First-Ever Guidelines for Children With Diabetes (type 2!)

The American Academy of Pediatrics has issued the first-ever guidelines for the management of type 2 diabetes in children and teens.

Type 2 diabetes is rising rapidly among children and teens because of soaring obesity rates. It now accounts for up to 1 in 3 new cases of diabetes in those younger than 18. These guidelines are for children between the ages of 10 and 18.

"Few providers have been trained in managing type 2 diabetes in children and, to date, few medications have been evaluated for safety and [effectiveness] in children," says co-author Janet Silverstein, MD, professor of pediatrics at the University of Florida and chief of endocrinology at Shands Hospital in Gainesville.

"This is a real issue in the pediatric population. It's something that many of us as pediatricians didn't grow up with because we just didn't see it very often," she says.

Central to the recommendations is the proper diagnosis of either type 1 or type 2 diabetes. But this can often take time and is not always clear-cut.

Because of that, the guidelines recommend giving insulin to patients if it's not clear whether they have type 1 or type 2 diabetes. If type 2 diabetes is confirmed, lifestyle changes along with the medication metformin are recommended. Metformin and insulin are the only two blood sugar-lowering medications approved for those younger than 18, but others are being studied, Silverstein says.

The panel also recommended that children with type 2 diabetes get their hemoglobin A1c levels measured every three months. The test measures blood sugar levels for the past two or three months...

Now can we please go back to cooking fries in lard?

Oh, right, that wouldn’t be healthy...

How did the heck we survive childhood without helmets and uber padded play grounds? How did we survive shooting guns, phones that required coins, and peanut butter?

Dang if we are letting this generation take it easy.

And not a word about carbohydrate restriction.

That is criminally irresponsible.

The panel that wrote the guidelines endorsed an A1c goal of less than 7% for young people with type 2 diabetes, but noted it may be adjusted depending on the person.

But:

Although the AHA and the ADA have been recommending low-fat, high-carbohydrate diets for diabetics for many decades, no one had compared the effects on the same patients of low- versus high-carbohydrate diets until the late 1980s. Independent studies performed in Texas and California demonstrated lower levels of blood sugar and improved blood lipids when patients were put on low-carbohydrate, high-fat diets. It was also shown that, on average, for every 1 percent increase in HgbA1C (the test for average blood sugar over the prior four months), total serum cholesterol rose 2.2 percent and triglycerides increased 8 percent. A long-term study of 7,321 “nondiabetics” in 2006 showed that for every 1 percent increase in HgbA1C above 4.5 percent, the incidence of coronary artery disease increased 2.5-fold. The same study also showed that for every 1 percent increase in HgbA1C above 4.9 percent, mortality increased by 28 percent. Yet the ADA still advocates a target HgbA1C of 6.5–7 percent for selected diabetics, and higher for many others. No wonder I call diabetes an “orphan disease.” The “authorities” who write the rules are not supporting our well-being.
Richard K. Bernstein, MD, "Dr. Bernstein's Diabetes Solution - A Complete Guide to Achieving Normal Blood Sugars

If you're unaware of his work, Dr. Berstein was diagnosed as a Type I diabetic in 1946. This picture was taken on his 79th birthday, when he had been living with Type I for sixty-six years. He still has his feet, and his eyesight, and even his hair.

In 2006, his HDL was 118, his LDL 53, his triglycerides were 45, and his average blood sugar was 83.

He's clearly doing something right - and what he's doing is the exact opposite of what the professional organizations have been advocating.

Not many, I'd bet. My youngest grandson is an energetic, skinny kid who is going through one of those notorious growth spurts. The school cafeteria no longer serves seconds (thanks, Moochelle--that's where the policy came from as a condition of getting 'free lunch Title whatever funds'), and he hates that. He comes home ready to eat everything in sight.

The only good part is that he has no use for the Moose. Let him learn early.

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