooking and meal planning skills prior to leaving for school consumed higher amounts of fruits and vegetables and had healthier BMIs.

Activity and Movement: What are Your Children Learning from You?

For the vast majority of Americans, creature comforts are real and present. Gone are the days of toting buckets of water from the spring, weeding acres of farmland by hand and hoe to raise food, splitting wood to heat the stove and oven and walking two miles to school. Calorie burning activities have been replaced with a flip of switch, a voice command to “Alexa,” and learning and working from home sitting in front of the computer for several hours each day. Sitting for more than 6 hours per day is detrimental to health.

How about your daily movements, steps, bending, lifting, or engagement in physical activity? What choices are you making that influence your kids’ movement enthusiasm and activity? When you walk up a flight of stairs or need to clean out a closet, do you complain or see it as an opportunity to get a little exercise? Kids model behavior.

Young kids can’t pass up the opportunity and individual attention to show their parent how fast or good they are as they bust out a dance move, kick or throw a ball, or to be included with a project or any other scenario. Young kids say “Watch me! Watch me!” with their activities. And then a few years later, kids are often so wrapped up in their tech devices that you can’t get them to budge. What can you do to change that?

Increase Activity Levels with Little Things

The American Academy of Pediatrics and other organizations recommend “30-60 minutes of moderate or vigorous physical activity five or more days per week for children with T2D. I am all for that level of activity, but how many overweight or obese children willingly undertake 30 - 60 minutes of vigorous activity because someone said so. There will be some who do their best, try very hard and succeed, but the natural tendency is more likely to resist or give up if they have to start at that level. This contributes to the failure and lack of progress in disease management.

You don’t start a new exercise program by running a marathon on the first day. Be successful with little increments of activity and build on that to get to the point of engaging in more vigorous activity. Encourage your kids and do it with them. These principles apply to all ages, abilities, and levels of health today and in the future.

Pandemic Stress and Changes

The Pandemic was a time of stress for all. Stress eating, increased sedentary behaviors, more computer/tech gadget time for school and friends, loss of athletics and social events, and disrupted schedules impacted everyone’s lifestyle choices in big ways. These concerns certainly affected biochemistry and metabolism too.

Pandemic shutdowns affected movement levels and activities for so many. Think about the little stuff that affected your child’s total activity level like walking to/from the bus stop and to classes? If you did online ordering with touchless pick-up at the store or delivered straight to your home, you and your kids did not spend the time walking around the store and parking lot. Those steps and movements count towards activity and movement. How about the loss of play time with neighborhood friends at the playground, pool, camp, or backyard?

Instill Healthy Meal Practices with The Five Rules and Mindful Choices

Instill mindful habits with healthy eating and meal planning. Meal timing is just as critical, if not more so as food quality. Breakfast with 20-30 grams or more of dietary protein and at least 25-30 grams of fiber per day has been proven critical for healthy metabolism. Go back to the basics with The Leptin Diet and The Five Rules.

1. Never eat after dinner. Finish eating dinner at least three hours before bed.

2. Eat three meals a day. Allow 5-6 hours between meals. Do not snack!

3. Do not eat large meals. Finish a meal when you are slightly less than full.

4. Eat a high protein breakfast. Aim for 20-30 grams of protein at breakfast.

5. Reduce the amount of carbohydrates eaten. Limit, don't cut out carbs.

Find ways to cope with stress other than eating. Sit down at the dinner table rather than eating in front of the computer or television. Choose other methods of reward rather than food and desserts. Encourage and support your kids when you see them making good dietary and lifestyle choices.

Go to the local farmer’s market with your kids and get them interested in where food actually comes from. There is still plenty of summer left to grow some herbs or vegetables in a plantar or small garden. Let your kids help with the project. Make choices together about foods in the grocery store and let them participate in meal preparation.

If access to quality foods is limited, focus on as much whole foods as possible. Make beans, legumes, whole grain rice, and sweet potatoes, etc. staples of your meals rather than processed/packaged foods made with white flour, white sugar, and white/refined rice.

Check Your Sugar and Carbohydrate Intake

From the 1700’s up until the discovery of insulin therapy 100 years ago, dietary reduction of carbohydrates was the treatment for blood sugar dysregulation and diabetes. Yet in this post-modern world with processed foods, the average American citizen consumes over 150 pounds of sugar per year.

It takes about 36.3 tablespoons of sugar to make one pound. 36.3 x 150 pounds of sugar = 5445 tablespoons per year. Now multiply your age by 150 pounds of sugar, e.g. 40 years x 150 pounds = 6000 pounds or 3 tons. Then calculate it for your child’s age, e.g. 10 years x 150 pounds = 1500 pounds or ¾ of a ton. When do you say enough?

Help your children understand the effects of white sugar and processed foods. In addition to its affect on blood sugar, obesity and diabetes, sugar causes bad breath, tooth decay, and likely more trips to the dentist to have cavities filled. It can worsen acne, anxiety, depression, and moodiness. Sugar can make it harder to think, do homework or remember things because of brain fog and fatigue.

Ask your child about how sugar makes their tummy feel. Is there more stinky gas, constipation, diarrhea, and tummy aches? Sugar causes inflammation and distress to your gut flora. It sends waves of unhealthy challenges and changes to your metabolic factories, leptin and insulin hormone management, liver and kidney function, etc. that ends with tissue damage and disease.

You can learn more about sugar trends, added sugar and concerns in the articles:

Sugar, Not Salt, Harms Bones and Strips out Minerals

New Research Links Cancer to Sugar Intake

Stevia – The Dark Side of This Natural Sweetener

Change Today or Settle for Crisis Management Tomorrow?

Prescription meds and insulin shots may be necessary for crisis management in children hospitalized for out-of-control T2D, but this disease doesn’t start overnight. Your child cannot change risk factors like their mother’s gestational diabetes, ethnicity, etc. You and your child make numerous choices every single day that greatly affect health and disease risk for type 2 diabetes risk, onset, and management for today and the future.

Instill fundamental, mindful food choices and intentional activities into your daily routine now. Other challenges may need to be addressed too that affect T2D. These include gut health and dysbiosis, removal of endocrine disrupting compounds (plastics, pesticides, flame retardants, etc) that affect estrogen levels and puberty, obesity and thyroid function, chronic inflammation, and more.

As the Pandemic winds down and activities resume, you may simply need a “reboot” to get back on track. For others, this may be a bigger challenge. If you feel this is too daunting, think about what you can do to affect these behaviors today – in this moment. Putting off healthy choices until tomorrow often means it will not happen until a crisis forces change. Unfortunately, too many youth are now in crisis and require powerful intervention and the trend will worsen. Prevention and management are both vitally important to your child, you, and the future of this country. You can make good choices and optimize actions today.

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