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0907504 cystic fibrosis, Cushing’s syndrome among others, and certain drugs have been found to be associated with its development. Finally, for Type 1 diabetes, there are several environmental factors that may play a role, but many are still under study. Type 2 diabetes has more concrete environmental factors including a direct link to obesity, specifically children with BMI greater than or equal to the 90th percentile. At the 85th percentile, children’s risk increases substantially as well.

what’s the treatment?

Treatment of diabetes exists in many forms and requires a team of providers. The focus is on tight glycemic, or sugar, control. Dieticians and diabetic educators are essential members of the team, along with an endocrinologist or primary care provider comfortable with pediatric diabetes. With children, parents are critical members of this team and are expected to be actively involved. Over time, the patient becomes the primary team leader.

Certainly, when one thinks of diabetes, insulin immediately comes to mind, and yes it is used widely and effectively. There are a variety of forms of insulin, including long-acting, short-acting, once daily, oral analogues, and even a pump. Insulin continues to be an efficient medicinal way of managing this complex disease process. Oral medications are too numerous to name, and more injectables make their way to the market every year. Research is the key to solving the problem that has become the diabetic epidemic.

what else can you do?

Let us not forget the power of prevention! While Type 1 cannot be prevented, diabetes may have factors that increase its likelihood in certain populations. We may not be able to change our heritage or genetics, but we do hold the power to alter many of these risk factors, and/or be more proactive in addressing them head-on:

• i.d. it Screening should begin at age ten or at onset of puberty, if children are at a BMI in the 85™ percentile or greater and have two or more risk factors such as family history, belonging to a high risk ethnic group as mentioned above, have signs of insulin resistance as determined by the medical provider, or maternal history of gestational diabetes or diabetes.

• lose it & move it Research shows us that weight loss and regular exercise can lead to improved glycemic [sugar] control in patients with diabetes or in those with the pre-diabetic state, also referred to as impaired glucose tolerance. Recommendations are around 5–10% weight loss in conjunction with approximately 30 minutes of physical activity a day. Even in Type 1 diabetics, these two things can often lead to improved control of diabetes thereby leading to better overall health outcomes. So, exercise with your children! Go for a walk or bike ride after dinner, even if for fifteen minutes.

• burn it Smoking cessation has been linked to improved control of diabetic states. North Dakota has a rate of roughly 21% of tobacco use among individual in grades 9–12. So, be a good example and stop it! It’s just bad for you!

• eat it together Sitting down with your children to eat one meal a day can greatly impact their food intake and choices. According to the North Dakota

Department of Health, 90% of high school students and more than 80% of students in middle school eat fewer than the recommended five fruits and vegetables daily. Take time to cook with your children, and consider starting a small garden. Involving children in food preparation makes them accountable members at your dinner table. Not only will you see a hopeful change in their eating habits, but you just might reconnect with that distant teenager.

• turn it off Roughly 30% of middle school children watch more than three hours of television on school days. Make yourself accessible and mimic good behaviors. Exercise and eating healthy benefit the whole family, including you, Mom and Dad! Remember to work on smoking cessation!

• improve it Finally, get involved in legislation at the local, state, and national level that impacts our children’s health. Physical education in schools is important and has been shown to increase blood flow to the brain, thereby aiding in improving cognition and focus. North Dakota studies have shown that less than adequate activity levels are reached in 52% of high school students and 37% of middle school children. Healthy food choices should be part of our school menus!

Parenting is a challenge in and of itself on a daily basis. Our society has exposed our children to a world filled with technological wonder. We live, work, and eat in a fast-paced world. How do we, as health providers and parents, help to make these inevitable changes safe and healthy? Get involved and be aware! It takes a community to raise a successful, healthy, and secure child, so be your child’s advocate! After all, we all signed up for this job whole-heartedly!

References

1. The Burden of Diabetes Mellitus in North Dakota 2009. North Dakota Department of Health.

2. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. Levitsky and Misra. Up to Date. Uptodate.com

3. Epidemiology, presentation, and diagnosis of type 2 diabetes mellitus in children and adolescents. Laffel an Svoren. Up to Date. Uptodate.com

4. Prediction and prevention of type 2 diabetes mellitus. McCulloch and Robertson. Up to Date. Uptodate.com

5. Prevention of type 1 diabetes mellitus. McCulloch and Pietropaolo. Up to Date. Uptodate.com

6. Effects of exercise in diabetes mellitus in children. McCulloch and Anding. Up to Date. Uptodate.com