Science update: fighting type 2 diabetes in the young
Diabetes was once thought of as an older person’s disease — but today children and young adults make up almost 10 per cent of new cases. HFG investigates.
Type 2 diabetes (T2D) is being increasingly diagnosed in children, adolescents and adults under 40. The nation’s expanding waistlines and increasing levels of inactivity — factors which are largely preventable — are partly to blame. So, what do we need to know — and just as importantly — do, to confront the worrying trend of early onset of T2D?
What is early-onset T2D?
Early-onset diabetes is T2D diagnosed in those under the age of 40, and is usually caused by insulin resistance. When a healthy person eats carbohydrates, bread or potato, for example, the carbs are broken down into sugar (‘glucose’) in the blood. The pancreas then releases the hormone ‘insulin’, which helps to move glucose from the bloodstream into the body’s cells to be used as energy. In someone with diabetes, however, the insulin doesn’t work as effectively. So blood sugar levels rise, causing the pancreas to pump out even more insulin — hence the term ‘insulin resistance’.
The plethora of hormonal changes that happen during puberty is thought to worsen insulin resistance for teenagers. For this reason, T2D is rarely diagnosed in pre-teens, and more likely to be diagnosed during adolescence.
Who is at risk?
If a child is overweight and has one or more of the following risk factors, they have a heightened risk of early-onset T2D, and should have a fasting blood test every two years:
Aboriginal and Torres Strait Islander, or those from a non-European background
A blood relative with T2D
Signs of insulin resistance
Adults under the age of 40 have a higher risk of diabetes if they:
Have a family history of diabetes
Are from an Aboriginal and Torres Strait Islander, Pacific Island, Indian or Chinese background, and are over the age of 35
Are female and have experienced gestational diabetes, have given birth to a baby that weighed more than 4.5kg, or have Polycystic Ovarian Syndrome (PCOS).
If a young person is otherwise well, they might show no symptoms of T2D. And at the other end of the spectrum, they could develop ketoacidosis.
Ketoacidosis is a serious condition that requires urgent medical attention. It’s where the body works itself into a state of fat-burning — because it can’t use carbohydrates due to insufficient insulin. Symptoms of ketoacidosis include rapid breathing, vomiting, or breath that smells like nail polish remover.
Generally speaking, the most common symptoms of T2D are the same at any age. They may include:
Blurred vision, dizziness and headaches
Feeling tired and lethargic
Gradual weight gain
How is T2D diagnosed?
A simple blood test or Oral Glucose Tolerance Test (OGTT) is used to diagnose T2D. Depending on the test, your doctor will analyse your fasting blood sugar levels, or your blood sugar after a large intake of carbohydrates. The doctor may also consider your insulin levels and HbA1c, which is an average measure of your blood sugar over several months. The doctor will also assess your lifestyle risk factors, signs and symptoms.
People with early-onset T2D can often experience lasting impacts on quality of life and reduced life expectancy. Early-onset T2D is so serious, in fact, that teens who are diagnosed with it have an estimated 15 years cut from their remaining life expectancy. That’s because they’re exposed to the disease for longer, and so have a higher risk of developing complications at a younger age.
Having high or uncontrolled blood sugar levels can damage both small and large blood vessels in the body, which can lead to eye, nerve and kidney damage, plus cardiovascular disease. It can also have a major impact on young people s mental and emotional health.
What’s the treatment?
Lifestyle intervention is the first line of treatment for T2D. Medication, too, may be needed to help balance blood sugars. For children and adolescents in particular, getting the whole family involved in lifestyle change is important to encourage long-term compliance.
Research makes it clear that if you are overweight, losing weight is one of the most important things you can do to manage T2D. Losing just 5 per cent of body weight can be very beneficial.
But there’s no magic bullet or quick-fix crash diet — it’s simply about getting the basics right, and helping your child stick to the plan once they’ve begun. Here are our top five tips to get started.
1 Spread small portions of quality carbs evenly across the day
Think rolled oats at breakfast, wholegrain bread at lunch, brown basmati rice at dinner.
2 Eat plenty of plants
Choose fresh fruit, vegetables, legumes, nuts, seed and whole grains, and aim for half a plate of vegetables at each main meal.
3 Incorporate small, regular amounts of lean protein
This could be a couple of eggs at breakfast, a small tin of tuna with lunch, or a piece of chicken or steak the size of your child or adolescent s palm at dinner.
4 Replace unhealthy saturated fat with healthy unsaturated fat
Swap butter for avocado, and use olive oil instead of coconut oil. Eat oily fish like salmon a few times a week, and snack on a handful of nuts every day.
5 Drink plenty of water
Make those sugary soft drinks and juices ‘occasional treats’ rather than everyday items. Flavour chilled water with your berries or lemon.
Encourage 5–to–17 year olds to exercise at least 60 minutes a day, and to limit daily recreational screen time to two hours. If you’re 18–64, your goal is 150–to–300 minutes of physical activity a week — and to break up long periods of sitting as much as possible. If both you and your family eat well and keep moving, it’s much easier to keep diabetes on the run!