Treatment Overview

Treatment of type 2 diabetes in children focuses on keeping blood sugar levels within a target range. Children may need higher blood sugar goals than adults because their bodies are still developing. Also, they may not be able to recognize symptoms of low blood sugar. To reach his or her target blood sugar, your child needs to eat healthy meals of appropriate portion size and get daily exercise. Treatment also may include medicine.

Healthy eating

A healthy diet with the right amount of calories will help your child achieve target blood sugar levels and maintain a healthy weight. The meal plan designed for your child will spread carbohydrate (starches and sugary foods) throughout the day. This helps prevent high blood sugar after meals as well as weight gain. A registered dietitian can design a meal plan that fits your child's needs. For more information, see the topic Healthy Eating for Children.

Being physically active

Physical activity is extremely important. It helps the body use insulin correctly and helps control weight. Your child does not have to start a rigorous exercise program, but being more active can help control blood sugar. For example, your child could play outside with friends, take brisk walks with family members, and participate in individual or team sports.

Experts recommend that teens and children (starting at age 6) do moderate to vigorous activity at least 1 hour every day.⁷ And 3 or more days a week, what they choose to do should:

• Make them breathe harder and make the heart beat much faster.
• Make their muscles stronger. For example, they could play on playground equipment, play tug-of-war, lift weights, or use resistance bands.
• Make their bones stronger. For example, they could run, do hopscotch, jump rope, or play basketball or tennis.

It’s okay for them to be active in smaller blocks of time that add up to 1 hour or more each day.

For children older than age 2: The American Academy of Pediatrics advises parents to limit TV time to 2 hours a day or less. For children age 2 and younger: To help your child's brain develop, it's best to talk, play, sing, or read together instead of letting him or her watch TV.

Medicines

Your child may need medicines if 3 months of eating healthy meals and getting regular physical activity have not lowered your child's blood sugar to his or her target level.

• Oral medicines for diabetes help the body produce more insulin, decrease the body's resistance to insulin, or slow the absorption of carbohydrate from the intestine. Your child may need one medicine at some times and more than one at other times.
• Some children need daily insulin shots—alone or with oral medicines. Even if your doctor does not prescribe daily insulin, your child may need to take insulin temporarily when first diagnosed or during illness or surgery. If the progression of diabetes cannot be stopped, your child eventually may need to take insulin daily.

Checking blood sugar, blood pressure, and cholesterol

Your child's blood sugar level needs to be checked regularly. Your child will probably have to test before breakfast and 2 hours after meals.

If your child has high blood pressure or high cholesterol, those conditions need to be treated.

• High blood pressure is usually treated with angiotensin-converting enzyme (ACE) inhibitors because these medicines also protect the circulatory system and the kidneys from damage caused by diabetes. Sexually active teens should be warned that ACE inhibitors should not be taken during pregnancy.
• Weight loss and well-controlled blood sugar can help lower your child's cholesterol. Your child's doctor may recommend medicine if these lifestyle changes do not lower cholesterol. Sexually active teens should be warned against becoming pregnant while taking these medicines.

What To Think About

Some children have very high blood sugar levels when they are diagnosed with type 2 diabetes. A child with a very high blood sugar level may develop the serious chemical imbalance diabetic ketoacidosis and need to be treated with insulin in a hospital. After blood sugar returns to a target level, the child usually no longer needs insulin. His or her own body may start making enough insulin again.

Treating diabetes with insulin or some oral medicines (or both) increases the risk for low blood sugar episodes. Your doctor will determine the range for your child's blood sugar that will prevent damage from diabetes while causing as few low blood sugar episodes as possible.

The lifestyle changes necessary to control diabetes can be especially difficult for a child or teen. Your child will have a better chance of being successful if the whole family is involved. Eating a healthy diet and getting regular exercise may help other family members avoid developing diabetes.

Teens who have depression or an eating disorder may have difficulty keeping their blood sugar at a healthy level. In addition, teens who smoke or use alcohol or other drugs have problems with blood sugar control. Support groups may help teens deal with diabetes management issues, which can improve the teens' perception of diabetes care and blood sugar control.