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[IP] Child diabetes may be misdiagnosed: Many doctors unaware that type 2 disease afflicts kids


NEW YORK, Jan. 18  A form of diabetes that has historically struck adults is
now also afflicting thousands of children and adolescents. Yet many doctors 
unaware of the trend  mistakenly diagnose the youngsters with another type
the disease, potentially subjecting them to inappropriate care, doctors here

        IN THE PAST, type 2 diabetes almost universally afflicted older,
overweight adults, who were advised to exercise, lose weight, watch their
diets to help control elevated blood sugar, and possibly take oral
       And type 1  which used to be called child-onset  diabetes
struck during childhood. Type 1 diabetics must take insulin to live because
their bodies do not produce enough of the hormone. They also are advised to
exercise and carefully control their diet.
       But the disease is changing markedly. Many type 2 diabetics now
eventually need to inject insulin, and unprecedented numbers of children as
young as age 4 are developing type 2 diabetes  most likely because they are
gaining weight and spending too much time on the couch, experts say.
       An estimated 16 million Americans have diabetes, mostly type 2. That
figure is expected to jump to 22 million by 2025, according to Dr. James
Gavin, a senior scientific officer of the Howard Hughes Medical Institute in
Chevy Chase, Md. We have an explosive disease on our hands, he said.
       Women can develop a form of type 2 diabetes during pregnancy called
gestational diabetes. Approximately 40 percent of women with gestational
diabetes who are obese before pregnancy develop type 2 diabetes within four
      People are more likely to develop diabetes if they are obese or have a
family history of the disorder. And as age increases, so does the risk of
diabetes. In addition, certain groups are at increased risk for diabetes,
including blacks, Hispanics and Native Americans.
     Some cases cannot be prevented. However, maintaining a healthy weight
exercising regularly may help protect against the development of type 2
diabetes in many people.
The American Diabetes Association recommends blood glucose screenings
beginning at age 45, or younger if someone has a family history of diabetes,
is obese or has other risk factors.
   At least a third of people with type 2 diabetes go untreated because they
dont know they have the condition. Many of these people will be diagnosed
with diabetes only after they have developed serious complications, such as
heart attack, kidney disease or impaired eyesight.
People with type 1 diabetes must take daily insulin shots to live and are
advised to carefully watch their diets.
   People with type 2 diabetes may be able to control their blood sugar
through diet and exercise. Others may need to take oral diabetes medicines to
lower their blood glucose levels. If this doesn't work, insulin may be
Source: American Diabetes Association
       We used to think of type 2 diabetes as a disease of our
said Dr. Kenneth Lee Jones, a professor of pediatrics and diabetes specialist
at the University of California in San Diego. Now, were seeing it in our
cousins, brothers, sisters and our children.

       Yet many pediatricians and family doctors are not aware that young
people are developing type 2 diabetes, speakers said Thursday at a news
conference on diabetes held by the American Medical Association and the
American Diabetes Association.
       As a result, if a child has elevated blood sugar, or glucose, levels 
a hallmark of both types of diabetes  a doctor may assume that the disease
type 1, since thats been the case throughout history, and prescribe
insulin therapy.

       While type 2 diabetics may need insulin initially to bring down
sky-high glucose levels, these patients can probably be weaned of the shots
later and prescribed an oral medication such as metformin, which is the only
oral drug to be officially approved for children, though others are also
Jones said.
       Aside from the daily discomfort of the shots, insulin therapy may
type 2 diabetics  who are likely to be overweight  to gain more weight,
further compounding their problem, he said.
       In addition, children with type 2 diabetes who are mistakenly
with type 1 may not be tested and treated for high cholesterol and high blood
pressure  two conditions associated with type 2, according to Jones.

       Kids with undiagnosed diabetes may experience extreme thirst, blurred
vision, frequent urination, fatigue and weight loss. A blood test can
elevated glucose levels, suggesting either type 1 or type 2 diabetes.

         Then, a doctor can use another blood test to measure antibodies
against insulin. The presence of antibodies indicates type 1, although only
percent of children with this form of the disease will have detectable
antibodies, according to Dr. John Buse, director of the diabetes program at
the University of North Carolina School of Medicine in Chapel Hill.
       Although there is no way to definitively diagnose the other 30 percent
of youngsters with type 1, other indicators include a family history of the
disease, weight loss and glucose levels that are particularly difficult to
       Children with type 2 diabetes tend to be overweight with a family
history of the condition, and they may have a condition known as Acanthosis
nigricans that causes dark pigmentation in the neck and underarms.
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