Is Your Child at Risk for Diabetes?

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You are listening to Weekly Dose of Wellness, it's brought to you by our friends at MemorialCare Health System. I'm Deborah Howell. Today's guests are Dr. Mario Brakin, a board-certified pediatric endocrinologist and the Medical Director of the Endocrine and Diabetes Center at Miller Children's Hospital, Long Beach. Trudy Bly is an RN and a certified diabetes educator at the Endocrine and Diabetes Center at Miller Children's. Welcome, Dr. Brakin and Trudy.

Trudy Bly, RN: Thank you.

Mario Brakin, MD: Glad to be here.

Deborah Howell (Host): Glad to have you. Today we're talking about American Diabetes Month. It's the whole month of November, a time to raise awareness about the immense impact of this disease. Just a couple of things. Diabetes is one of the most common chronic diseases in children and adolescents. 215,000 Americans younger than age 20 have diabetes. And most cases of diabetes among children and adolescents are Type 1. Each year, more than 13,000 young people are diagnosed with Type 1 diabetes. It is a huge problem, it's heartbreaking, so let's get right into it. First of all, what is diabetes?

Mario Brakin, MD: Diabetes is a condition characterized by high blood sugar resulting from the body's inability to use the blood sugar for energy.

Deborah Howell (Host): Okay, are there any signs parents should be looking for in their children?

Mario Brakin, MD: Yes, the warning signs that the parents should be looking for include increased thirst, frequent or nighttime urination, blurry vision, unusual fatigue, unexplained weight loss in spite of increased appetite, and dark skin around the neck or armpit.

Deborah Howell (Host): Oh, I hadn't heard that last one.

Mario Brakin, MD: I'll give you a little more explanation on what that is maybe a little later, or I can do it now. It's a condition called acanthosis nigricans, and is a darkened skin patches common in people whose body is not responding correctly to the insulin that they make in their pancreas. Also called insulin resistance, and it's seen mostly in people that have prediabetes or Type 2 diabetes.

Deborah Howell (Host): Okay. Thank you for that. So what is the difference between Type 1 and Type 2?

Mario Brakin, MD: In Type 1 diabetes, the pancreas no longer makes insulin, and therefore blood sugar cannot enter the cells to be used for energy. Type 1 diabetes is usually diagnosed in children and young adults, and was previously called juvenile onset diabetes. On the other hand, Type 2 diabetes, in Type 2 diabetes the body is unable to use insulin correctly or does not respond to it properly. It's also called insulin resistance, and eventually the pancreas does not make enough insulin. In both types of diabetes, blood sugar cannot get into the cells normally. In the past, Type 2 diabetes was almost exclusively seen in adults. That is why it was called adult onset diabetes. But now more children and teens are being diagnosed with Type 2 diabetes, which is directly related to the rapidly increasing number of overweight children.

Deborah Howell (Host): That's just heartbreaking. What causes Type 1 diabetes?

Mario Brakin, MD: Type 1 diabetes is an autoimmune disease. The immune system attacks the pancreas and destroys the cells that make insulin.

Deborah Howell (Host): Okay. So how are we treating Type 1 diabetes these days?

Mario Brakin, MD: The treatment and management of Type 1 diabetes is composed of a handful of elements, including insulin, nutrition, exercise, blood sugar monitoring, and emotional support slash education. It is up to the child and the family to monitor blood sugar levels at least four times a day or more, and appropriately administer multiple daily injections of insulin, with either insulin pens or syringes or an insulin pump. The parents need to work closely with the healthcare team to determine which insulin or insulins are best for their child. In regards to nutrition, eating well is one of life's greatest pleasures. Having diabetes does not prevent your child from enjoying a wide variety of foods. People with diabetes have the same nutritional needs as anyone else. It is important for growing kids to get enough calories and nutrients for normal growth and development. The parents should learn how to prepare well-balanced meals in the correct amounts, read labels, and choose the so-called diabetes superfoods or healthy foods that are more, that are going to help more with the management of the blood sugars. And finally, exercise. Exercise, regardless of the type of diabetes that your child has, regular physical activity is important for his or her overall health and wellness. With Type 1 diabetes, it's very important to balance the insulin doses with the food your child eats and the activity that he or she does. Planning ahead and knowing your child's body's typical blood sugar response to exercise can help keep the blood sugar from going too low or too high.

Deborah Howell (Host): Right. That's Type 1. Now what causes Type 2 diabetes?

Mario Brakin, MD: Type 2 diabetes is directly related to excessive weight gain and the obesity epidemic that affects not only adults but also children and adolescents. There are other risk factors that make you more prone to develop Type 2 diabetes, like a positive family history of diabetes, if you belong to the following ethnic groups, African-Americans, Latinos, Asian-Americans, Pacific Islanders, and Native Americans. Also physical inactivity, and like I mentioned in the beginning, if your child has acanthosis nigricans or the darkened patches around the skin of the neck or armpit, also is predisposed to develop Type 2 diabetes.

Deborah Howell (Host): Can Type 2 diabetes be prevented?

Mario Brakin, MD: Yes, there are things you can do to help prevent Type 2 diabetes. Specifically to encourage a healthy lifestyle. Active play, physical activity, as simply as walking the dog or mowing the lawn. Eating healthy meals, low-fat nutrient-rich foods, like whole grain foods and breads, fruits, vegetables, dairy products, and lean proteins. Try to limit the time for TV and video games to less than four hours a day. Drink less regular sodas, sports drinks, juices, and drink more water instead. And finally, limit the fast foods and or eat smaller portion sizes, what we call portion control.

Deborah Howell (Host): Okay. Doctor, I have one more question for you and then we'll bring in Nurse Bly. My child has diabetes, what do I need to do to ensure their diabetes is managed correctly?

Mario Brakin, MD: Well, I want to mention that diabetes is a disease that affects the whole family, especially when a child is diagnosed with diabetes. Whether you are a parent, sibling, or a family member, your support and understanding can make all the difference in the management of this disease. And we all work as a team, you're not alone, we're all united in this, and maintaining close contact with the healthcare team is what's going to make the difference on how the child is going to do.

Deborah Howell (Host): Okay. Alright. Nurse Bly, as a parent, how can I help my child cope with diabetes?

Trudy Bly, RN: Well, I think one of the most important things that we do is we try to let them know that this is a lifestyle change. This isn't, they're not sick. We're just changing their lifestyle. One of the biggest predictors though on how well children are going to do is if both parents are involved. Because if you have a dad who's not involved and a mom is, then they're giving the child conflicting information. The child gets confused and then typically they'll just stop managing their disease because they don't know which way to go. Or they'll use one parent against the other. The other thing is not to make them just a diabetic. They're still the same child they were before they were diagnosed. But now they happen to have diabetes, which is just a little part of them.

Deborah Howell (Host): It doesn't define them.

Trudy Bly, RN: Yeah. So when they come in from school, the first question out of your mouth shouldn't be what was your blood sugar while you were at school. It should, you know, be how was school, and you know go around to the diabetes part, but it's not their whole being.

Deborah Howell (Host): I have one last question and I'm sad that we are running out of time. We could talk for hours. Diabetes is a disease that affects the whole family, especially when a child is diagnosed. How can parents find support for themselves and for their child?

Trudy Bly, RN: Well, here at Miller Children's we have two different programs. We have a program called SQUID, Supporting Kids with Diabetes. It's a parent-driven group and they put on events for kids because we know it's important to bring these families together so that they can meet each other and not feel like they're the only ones. We also have a support group for children where they can come and get education and go through some of the emotional components of this disease. But by going on the webpage you can find different support groups. Try to stay on reputable websites such as the American Diabetes Association, Children with Diabetes. Juvenile JDRF is a good, another good website that they can go to. There's a lot of false information out there so they just have to be careful of what the information they're getting.

Deborah Howell (Host): Thank you both so much, Dr. Brakin and Nurse Bly. It has been really wonderful to have both of you on the program today.

Mario Brakin, MD: Sure, it was a pleasure.

Trudy Bly, RN: Thank you.

Deborah Howell (Host): To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic and healthy day from all of us here.