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 Article of Interest - Diabetes

More children suffer 'adult' diabetes
Experts cite rise in obesity among young
by P. Douglas Filaroski, July 30, 2002, Jacksonville Times-Union

Ten years ago, it was rare for doctors to see children with the type of diabetes in which the body ignores or under-produces insulin.

So rare, Type 2 diabetes was called "adult" diabetes, a serious illness that inhibits the conversion of sugar, usually later in life, and damages the eyes, kidneys and heart.

Now, physicians such as Larry Fox see a steady stream of overweight children with this type of diabetes for whom they prescribe blood pressure pills and worry about heart problems before high school graduation.

"The incidence [of diabetes] is rising because obesity among children is very much on the rise," said Fox, director of the Northeast Florida Pediatric Diabetes Center at Wolfson Children's Hospital in Jacksonville. "It's a serious problem."

And a sudden one. So new is the disease among children, the center did not even exist a decade ago, when Type 2 diabetes -- which accounts for 90 to 95 percent of all diabetes cases -- was largely confined to adults.

But as the percentage of overweight adolescents tripled since 1980, Type 2 diabetes sneaked up on physicians such as Fox, who diagnosed 55 cases last year and is on pace for more this year.

"It's bad news for a number of reasons," said Fox, an endocrinologist with Nemours Children's Clinic in Jacksonville. "It reflects the ills of society at large, and the trend towards these kinds of disease."

People spend less time exercising. Schools don't emphasize physical education as much as a generation ago. Food makers stress larger, starchier and more sugary portions.

The health implications are serious.

One researcher in Canada who followed 51 diabetic children into early adulthood reported alarming results recently.

Heather Dean of the University of Manitoba told the American Diabetes Association last month that two of the 51 died on kidney dialysis; three others remained on dialysis and one young woman had become blind.

Of 56 pregnancies in the test subjects, only 35 resulted in live births.

Many experts agree on the formula for this illness. Start with a diet heavy on fast food and high-calorie soft drinks, and add the exchange of exercise for video games.

The result is more overweight children.

An analysis by the U.S. Centers for Disease Control and Prevention recently showed that Type 2 cases among children have doubled in 20 years.

The report, published in May in the journal Pediatrics, said the share of child-hospitalization costs related to obesity and diabetes increased fourfold.

Diabetes pitfalls

Rebecca Nestor knows the pitfalls of childhood diabetes. Before being diagnosed, the Jacksonville girl felt as if she was going to die.

Thirsty, shivering and unable to walk, the 12-year-old's mother took her to an emergency room.

"She was drinking water, going to the bathroom all the time, and cold like ice," her mother, Carmelitte Nestor, recalled. "The doctor said she had blood pressure [three to four times the normal level]."

Fox diagnosed her with Type 2 diabetes, gave her insulin, a kit to monitor blood sugar and a meal plan to cut down on sugar and carbohydrates.

Rebecca Nestor had recently returned from Haiti, where she spent five unhappy years with her father, away from her mother, and eating a poor diet.

"When my mom left, I just cried," she said.

She often stayed indoors alone, comforting herself with starchy grits and rice and sugary plantains -- the Haitian equivalent of fast food.

Rebecca, who is now 14, admits she loves soda, hates sports and struggles to lose weight.

But she is taking her illness seriously now. Since her diagnosis, she is trying to stay on her diet and walks about an hour a day.

Rebecca has progressed to where she doesn't need insulin shots anymore and can take oral medication.

Her mother is betting Rebecca will get healthier. "She is a very responsible girl," Carmelitte Nestor said. "She acts older than she is."

Poor prospects

The outlook is not as good for other children.

David Satcher, a former U.S. surgeon general, has called childhood obesity a national epidemic.

The government this month launched a media campaign called "VERB: It's What You Do," to encourage kids to find a verb -- run, paint, sing or bowl -- and stay active.

"We need to get our children away from the PlayStation and onto the playground," said U.S. Health and Human Services Secretary Tommy Thompson.

Government figures show 25 percent of children spend at least four hours a day watching television and three-fourths fail to engage in physical activity most days.

Three-fourths of overweight and obese adolescents do not change their habits and remain overweight and obese as adults, officials said.

"That's the problem," Fox said. "It gets passed from generation to generation. ... If parents drink soda after soda after soda, they are not setting a good example."

He suggests that parents help by taking care of themselves, and provide a model for children to follow.

Turn off the TV. Get out and play. Eat healthier meals at home.

"People need to change their habits," Fox said. "The health of their kids depends on it."


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