Diabetes Diabetes Basics

Kids Confront Double Dose of Diabetes

Already faced with a troubling rise of adult diabetes in children, doctors are now finding increasing incidences of "double diabetes"—children with symptoms of both forms of the disease.

About 18 million Americans have either type 1 or type 2 diabetes, and until recently, the two types—one caused by bad genes, the other by bad habits—seldom overlapped. But with the growing rise of childhood obesity, researchers are now finding that many kids are showing signs of both.

"Differentiating between the types of diabetes is becoming increasingly challenging," said Dr. Dorothy Becker, a diabetes expert at the University of Pittsburgh.

Double Trouble
In type 1 diabetes, which is usually diagnosed in children, the body has trouble making insulin. These children need constant monitoring of their blood sugar and insulin injections to keep levels in check. Type 2 diabetes, on the other hand, is more common in overweight adults, when the body often develops a resistance to insulin. This form of the disease is controlled with medication, physical activity and weight loss.

The incidence of type 2 diabetes has been on the rise, most notably in obese children, but type 1 is also increasing. As children's waistlines grow, the health repercussions are being seen earlier and in more complicated manners.

Researchers first noted overlapping diabetes symptoms in a 2003 study, published in Diabetes Care, where an equal mix of African-American and Caucasian children diagnosed with diabetes were followed for nine years. The study found that 25 percent of the children originally diagnosed with type 1 diabetes went on to develop features of type 2 diabetes. Conversely, 50 percent of children with type 2 diabetes also had features of type 1.

"We see many kids who look like they have type 2, but show signs of type 1," said Dr. Francine Kaufman, head of the Center for Diabetes and Endocrine Disorders in the Children's Hospital of Los Angeles. "But there's also the type 1 patient who is putting on weight and shows signs of type 2."

Doctors are beginning to grasp how double diabetes—also referred to as type 1.5 or type 3 diabetes—may work. When a child with type 1 diabetes grows older and begins to gain weight during adolescence, the symptoms of type 2 may begin in the same way it does with overweight adults.

However, when a type 2 patient begins to show signs of type 1 diabetes, the mechanism appears to be different. In this case, excess weight may degrade the body's defenses and trigger an already-existing genetic predisposition to type 1.

How to Treat Double Diabetes
When a child has symptoms of both type 1 and type 2 disease, the question then turns to how to properly treat it. At this point, no formal guidelines have been developed, so some doctors treat with either insulin injections or medications, while others use a combination of the two.

If a young person shows signs of type 1 diabetes and has insulin levels low enough, Kaufman suggests treating the child with insulin shots. But whether or not the patient should also receive an oral medications is still being studied, she said.

In either case, doctors stress the importance of prevention. While type 1 diabetes is genetic in nature, complications of the disease can be avoided by maintaining a healthy weight and making exercise a priority. And type 2 diabetes can be avoided altogether with these same measures.

Taking such steps, said Kaufman, will help children with one form of the disease control their symptoms, preventing double diabetes altogether.