Treating Type 2 Diabetes

After kids or teens are diagnosed with type 2 diabetes, the next step is to create a diabetes management plan to help them stay healthy and active.

Treatment plans for type 2 diabetes are based on each child's needs and the suggestions of the diabetes health care team.

Type 2 Diabetes Treatment Basics

The blood glucose level is the amount of glucose in the blood. Glucose is the main source of energy for the body's cells and is carried to them through the bloodstream. The hormone insulin allows the glucose to get into the cells. In type 2 diabetes, the body doesn't respond normally to insulin, so glucose is less able to enter the cells. This makes the blood glucose level rise.

Treatment goals for kids with diabetes are to control the condition in a way that helps them have normal physical and emotional growth and development, and prevents short- and long-term health problems. To do this, parents and kids should try to keep blood sugar levels as close to normal as possible.

It is also important to treat other conditions that can be associated with type 2 diabetes, like obesity, high blood pressure, or abnormal blood lipid (cholesterol) levels.

In general, kids with type 2 diabetes need to:

• eat a healthy, balanced diet and follow a meal plan
• get regular exercise
• take medicines as prescribed
• monitor blood sugar levels regularly

Helping kids with type 2 diabetes switch to healthier habits is a key part of treatment. Because most kids are overweight when they're diagnosed, it's important to promote healthy eating and physical activity to prevent further weight gain or to encourage weight loss while making sure they grow and develop properly.

Healthy Eating and Following a Meal Plan

Weight gain happens when someone consumes more calories than he or she uses up through physical activity. The body stores those extra calories as fat. Over time, excessive weight gain can lead to obesity and diseases related to obesity, such as type 2 diabetes and heart disease.

Kids with type 2 diabetes who are trying to manage their weight still need energy to develop normally. To get it, they'll need enough calories to grow without gaining too much fat. The best way is to eat nutritious foods and get regular exercise.

Many parents worry about what to feed their kids with type 2 diabetes. The key is a balanced, healthy diet. Kids with diabetes benefit from the same kind of diet as those without diabetes — one that includes a variety of nutritious foods that help the body grow and function properly.

The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which provide energy in the form of calories. Foods containing carbs cause blood sugar levels to go up the most. Foods that are mostly protein and/or fat don't affect blood sugar levels nearly as much.

Our bodies need many nutrients — in different amounts — to work as they should. So when you and the diabetes health care team create a diabetes meal plan to help keep your child's blood sugar within the target range, it will include a variety of nutrients.

Meal plans usually include breakfast, lunch, and dinner with small, scheduled between-meal snacks. The plan won't restrict your child to specific foods, but will guide you in selecting from the basic food groups to achieve a healthy balance.

Meal plans are based on a child's age, activity level, schedule, and food likes and dislikes, and should be flexible enough for special situations like parties and holidays. The meal plan should make it easier to keep blood sugar within your child's goal range.

The meal plan also might recommend limiting extra fat and "empty" calories (foods with lots of calories but few nutrients). Everyone should limit these foods anyway — eating too much of them can lead to excess weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Controlling Portions

Portion control — even of healthy foods — is important for kids with type 2 diabetes. As you follow your child's meal plan, be wary of special foods marketed to people with diabetes. Sugar-free and fat-free foods are not always calorie-free or even low-calorie foods.

A registered dietitian (RD) can help you choose and cook healthier foods, read food labels, and learn how much food your child should be eating in a day. The RD also can adjust meal plans based on how your child is meeting weight management goals. If you don't have a dietitian on the diabetes health care team, ask your doctor for a referral to see one.

Getting Regular Exercise

Regular physical activity is an important part of diabetes treatment.

Exercise helps improve the body's response to insulin, which helps to control blood sugar levels. It also helps the body burn more calories, which can reduce excess body fat. And it's healthier for growing kids who are overweight to burn more calories through exercise than to severely restrict the food they eat.

Exercise also can help kids with diabetes:

• keep blood cholesterol and blood pressure under control
• get and keep their heart, lungs, and blood vessels in good shape
• do things that kids without diabetes can do

Kids don't have to be athletic to get the benefits of physical activity. Things like walking the dog, helping around the house, and playing outside with friends are great — anything that gets them moving regularly can go a long way toward helping control diabetes.

Avoiding Problems During Exercise

To help avoid problems during exercise, kids with type 2 diabetes might need to:

• have an extra snack before the activity
• carry snacks, water, and supplies with them when they exercise
• check their blood sugar levels before, during, and after exercise
• make sure their coaches know about their diabetes and what to do if problems happen

Make sure your child wears a medical identification bracelet (this should always be worn, but it's even more important during exercise, sports, and fitness activities).

The care team will offer tips to help your child get ready for exercise or join a sport. They'll also give instructions to help you and your child respond to any diabetes problems that could happen during exercise, like hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Taking Medicines as Prescribed

Sometimes, diet and exercise are enough to control blood sugar levels in kids with type 2 diabetes. But some will need to take pills that help their own insulin work better. These pills are not a form of insulin.

Sometimes pills for diabetes — even when combined with diet and exercise — still aren't enough to keep blood sugar levels under control, and a child with type 2 diabetes must take insulin. The acids and digestive juices in the stomach and intestines would break down and destroy insulin if it was swallowed, so it can't be taken in a pill. The only way to get insulin into the body is with an injection or an insulin pump.

There is no-one-size-fits-all insulin schedule. The types of insulin used and number of daily injections a child needs will depend on the diabetes management plan. Usually, two different types of insulin are needed to handle blood sugar needs both after eating and between meals.

Eating meals at regular times can make this easier. Eating on schedule may work well for younger kids, but sticking to a routine can be a challenge for older kids, whose school, sleep, and social schedules vary. The diabetes health care team can help you work through problems with scheduling meals and insulin injections.

Remember, a balanced diet, regular physical activity, and a healthy weight can improve blood sugar levels greatly. Some kids who follow the treatment plan for type 2 diabetes can even stop taking insulin altogether.

Monitoring Blood Sugar Levels

Treating type 2 diabetes also involves checking blood sugar levels regularly and responding to the results. Controlling blood sugar levels helps kids with diabetes feel well, grow and develop normally, and reduce the risk of long-term diabetes complications.

The diabetes treatment plan will recommend how many times a day to check blood sugar levels, which is the only way to know the effectiveness of your child's day-to-day treatment plan.

The diabetes health care team also will explain what your child's target blood sugar levels are. In general, kids with type 2 diabetes should test their blood sugar levels with a blood glucose meter at least twice a day, but might need to test more often if they're taking insulin, have been just diagnosed, or have problems with blood sugar control.

The care team may recommend that your child use a continuous glucose monitor (CGM). A CGM is a wearable device that can measure blood sugar every few minutes around the clock. It's measured by a thread-like sensor that's inserted under the skin and secured in place. Sensors can stay in place for about a week before they have to be replaced. The more frequent CGM blood sugar readings can help you and the care team do an even better job of troubleshooting and adjusting your child's insulin doses and diabetes management plan to improve blood sugar control.

A blood glucose meter or CGM measures the blood sugar level at the moment of testing. Another blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, shows how blood sugar levels have been running over the past few months.

Putting it All Together

Treating and managing diabetes can seem overwhelming at times. But the diabetes health care team is there for you.

Your child's diabetes management plan should be easy to understand, detailed, and written down for easy reference. You also should have the names and phone numbers of the health care team members in case of emergencies or if you have questions.

You might hear of alternative or complementary treatments, such as herbal remedies and vitamin or mineral supplements. Although research continues into their possible benefits, studies thus far haven't proved their effectiveness. They also could be dangerous for kids and teens with type 2 diabetes, especially if used to replace medically recommended treatments. Talk to the diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and advances have made treatment easier and more effective. Insulin might soon be available in patch and spray forms, and scientists continue to improve results of pancreas or islet cell transplants. Versions of an "artificial pancreas" — a device that senses blood sugar continuously and gives insulin directly based on the blood sugar level — also are being tested. 

Your diabetes health care team keeps track of the latest research developments, and will introduce new products as they become available.