SHERRI
SHAFER, R.D.,
Certified Diabetes Educator
High-Fat Diets and Sedentary Lifestyles Contribute to Childhood Obesity Type
2 diabetes was once considered an adult-only disease. Not anymore.
Every year the number of cases of type 2 diabetes in children and
adolescents increases. Why? Because kids are getting heavier and
are exercising less. Obesity
is becoming an epidemic. As the incidence of obesity rises, the
incidence of obesity-related diseases rises. Type 2 diabetes, high
blood pressure, and high cholesterol are all associated with
obesity and threaten potential long-term complications. The
duration of diabetes is a strong predictor of risk for developing
complications. How much more likely is someone to develop
complications if that person is diagnosed with type 2 diabetes at
age 15 instead of age 45? No one knows for sure, but giving type 2
diabetes a 30-year head start can’t help. Fortunately, we have
good studies showing that complications are preventable. We know
that controlling the blood sugar, the blood pressure, and the
blood cholesterol is critical in preventing complications.
Appropriate education, treatment, and control must start
immediately. Children
who develop type 2 diabetes usually do so after age 10 or when
puberty kicks in. The changing hormone levels associated with
puberty cause increased insulin resistance. Who’s
at Risk, and Should Be Screened? All
children who are overweight or over 10 years old should
be screened every 2 years if they have any 2 of the following risk
factors: *
Has a family history of type 2 diabetes *
Is a member of a high-risk ethnic group *
Has high blood pressure *
Has high cholesterol or high triglycerides *
Has polycystic ovary syndrome (PCOS) *
Has acanthosis nigricans Fasting
blood sugar of 126 mg/dl or higher, indicates diabetes. Nonfasting
blood sugar of 200 mg/dl or higher, indicates diabetes. Coping With the Diagnosis
Dealing
with type 2 diabetes can be especially challenging for an
adolescent. Adolescents need support, and at the same time they
struggle for independence. They want to fit in but must accept and
cope with a chronic disease. Diabetes requires planning and many
self-care strategies to prevent complications. Yet children live
in the moment, tend to experiment, and generally feel invincible.
Overweight children are often teased, which can damage
self-esteem. Children who have a hard time fitting in with their
peers may not want to disclose that they have diabetes. Children
who get chronic diseases may harbor feelings that they caused the
diabetes because they did something wrong or because they were
bad. Children with diabetes often experience a myriad of emotions,
including anger, frustration, denial, fear, depression, and
anxiety. Children need support. Seek the help of a counselor or
mental health specialist who can meet with the child, as well as
with other members of the family.
Parents can be supportive by talking with and listening to
their children. Keep the lines of communication open. Provide
options to children whenever possible. For example, children have
to check their blood sugar. Monitoring is not an option. But you
can allow the child to choose which finger to use. Remind older
children that it’s time to check the blood sugar but don’t
nag. Older children may not want their parents looking over their
shoulder while the blood sugar check is being performed. But
parents should have access to knowing what the numbers are. Blood
sugar monitors retain a record of past readings.
Parenting Pointers
Parenting
a child with diabetes takes knowledge, skill, patience, trust,
finesse, courage, hope, support, discipline, and a great deal of
responsibility. No one will tell you it’s easy. At first, the
brunt of the responsibility for diabetes care falls on the
parents. As children get older, they can begin to take on
age-appropriate diabetes self-management tasks. The transfer of
responsibility from parent to child is a tricky dance. Despite the
fact that some children are quite capable of performing
diabetes-related tasks themselves, parents should not relinquish
their support and supervision. It’s crucial that the child
isn’t overly burdened too soon. Kids can get burned out. They
don’t get a vacation from diabetes. Responsibility for diabetes
care should be shared between the child and caretakers. Instead of
considering it “the child’s diabetes,” consider it “the
family’s diabetes.”
Adolescence is a tricky time, when parents must supervise
and support yet give up some of the control. Teens tend to be
risk-takers and feel as if they’re indestructible. They want to
fit in. They don’t want to be different and may not want their
friends to know they have diabetes. Caregivers must convey the
importance of diabetes self-management without using scare
tactics. Don’t threaten a child with diabetes complications.
Fear isn’t a good motivator and can actually leave the child
feeling, “Why bother?” Children need praise and reinforcement.
Use positive motivators such as allowing the child to earn a
privilege for performing diabetes tasks. Let kids know that blood
sugar control improves the ability to concentrate and do well in
school. Well-controlled blood sugar also reduces fatigue and
allows peak athletic performance. One thing has become evident to
me; the kids who receive the most support and supervision tend to
have the best blood sugar control. Meal
Planning The
nutritional management of diabetes involves establishing healthful
eating behaviors that should last a lifetime. It’s important for
parents to demonstrate healthful eating behaviors. Kids learn many
eating habits from their parents. Children with diabetes should
not be singled out to eat entirely different foods from the rest
of the family. Here
are a few suggestions to improve childhood nutrition: *Don’t
skip meals. Eat three meals per day (plus snacks if desired). *Choose
healthful, lowfat snacks. Limit junk food. *Strive
for five! Choose at least five servings per day from a combination
of fruits and vegetables. *Choose
lean meats and lowfat dairy products. *Limit
added fats and fried foods. *Try
to use higher fiber and higher water content foods. *Eat
fewer fast food meals. Consider fast food fat
food. *Discourage
eating out of boredom or for emotional reasons. *Limit
eating in front of the television. *Choose
diet soft drinks instead of regular sodas and sugary beverages. *Don’t
force kids to clean their plates! Provide healthful menu
selections and let kids choose from those selections and choose
how much they want to eat. Children need to learn to quit eating
when they’re full, by following their appetite cues. Kids
with diabetes are still kids!
It’s
important to incorporate favorite foods in reasonable amounts,
even if those foods aren’t the most healthful choices. It’s
all about moderation. If a child has a well-balanced, healthful
diet most of the time, that’s what counts. There’s room to fit
a candy bar or a couple of cookies into the meal plan. Besides, if
you don’t negotiate the inclusion of some favored items, those
items tend to get eaten anyway. The kids just don’t tell you.
It’s better to fit the item in at a designated snack time or
mealtime. Treats can be traded for the usual carbohydrate snacks.
Forbidding treats can lead to feelings of anger and isolation.
Imagine being the only child at the birthday party who is not
allowed to eat cake. The psychological impact of being singled out
is probably more damaging than fitting a piece of cake into the
meal plan for a child with diabetes.
In addition to the general dietary guidelines listed here,
carbohydrate counting or the exchange system can be used to manage
carbohydrate intake and distribution. A registered dietitian who
is familiar with both pediatrics and diabetes can help to develop
an individualized meal plan.
Children must learn that having diabetes doesn’t have to
be a roadblock in life. Children with diabetes can do anything,
and be anything. They should be encouraged to believe that they
are capable of attaining their goals. The sky is the limit. |
