RespiteMatch.com Health Blog

After kids or teens are diagnosed with type 2 diabetes, the next step for parents and doctors is creating a treatment plan that allows kids to manage their condition and stay healthy and active. Doctors or members of your child’s diabetes health care team may call this a diabetes management plan.

Treatment plans for type 2 diabetes differ from child to child, based on your child’s needs and the suggestions of your child’s diabetes health care team.

Type 2 Diabetes Treatment Basics
The blood glucose level is the amount of glucose in the blood. Glucose is a sugar that comes from the foods we eat, and it’s also formed and stored inside the body. It’s the main source of energy for the cells of the body, and it’s carried to each cell through the bloodstream. Insulin is a hormone that allows the glucose to get into the cells. In type 2 diabetes, the body doesn’t respond normally to insulin, so glucose is less able to enter the cells. This causes the blood glucose level to rise.

For children with diabetes, the goals of treatment are to control the condition in a way that helps minimize symptoms and prevent short- and long-term health problems, while making sure a child has normal physical, mental, emotional, and social growth and development.

High levels of blood glucose, or blood sugar, can cause both short- and long-term health problems, so a major goal of treatment for kids with diabetes is to keep blood sugar levels in a healthy range. It is also important to treat other conditions that can be associated with type 2 diabetes, like obesity, high blood pressure, or abnormal blood lipid (fat) levels.

In general, kids with type 2 diabetes need to:

eat a healthy, balanced diet and follow a meal plan
get regular exercise
take medications as prescribed
monitor blood sugar levels regularly
Helping kids with type 2 diabetes switch to healthier habits is a key part of treatment. Because most children with type 2 diabetes are overweight when they are diagnosed, it’s important to promote healthy eating and physical activity to prevent further weight gain or to encourage weight loss while making sure kids grow and develop properly.

Eat a Healthy, Balanced Diet and Follow a Meal Plan
Weight gain occurs when a person eats more calories, or energy, than he or she uses up through physical activity. The body stores those extra calories as fat. Over time, excessive weight gain can lead to obesity and diseases related to obesity like type 2 diabetes and heart disease.

Kids with type 2 diabetes who are trying to manage their weight still need energy to develop normally. To get it, they’ll need enough calories to grow without gaining too much fat. The best way for a child with type 2 diabetes to manage his or her weight is to eat nutritious foods and exercise.

Many parents worry, “What can I feed my child with type 2 diabetes?” The answer is simple: a balanced, healthy diet. Kids with diabetes benefit from the same kind of diet as people without diabetes - one that includes a variety of nutritious foods that help the body grow and function properly.

The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which all provide energy in the form of calories. Foods containing carbohydrates cause blood sugar levels to go up the most. Foods that contain mainly protein and/or fat don’t affect blood sugar levels as much as foods with carbohydrates, but they still contain calories. Our bodies need all of the nutrients - in varying amounts - to function normally.

You and the diabetes health care team will create a diabetes meal plan for your child that incorporates foods with all of the essential nutrients. Meal plans typically consist of guidelines for providing your child breakfast, lunch, and dinner with small, scheduled snacks.

The diabetes meal plan won’t restrict your child to eating specific foods, but it will guide you in selecting choices from the basic food groups to achieve a nutritious balance. A meal plan is based on your child’s age, activity level, schedule, and food likes and dislikes. It should also be flexible enough to accommodate special situations like parties and holidays. The meal plan should make it easier to keep your child’s blood sugar within his or her goal range.

Your child’s diabetes meal plan may also recommend limiting extra fat and “empty” calories (foods that contain lots of calories but few nutrients like vitamins and minerals). To reap the benefits of a healthy diet, everyone should limit these foods, anyway, because eating too much of them can lead to weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Portion control - even of healthy foods - is key for kids with type 2 diabetes because they generally weigh more than kids their age who don’t have the disease. As you’re following your child’s meal plan, be wary of special foods marketed to people with diabetes. Sugar-free and fat-free foods are not always calorie free or even low calorie. And remember, to get to a healthy weight, kids need to cut back on extra calories, not eat more of them.

A registered dietitian (RD) can help you choose and cook healthier foods, read food labels, and learn how much food your child should be eating in a day. He or she can also adjust meal plans depending on how your child is doing with regard to meeting his or her weight management goals. If you haven’t met a dietitian as part of your child’s diabetes health care team, ask your child’s doctor for a referral to see one.

Get Regular Exercise
Exercise is good for everyone - adults and children - with or without diabetes. But overweight children and teens with type 2 diabetes tend to be less active than children without diabetes, so exercise is a very important part of the treatment plan. Exercise helps improve the body’s response to insulin, which helps to control blood sugar levels. It also helps the body burn more calories, which can promote a loss of excess body fat. And it’s healthier for growing kids who are overweight to burn more calories through exercise than to severely restrict the amounts of food they can eat.

Regular physical activity may also help reduce the risk of other chronic illnesses, like cancer. In addition to all of these benefits, exercise can help kids with diabetes:

keep blood lipids and blood pressure under control
get and keep their heart, lungs, and blood vessels in good shape
feel more normal by doing things that kids without diabetes can do
Kids don’t have to be athletic to reap the benefits of physical activity. Things like walking the dog, helping around the house, and playing outside with friends are great - anything that gets your child moving regularly can go a long way toward helping your child’s diabetes. To help avoid problems during exercise, kids with type 2 diabetes may need to:

have an extra snack prior to activity
carry snacks, water, and supplies with them when they exercise
check their blood sugar levels before, during, and after exercise
wear a medical identification bracelet (this should be worn always, but it’s even more important when exercising)
make sure their coaches know about their diabetes and what to do if problems occur
Your child’s diabetes health care team will offer specific suggestions to help your child get ready for exercise or join a sport. They’ll also give you written instructions to help you and your child respond to any diabetes problems that may occur during exercise, like hypoglycemia (low blood sugar), or hyperglycemia (high blood sugar).

Take Medications as Prescribed
Sometimes, a combination of diet and exercise are enough to control blood sugar levels in a child with type 2 diabetes. Other times, pills that help the child’s insulin work better need to be taken as well. These pills are not a form of insulin.

Sometimes pills for diabetes - even when combined with diet and exercise - still aren’t enough to keep blood sugar levels under control, and a child with type 2 diabetes must take insulin. The acids and digestive juices in the stomach and intestines would break down and destroy insulin if it was swallowed, so it can’t be taken in a pill. The only way to get insulin into the body right now is with an injection or an insulin pump.

There is no-one-size-fits-all insulin schedule - the types of insulin used and number of daily injections your child needs will depend on your child’s diabetes management plan. Usually, children inject a combination of different types of insulin to handle the sugar which circulates in the blood both after eating and in between meals.

You can’t turn off the action of insulin once it’s been injected, so insulin doses need to be adjusted to handle the rise in blood sugar that occurs with meals and provide the amounts of insulin the body needs between meals and overnight. Eating meals at regular times generally makes this easier to accomplish. Although eating on schedule may work well for younger children, sticking to a routine may be a bigger challenge for older kids, whose school, sleep, and social schedules may not be as routine. Your child’s diabetes health care team can help you work through any problems your child may be having with scheduling meals and insulin injections.

The promising news about type 2 diabetes is that by following a balanced diet, getting regular physical activity, and achieving a healthy weight for height, blood sugar levels can improve significantly. In some kids, following the treatment plan for type 2 diabetes can even eliminate the need for medication altogether.

Monitor Blood Sugar Levels
Another part of treating type 2 diabetes involves checking blood sugar levels regularly and responding to the results. Frequent testing is necessary to help control blood sugar levels, so that kids with diabetes feel well, grow and develop normally, and have a reduced risk of developing long-term diabetes problems. Your child’s diabetes treatment plan will recommend how many times a day your child’s blood sugar levels should be checked - it’s the only way to know how your child is doing with blood sugar control.

Your child’s diabetes team will also let you know what your child’s target blood sugar levels should be. In general, kids with type 2 diabetes should test their blood sugar levels with a blood glucose meter at least twice a day, but your child may need to test more frequently if he or she is taking insulin, has just been diagnosed, or is having problems with blood sugar control.

A blood glucose meter tells you what your child’s blood sugar level is at the moment you test. Another type of blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, can give an indication of what your child’s blood sugar levels have been like over the past few months.

Putting It All Together
Treating and managing diabetes may seem complicated and overwhelming at times. But your child’s diabetes health care team is there for you. Your child’s diabetes management plan should be easy to understand, detailed, and written down for easy reference. You should also have the names and phone numbers of your child’s diabetes health care team members in case of emergencies or if you have questions about how to take care of your child’s diabetes.

In addition to the diabetes treatments mentioned above, you may also hear about alternative or complementary treatments for diabetes, such as herbal remedies and vitamin or mineral supplements. Not enough studies have been done to prove their effectiveness, although research is presently being done to study their possible benefits. Aside from being potentially ineffective, these practices can even be dangerous for kids and teens with type 2 diabetes, especially if they are used to replace medically recommended treatments. Talk to your child’s diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and many treatment advances have occurred to make treatment easier and more effective. Insulin may soon be available in pill, patch, and spray forms, and an artificial pancreas - a device that senses blood sugar and gives insulin - is currently being tested. Although these new developments are exciting, all of them still need extensive testing - especially for use in children - before they become available.

Reviewed by: Steven Dowshen, MD, and Elana Pearl Ben-Joseph, MD
Date reviewed: April 2005