When the Type of Diabetes Isn't Clear:
Answers for Parents

Beth Ann Coonrod, PhD, MPH, RN, CDE

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My child was diagnosed with diabetes. Why can't the doctor tell me what type of diabetes it is?
In the past, when a child had diabetes, it was often quickly diagnosed as type 1 (in which the body doesn't make insulin). But today, more and more children are developing type 2 diabetes (in which the body makees insulin, but not enough). Also, we now know that there are more than two types of diabetes.

The signs and symptoms of the different types can be a lot alike at first. It can take a while after getting the blood glucose level under control before your doctor can spot differences and tell for sure what type of diabetes your child has.

Is there any way the doctor can tell for sure what type of diabetes my child has?
Once a child's blood glucose level is under control, the type of diabetes usually becomes clear. Blood tests can help. If blood work shows antibodies to insulin-making cells (which means that these cells are being destroyed), your child has type 1 diabetes and will need to use insulin right away.

Children who are overweight or have thick, darkened skin around the neck or on other body parts that are frequently bent or rubbed (a condition called acanthosis nigricans) may have type 2 diabetes. Thin children can develop a form of diabetes that is neither type 1 nor type 2 but can be treated as type 2.

Be alert to the term "MODY," which stands for Maturity Onset Diabetes of Youth. This form of diabetes is rare and happens when there are genetic changes that cause problems with how insulin is made or used. It is not uncommon for any child with diabetes who does not need to use insulin to be wrongly diagnosed as having "MODY." Only special blood tests can diagnose this form of diabetes.

How does the care of a child with type 2 diabetes differ from that of one with type 1 diabetes?
While meal planning is a basic part of self-care for any child with diabetes, it may be the main focus of the diabetes care plan for a child with type 2 diabetes. A child with type 2 diabetes may or may not need to use insulin or take diabetes pills.

If your child is overweight, weight loss will be a goal within a healthy meal plan to allow normal growth and development. Watching fat intake is very important.

Exercise is encouraged in both type 1 and type 2 diabetes. It is especially important for children with type 2 diabetes.

High blood pressure or changes in blood fats (such as cholesterol) may occur earlier in children with type 2 diabetes. Your child should be checked for complications of diabetes (for example, changes in the eyes or kidneys) at the time of diagnosis and again every year.

Why are more youngsters developing type 2 diabetes?
The answer, in a word, is "lifestyle." Children today gain more weight and are less physically active than in the past. With more calories coming from "fast" and processed foods and less activity because of computer games and television, youngsters not only eat more but also burn fewer calories.

While genes have always played a role in type 2 diabetes, the combination of increased weight and decreased exercise promotes diabetes that might otherwise have been "kept in check."

I have heard that type 2 diabetes runs in families more strongly than type 1. What can I do to help keep my other children from developing diabetes?
While there are no guarantees, the most important things you can do are encourage an active lifestyle and promote a healthful weight.

Watch for signs, such as being overweight or acanthosis nigricans, that might mean that your other children are at risk for diabetes. Also watch for signs of diabetes itself (for example, increased desire for liquids, increased urine output, unusual tiredness, or a quick but unexplained drop in weight). If you notice any of these signs, have your child seen by a doctor right away.