Friday, December 23, 2011

Pediatric diabetes

St. Luke’s Health Watch

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By DR. BART ADRIAN

Type 2 diabetes, once referred to as "adult-onset diabetes," has seen an alarming increase among children and adolescents over the past 20 years. This increase has paralleled the rise of childhood obesity. Since 1980, obesity among children and adolescents has almost tripled.

Studies suggest that from 1990 to 1998, there was a 5 percent increase in Type 1 diabetes, but a 46 percent increase in Type 2 diabetes. Excess weight is the leading factor contributing to Type 2 diabetes, though a family history and certain ethnicities increase the risk. African-Americans, some Native Americans and Hispanics are especially at risk. Virtually all children with Type 2 diabetes are either overweight or obese.

Initially, Type 2 diabetes may have similar signs and symptoms as Type 1 diabetes. These include excessive thirst and urination, rapid breathing and dehydration. However, there may be almost no external symptoms for years besides "acanthosis nigricans," which is dark, sunburned or dirty-looking skin on the neck.

Despite limited signs and symptoms, blood vessel damage is occurring in the eyes, kidneys and heart. This is why children with excessive weight need to be screened with a blood test at their physicals. If diagnosed with Type 2 diabetes, children need to participate in diabetes education and nutrition counseling. This education promotes weight management via lifestyle changes, including nutrition and exercise. The doctor may prescribe a medication called Metformin if diet and exercise are not enough.

It is recommended that those with diabetes have regular medical visits and a hemoglobin A1c lab test every three to six months to monitor their response to medications and complications of the disease. The A1c test result reflects the average blood sugar level for the past two to three months.

There are several programs in the Wood River Valley that can help if you are seeking help or treatment. The St. Luke's Wood River Diabetes Self-Management Training program began in 2005, and provides nutrition education, diabetes management training and regular lab testing for adults with Type 1 or 2 diabetes. Last year, the average A1c test results for patients before beginning the program was 35 percent higher than the target range. After completing the program, the patients' average A1c dropped to 6.8 percent, within the target range for adults with diabetes.

St. Luke's, in partnership with the YMCA, developed a program called YEAH (Youth Engaged in Activities for Health) to address the health concerns of overweight youth. Our young participants meet with a doctor, dietitian, nurse, physical therapist and social worker to make individualized goals that help them move to a healthier lifestyle. Participants and their families also take part in nutrition and physical activity classes, where they can try new healthy recipes and have fun with a variety of physical activities.

Talk to your doctor to seek help or treatment, or to access one of these programs. St. Luke's Wood River will be expanding these two programs to help more families, thanks in part to a new grant from the State Office of Rural Health. St. Luke's is also working to establish a pediatric diabetes outpatient clinic where children with Type 1 or Type 2 diabetes can see their doctor, a dietician and a diabetes nurse educator in one visit.

Dr. Bart Adrian has practiced as a pediatrician for more than 30 years. He currently works in conjunction with primary care providers in the Wood River Valley to provide pediatric-level consultations, allowing residents to receive the expert care they need closer to home. 

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