Male1: It seems to be an epidemic or phenomenon that we thought would never happen in pediatrics—only in diabetes. Diabetes when somebody gets like 40 and gets a little heavy, how come that is happening and how can we address this and maybe prevent that.
Male2: Well I think it is a very, very good question. We are seeing a rise now in that kind of diabetes in childhood to the point where it may soon surpass the typical kind of diabetes that we see in childhood which is juvenile diabetes caused by a completely different mechanism. And the single most important cause of this type of diabetes in childhood is overweight and as overweight worsens and we do not see any end in sight, so does the epidemic of type II diabetes. I think it is important to stress that it can be prevented. If children are brought to medical attention early enough and the medical attention is appropriate and sensitive enough to preserve the child’s self esteem, to preserve the child’s sense of self efficacy, then those kinds of interventions may help those children for stalling the onset of this kind of diabetes and of course the complications of that diabetes, the loss of limb, the loss of vision, the loss of kidney function and of course, premature death.
Male1: Is type II diabetes—is different from type I because type I, they do not make insulin, this one, they seem to make insulin?
Male2: Individuals with typical juvenile diabetes suffer from a condition where the body destroys the ability of the pancreas which is a tubular shaped gland that sits behind the stomach and makes insulin and in doing so, destroys the bodies ability to make that chemical messenger called insulin. Insulin carries sugar from the blood into the factories which is inside of each and every cell. This is different than type II diabetes where we are making a lot of insulin, but it is just not enough to feed the size of our body. And after a while, the pancreas tire out and cannot make enough insulin to keep up with the size of the body and that is when type II diabetes occurs. Clearly, the treatments and approaches to them are different. In type I diabetes, you must take insulin. There is no other form of treatment. In type II diabetes, in the early stages, if it is caught early enough, then certainly exercise, diet and maybe some oral medication may suffice and I think it is an important time for me to reinforce and to stress with parents that if you see your child bedwetting in a child that has previously been toilet trained, please bring this to the attention of your primary care provider as soon as possible. It maybe one of the earlier signs that your child has in fact developed diabetes. If they experience excessive thirst or they experience weight loss despite adequate intake of food, that too maybe a sign of diabetes and I would urge you to bring those kinds of symptoms to the attention of your primary care provider as soon as possible.
Male1: As a diabetic expert, today, we can get diabetes pretty well controlled with different types of insulin, is this correct?
Male2: There is no question that the advances in diabetes management today have really allowed our children to live full healthy and happy life spans. We have insulin treatments that are far superior to what they were years ago, and closely mimic what the pancreas typically does. We have insulin delivery devices, like for example insulin pumps, which allow the insulin to be delivered almost as well as the pancreas does and we have wonderful monitoring devices such as fingerstick blood sugar testing and continuous glucose monitors that allow us to know what the blood sugars are almost every minute of the day. These advances have lengthened the life span of children with diabetes so that they can all live happy and healthy long lives.
Male1: So a well-managed diabetic can almost expect to live a full life like a normal person?
Male2: Without question, a child who has diabetes that takes care of themselves and a family that strives to take care of their child with diabetes, as challenging as that maybe, the payoff is enormous and I think that if they do, they will see their children live long and happy and healthy lives without any long term complications.
Male1: So the best treatment for type II diabetic would be prevention? That would be exercising at an early age, weight control in the early age, is that true?
Male2: I think for all children, regardless of whether or not they develop type II diabetes, but certainly in those at risk where family members may have diabetes, those are families that should be paying particular attention to be physically active and eating right so that they can prevent the onset of type II diabetes in their children.
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