Until recently, the common type of diabetes in children and teens was type 1. It was called juvenile diabetes. With Type 1 diabetes, the pancreas does not make insulin. Insulin is a hormone that helps glucose,or sugar, get into your cells to give them energy. Without insulin, too much sugar stays in the blood.

Now younger people are also getting type 2 diabetes. Type 2 diabetes used to be called adult-onset diabetes. But now it is becoming more common in children and teens, due to more obesity. With Type 2 diabetes, the body does not make or use insulin well.

Children have a higher risk of type 2 diabetes if they are overweight or have obesity, have a family history of diabetes, or are not active. Children who are African American, Hispanic, Native American/Alaska Native, Asian American, or Pacific Islander also have a higher risk. To lower the risk of type 2 diabetes in children

• Have them maintain a healthy weight
• Be sure they are physically active
• Have them eat smaller portions of healthy foods
• Limit time with the TV, computer, and video

Children and teens with type 1 diabetes may need to take insulin. Type 2 diabetes may be controlled with diet and exercise. If not, patients will need to take oral diabetes medicines or insulin. A blood test called the A1C can check on how you are managing your diabetes.

If you have type 1 diabetes, your pancreas doesn’t make insulin or makes very little insulin. Insulin helps blood sugar enter the cells in your body for use as energy. Without insulin, blood sugar can’t get into cells and builds up in the bloodstream. High blood sugar is damaging to the body and causes many of the symptoms and complications of diabetes.

Type 1 diabetes was once called insulin-dependent or juvenile diabetes. It usually develops in children, teens, and young adults, but it can happen at any age.

Type 1 diabetes is less common than type 2—about 5-10% of people with diabetes have type 1. Currently, no one knows how to prevent type 1 diabetes, but it can be treated successfully by:

• Following your doctor’s recommendations for living a healthy lifestyle.
• Managing your blood sugar.
• Getting regular health checkups.
• Getting diabetes self-management education and support.

For Parents

If your child has type 1 diabetes—especially a young child—you’ll handle diabetes care on a day-to-day basis. Daily care will include serving healthy foods, giving insulin injections, and watching for and treating hypoglycemia (low blood sugar). You’ll also need to stay in close contact with your child’s health care team. They will help you understand the treatment plan and how to help your child stay healthy.

What Causes Type 1 Diabetes?

Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction destroys the cells in the pancreas that make insulin, called beta cells. This process can go on for months or years before any symptoms appear.

Some people have certain genes (traits passed on from parent to child) that make them more likely to develop type 1 diabetes. However, many of them won’t go on to have type 1 diabetes even if they have the genes. A trigger in the environment, such as a virus, may also play a part in developing type 1 diabetes. Diet and lifestyle habits don’t cause type 1 diabetes.

Symptoms and Risk Factors

It can take months or years before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe.

Some type 1 diabetes symptoms are similar to symptoms of other health conditions. Don’t guess! If you think you could have type 1 diabetes, see your doctor to get your blood sugar tested. Untreated diabetes can lead to very serious—even fatal—health problems.

Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes. However, studies show that family history plays a part.

Testing for Type 1 Diabetes

A simple blood test will let you know if you have diabetes. If you were tested at a health fair or pharmacy, follow up at a clinic or doctor’s office. That way you’ll be sure the results are accurate.

If your doctor thinks you have type 1 diabetes, your blood may also be tested for autoantibodies. These substances indicate your body is attacking itself and are often found with type 1 diabetes but not with type 2. You may have your urine tested for ketones too. Ketones are produced when your body burns fat for energy. Having ketones in your urine indicates you have type 1 diabetes instead of type 2.

Managing Diabetes

Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team:

• Primary care doctor
• Foot doctor
• Dentist
• Eye doctor
• Registered dietitian nutritionist
• Diabetes educator
• Pharmacist

Also ask your family, teachers, and other important people in your life for help and support. Managing diabetes can be challenging, but everything you do to improve your health is worth it!

If you have type 1 diabetes, you’ll need to take insulin shots (or wear an insulin pump) every day. Insulin is needed to manage your blood sugar levels and give your body energy. You can’t take insulin as a pill. That’s because the acid in your stomach would destroy it before it could get into your bloodstream. Your doctor will work with you to figure out the most effective type and dosage of insulin for you.

You’ll also need to do regular blood sugar checks. Ask your doctor how often you should check it and what your target blood sugar levels should be. Keeping your blood sugar levels as close to target as possible will help you prevent or delay diabetes-related complications.

Stress is a part of life, but it can make managing diabetes harder. Both managing your blood sugar levels and dealing with daily diabetes care can be tougher to do. Regular physical activity, getting enough sleep, and exercises to relax can help. Talk to your doctor and diabetes educator about these and other ways you can manage stress.

Healthy lifestyle habits are really important too:

• Making healthy food choices
• Being physically active
• Controlling your blood pressure
• Controlling your cholesterol

Make regular appointments with your health care team. They’ll help you stay on track with your treatment plan and offer new ideas and strategies if needed.

Hypoglycemia and Diabetic Ketoacidosis

These 2 conditions are common complications of diabetes, and you’ll need to know how to handle them. Meet with your doctor for step-by-step instructions. You may want to bring a family member with you to the appointment so they learn the steps too.

Hypoglycemia (low blood sugar) can happen quickly and needs to be treated quickly. It’s most often caused by:

• Too much insulin.
• Waiting too long for a meal or snack.
• Not eating enough.
• Getting extra physical activity.

Talk to your doctor if you have low blood sugar several times a week. Your treatment plan may need to be changed.

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA develops when you don’t have enough insulin to let blood sugar into your cells. Very high blood sugar and low insulin levels lead to DKA. The two most common causes are illness and missing insulin shots. Talk with your doctor and make sure you understand how you can prevent and treat DKA.

Get Diabetes Education

Meeting with a diabetes educator is a great way to get support and guidance, including how to:

• Develop and stick to a healthy eating and activity plan
• Test your blood sugar and keep a record of the results
• Recognize the signs of high or low blood sugar and what to do about it
• Give yourself insulin by syringe, pen, or pump
• Monitor your feet, skin, and eyes to catch problems early
• Buy diabetes supplies and store them properly
• Manage stress and deal with daily diabetes care

Ask your doctor about diabetes self-management education and support services and to recommend a diabetes educator. You can also search this nationwide directory for a list of programs in your community.

Get Support

Tap into online diabetes communities for encouragement, insights, and support. Check out the American Diabetes Association’s Community page and JDRF’s TypeOneNation. Both are great ways to connect with others who share your experience.

More than 34 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes. Type 2 diabetes most often develops in people over age 45, but more and more children, teens, and young adults are also developing it.

What Causes Type 2 Diabetes?

Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. If you have type 2 diabetes, cells don’t respond normally to insulin; this is called insulin resistance. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. High blood sugar is damaging to the body and can cause other serious health problems, such as heart disease, vision loss, and kidney disease.

Symptoms and Risk Factors

Type 2 diabetes symptoms often develop over several years and can go on for a long time without being noticed (sometimes there aren’t any noticeable symptoms at all). Because symptoms can be hard to spot, it’s important to know the risk factors and to see your doctor to get your blood sugar tested if you have any of them.

Testing for Type 2 Diabetes

A simple blood test will let you know if you have diabetes. If you’ve gotten your blood sugar tested at a health fair or pharmacy, follow up at a clinic or doctor’s office to make sure the results are accurate.

Managing Diabetes

Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team (including your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian nutritionist, diabetes educator, and pharmacist), family, and other important people in your life. Managing diabetes can be challenging, but everything you do to improve your health is worth it!

You may be able to manage your diabetes with healthy eating and being active, or your doctor may prescribe insulin, other injectable medications, or oral diabetes medicines to help manage your blood sugar and avoid complications. You’ll still need to eat healthy and be active if you take insulin or other medicines. It’s also important to keep your blood pressure and cholesterol close to the targets your doctor sets for you and get necessary screening tests.

You’ll need to check your blood sugar regularly. Ask your doctor how often you should check it and what your target blood sugar levels should be. Keeping your blood sugar levels as close to target as possible will help you prevent or delay diabetes-related complications.

Stress is a part of life, but it can make managing diabetes harder, including managing your blood sugar levels and dealing with daily diabetes care. Regular physical activity, getting enough sleep, and relaxation exercises can help. Talk to your doctor and diabetes educator about these and other ways you can manage stress.

Make regular appointments with your health care team to be sure you’re on track with your treatment plan and to get help with new ideas and strategies if needed.

Whether you were just diagnosed with diabetes or have had it for some time, meeting with a diabetes educator is a great way to get support and guidance, including how to:

• Develop a healthy eating and activity plan
• Test your blood sugar and keep a record of the results
• Recognize the signs of high or low blood sugar and what to do about it
• If needed, give yourself insulin by syringe, pen, or pump
• Monitor your feet, skin, and eyes to catch problems early
• Buy diabetes supplies and store them properly
• Manage stress and deal with daily diabetes care

Ask your doctor about diabetes self-management education and support services and to recommend a diabetes educator, or search the Association of Diabetes Care & Education Specialists’ (ADCES) nationwide directory for a list of programs in your community.

Type 2 Diabetes in Children and Teens

Childhood obesity rates are rising, and so are the rates of type 2 diabetes in youth. More than 75% of children with type 2 diabetes have a close relative who has it, too. But it’s not always because family members are related; it can also be because they share certain habits that can increase their risk. Parents can help prevent or delay type 2 diabetes by developing a plan for the whole family:

• Drinking more water and fewer sugary drinks
• Eating more fruits and vegetables
• Making favorite foods healthier
• Making physical activity more fun

Healthy changes become habits more easily when everyone makes them together.

A recent study found that rates of new cases of diabetes in children and teens rose during 2002 to 2012. The researchers reported increases in the rates of both type 1 and type 2 diabetes.

More than 29 million Americans are living with diabetes. People with diabetes have sugar (glucose) levels that are too high. Over time, high levels of blood glucose can cause many health problems.

In type 1 diabetes, the body does not produce insulin. People with type 1 diabetes need to take insulin every day to stay alive. Type 2 diabetes is caused when the body doesn’t make or use insulin well.

Researchers found that, for each year between 2002 and 2012, the rate of new cases of type 1 diabetes in youths under 20 rose by about 2%. The rate of new cases of type 2 diabetes in youths ages 10 to 19 increased by about 5%. Unlike type 1 diabetes, type 2 is seldom diagnosed in children younger than 10.

The researchers noted that rates of diabetes rose significantly in certain racial and ethnic groups. For type 1 diabetes, the rate of new cases increased in Hispanics, non-Hispanic blacks, and non-Hispanic whites. For type 2 diabetes, the rate of new cases rose in Hispanics, non-Hispanic blacks, Asian Americans/Pacific Islanders, and Native Americans.

The study also detected differences in the rates for male and female youths. For type 1 diabetes, the rate rose more in males. For type 2 diabetes, the rate increased more in females.

“The differences among racial and ethnic groups and between genders raise many questions,” says Dr. Barbara Linder, NIH’s senior advisor for childhood diabetes research. “We need to understand why the increase in rates of diabetes development varies so greatly and is so concentrated in specific racial and ethnic groups.”

NIH-funded studies are now examining what factors may increase the risk of diabetes.

Type 1 Diabetes

Type 1 diabetes is thought to be caused by an immune reaction (the body attacks itself by mistake). Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes. Known risk factors include:

• Family history: Having a parent, brother, or sister with type 1 diabetes.
• Age: You can get type 1 diabetes at any age, but it’s more likely to develop when you’re a child, teen, or young adult.

In the United States, whites are more likely to develop type 1 diabetes than African Americans and Hispanic/Latino Americans.

Currently, no one knows how to prevent type 1 diabetes.

Type 2 Diabetes

You’re at risk for developing type 2 diabetes if you:

• Have prediabetes
• Are overweight
• Are 45 years or older
• Have a parent, brother, or sister with type 2 diabetes
• Are physically active less than 3 times a week
• Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 pounds
• Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

You can prevent or delay type 2 diabetes with simple, proven lifestyle changes such as losing weight if you’re overweight, eating healthier, and getting regular physical activity.

Prediabetes

You’re at risk for developing prediabetes if you:

• Are overweight
• Are 45 years or older
• Have a parent, brother, or sister with type 2 diabetes
• Are physically active less than 3 times a week
• Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 pounds
• Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

You can prevent or reverse prediabetes with simple, proven lifestyle changes such as losing weight if you’re overweight, eating healthier, and getting regular physical activity. The CDC-led National Diabetes Prevention Program can help you make healthy changes that have lasting results.

Gestational Diabetes

You’re at risk for developing gestational diabetes (diabetes while pregnant) if you:

• Had gestational diabetes during a previous pregnancy
• Have given birth to a baby who weighed more than 9 pounds
• Are overweight
• Are more than 25 years old
• Have a family history of type 2 diabetes
• Have a hormone disorder called polycystic ovary syndrome (PCOS)
• Are African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander

Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later in life. Your baby is more likely to have obesity as a child or teen, and is more likely to develop type 2 diabetes later in life too.

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight, eating healthier, and getting regular physical activity.

Until recently, children got only Type 1 diabetes. With the spread of childhood obesity, a lot more children are also being diagnosed with Type 2 diabetes. Kids with either Type 1 or Type 2 can lead healthy, active lives when communities, providers, and schools work with parents to ensure their children can participate safely in any activities.

What You Should Do

• Look for warning signs that your child should be tested for diabetes. Remember that Type 1 and Type 2 diabetes are different. Type 1 usually has an acute (sudden) onset. Early symptoms include:
  • Increased thirst and urination
  • Constant hunger
  • Weight loss
  • Blurred vision
  • Extreme tiredness
• Children and teens with Type 2 diabetes may not have any symptoms. If your child is overweight and does not exercise, talk to your pediatrician about testing for Type 2 diabetes.
• If your child is diagnosed, work with your family doctor to develop a treatment plan, and then work with the whole family to develop a nutrition and exercise plan.
• Carefully regulate the timing, size, and contents of your child's meals and snacks.
• Work with your child to check blood sugar regularly and recognize signs of low blood sugar.
• Coordinate with your child’s school.

Doctors use a variety of tests to diagnose diabetes and prediabetes. Your doctor may recommend different tests depending on whether you have symptoms or not, or whether you are pregnant.

Fasting plasma glucose test

The fasting plasma glucose (FPG) test measures your blood glucose level at a single point in time. For the most reliable results, your doctor will give you the test in the morning after you have fasted for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.

A1C test

The A1C test is a blood test that provides your average levels of blood glucose over the last 3 months. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. Before using the A1C test to diagnose diabetes, your doctor will consider factors, such as whether you are in your second or third trimester of pregnancy or whether you have certain types of anemia NIH external link or another problem with your blood.¹ The A1C test might not be accurate in those cases.

Certain types of hemoglobin, called hemoglobin variants, can interfere with measuring A1C levels. Most A1C tests used in the United States are not affected by the most common variants. If your A1C test results and blood glucose levels do not match, your doctor should consider that the A1C test may not be a reliable test for you.

Your doctor will report your A1C test result as a percentage, such as an A1C of 7%. The higher the percentage is, the higher your average blood glucose levels are.

Random plasma glucose test

Sometimes doctors use the random plasma glucose test to diagnose diabetes when you have symptoms of diabetes and they do not want to wait until you have fasted for 8 hours. You may have this blood test at any time.

What is diabetes?

Diabetes is a chronic disease in which blood glucose, also called blood sugar, is too high. Blood glucose is our main source of energy and comes from the food people eat. People with diabetes have problems regulating the amount of blood glucose in their blood.

Among school-age children, type 1 diabetes is more common than type 2 diabetes. In type 1 diabetes, the body doesn’t make insulin, a hormone that helps glucose get into the cells and be used for energy. As a result, the amount of glucose in their blood may be higher than normal, and their bodies may not use glucose effectively. Students with type 1 diabetes need to take insulin every day to stay alive.

Other students may have type 2 diabetes. This type of diabetes, while more common among middle-aged and older adults, is increasingly being diagnosed among children. In type 2 diabetes, the body may make insulin, but may not make enough to control blood glucose.

Why is it important to manage diabetes?

Keeping blood glucose in the target range can help prevent many health problems.

• Over time, too much glucose in the blood (called hyperglycemia) can lead to serious health problems, including heart disease, stroke, and diseases affecting the kidneys, eyes, feet, and gums.
• Blood glucose levels that drop too low (called hypoglycemia) can be life-threatening and need to be treated right away.

The good news is that research shows these problems can be greatly reduced, delayed, or possibly prevented by keeping blood glucose levels near normal. Maintaining blood glucose levels within a target range can also prevent symptoms that can interfere with learning, such as fatigue, increased hunger, and blurred vision.

How is diabetes managed?

Diabetes is managed by checking blood glucose levels throughout the day and making sure that they stay within a target range. As a general rule, eating food makes blood glucose levels go up after the meal. Physical activity, insulin, and diabetes medicines taken by mouth make blood glucose levels go down.

Students with diabetes may check their glucose levels by using one or both of these devices

• a blood glucose meter, which uses a small drop of blood from a finger to measure blood sugar levels
• a continuous glucose monitor, a device that works through a tiny sensor inserted under the skin of the belly or arm, which can test blood glucose every few minutes

If blood glucose levels are out of the student’s target range, it may be necessary to take action to bring them back to that range. These actions should be specified in the student’s health care plans.

What kind of help do students need to manage diabetes?

The type of help students may need to manage their diabetes may vary by student. In general,

• toddlers and preschool-age children need help with all aspects of diabetes care.
• some elementary school-age students can monitor their glucose, but most will need help from adults.
• middle school- and high school-age students should be able to manage their diabetes themselves, depending on how long they have had diabetes and their level of maturity.

Regardless of their age, there are times when all students who have diabetes need someone else to help them with their diabetes care. This is particularly true if the student experiences low blood glucose, which can be life-threatening.

Students with diabetes must have access to supplies and equipment to quickly treat high and low blood glucose levels at all times.

There’s a growing type 2 diabetes problem in our young people. But parents can help turn the tide with healthy changes that are good for the whole family.

Until recently, young children and teens almost never got type 2 diabetes, which is why it used to be called adult-onset diabetes. Now, about one-third of American youth are overweight, a problem closely related to the increase in kids with type 2 diabetes, some as young as 10 years old.

Weight Matters

People who are overweight—especially if they have excess belly fat—are more likely to have insulin resistance, kids included. Insulin resistance is a major risk factor for type 2 diabetes.

Insulin is a hormone made by the pancreas that acts like a key to let blood sugar into cells for use as energy. Because of heredity (traits inherited from family members) or lifestyle (eating too much and moving too little), cells can stop responding normally to insulin. That causes the pancreas to make more insulin to try to get cells to respond and take in blood sugar.

As long as enough insulin is produced, blood sugar levels remain normal. This can go on for several years, but eventually the pancreas can’t keep up. Blood sugar starts to rise, first after meals and then all the time. Now the stage is set for type 2 diabetes.Insulin resistance usually doesn’t have any symptoms, though some kids develop patches of thickened, dark, velvety skin called acanthosis nigricans, usually in body creases and folds such as the back of the neck or armpits. They may also have other conditions related to

insulin resistance, including:

• High blood pressure
• High cholesterol
• Polycystic ovary syndrome

Activity Matters

Being physically active lowers the risk for type 2 diabetes because it helps the body use insulin better, decreasing insulin resistance. Physical activity improves health in lots of other ways, too, from controlling blood pressure to boosting mental health.

Age Matters

Kids who get type 2 diabetes are usually diagnosed in their early teens. One reason is that hormones present during puberty make it harder for the body use insulin, especially for girls, who are more likely than boys to develop type 2 diabetes. That’s an important reason to help your kids take charge of their health while they’re young.

More Risk Factors

These factors also increase kids’ risk for type 2 diabetes:

• Having a family member with type 2 diabetes.
• Being born to a mom with gestational diabetes (diabetes while pregnant).
• Being African American, Hispanic/Latino, Native American/Alaska Native, Asian American, or Pacific Islander.
• Having one or more conditions related to insulin resistance.

If your child is overweight and has any two of the risk factors listed above, talk to your doctor about getting his or her blood sugar tested. Testing typically begins at 10 years old or when puberty starts, whichever is first, and is repeated every 3 years.

Take Charge, Family Style

Parents can do a lot to help their kids prevent type 2 diabetes. Set a new normal as a family—healthy changes become habits more easily when everyone does them together. Here are some tips to get started:

Mealtime Makeover

• Drink more water and fewer sugary drinks.
• Eat more fruits and vegetables.
• Make favorite foods healthier.
• Get kids involved in making healthier meals.
• Eat slowly—it takes at least 20 minutes to start feeling full.
• Eat at the dinner table only, not in front of the TV or computer.
• Shop for food together.
• Shop on a full stomach so you’re not tempted to buy unhealthy food.
• Teach your kids to read food labels to understand which foods are healthiest.
• Have meals together as a family as often as you can.
• Don’t insist kids clean their plates.
• Don’t put serving dishes on the table.
• Serve small portions; let kids ask for seconds.
• Reward kids with praise instead of food.

Getting Physical

• Aim for your child to get 60 minutes of physical activity a day, in several 10- or 15-minute sessions or all at once.
• Start slow and build up.
• Keep it positive—focus on progress.
• Take parent and kid fitness classes together.
• Make physical activity more fun; try new things.
• Ask kids what activities they like best—everyone is different.
• Encourage kids to join a sports team.
• Have a “fit kit” available—a jump rope, hand weights, resistance bands.
• Limit screen time to 2 hours a day.
• Plan active outings, like hiking or biking.
• Take walks together.
• Move more in and out of the house—vacuuming, raking leaves, gardening.
• Turn chores into games, like racing to see how fast you can clean the house.

Young kids and teens are still growing, so if they’re overweight the goal is to slow down weight gain while allowing normal growth and development. Don’t put them on a weight loss diet without talking to their doctor.

Want to Limit Overeating? Limit TV Time

A recent study showed that when the amount of TV kids watched was limited, they lost weight—but not because they were more active when they weren’t watching. The difference was snacking: kids ate more when they were watching TV than when doing other activities, even sedentary (not physically active) ones.