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Healthy Balance

UVA Children’s Fitness Clinic: Tackling Type 2 Diabetes

Type 2 diabetes used to be extremely rare in children, but rates have increased in the last 20 years, along with rates of childhood obesity.

I talked to nurse practitioner Susan Cluett at the UVA Children’s Fitness Clinic to find out what causes Type 2 diabetes in children and how at-risk patients can slow or reverse the progress of the disease.

What’s the difference between Type 1 and Type 2 diabetes?

In Type 1 diabetes, the body can’t make insulin. So people with this disease inject insulin every day so their bodies can break down glucose, a sugar that the body uses to give you energy. You can’t prevent Type 1 diabetes.

In Type 2 diabetes, the body still makes insulin but the body might not make enough or the insulin the body makes does not work or both. You can prevent or delay Type 2 diabetes with lifestyle changes.

Type 2 diabetes used to be called “adult onset diabetes.” Why are more children getting it?

Many things factor into it. Restaurant portions are bigger, sugary drinks are everywhere. Parents work long hours or irregular shifts and fewer families eat meals at scheduled times. Many processed foods contain sugar or high fructose corn syrup — even foods that you don’t think would contain sugar.

Many children live in neighborhoods where, for safety reasons, they can’t exercise outside, so they spend time indoors in front of screens, and screens have a negative impact on sleep. When you’re under rested, you tend to eat more.

So it’s not just one factor. Type 2 diabetes is what’s called a lifestyle disease. Meaning that things like eating, exercise, and sleep habits impact whether you develop the disease.

Is your child at risk for Type 2 diabetes? Contact the Children’s Fitness Clinic today.

How do your patients get referred to the Children’s Fitness Clinic?

Pediatricians or primary care providers identify kids who are high risk for developing diabetes and refer them to us. If they haven’t had a glucose test we will do that as well as an endocrine workup.

What can patients — and parents — expect?

Parents are scared to get this kind of diagnosis for their child. It’s a wake up call. Diabetes is a life altering disease with serious health consequences. While it is hard news to get, we start small and make it manageable. Our first meeting is a 45-minute intake meeting and then we’ll meet every two to four weeks for six months, sometimes longer.

Controlling type 2 diabetes through portion control
This is the size of one portion of food.

Do you have kids weigh and measure their food?

No. We have a simpler method that anyone can follow! Put your hands together, palms up and cup them. That’s what one portion looks like. For some of our patients, that’s a shock. First, we tackle portion size and then we work with our patients to help them make healthier food choices.

One simple way to reduce sugar is to cut out juice and soda in favor of water and, sometimes, milk. We have no specific meal plans, but we recommend:

  • Increase omega 3s
  • Eat lean meats
  • Eat cold-water fish two times a week
  • Add more fruits and vegetables

We also work with our patients to schedule meals and snacks. When you know that there are set meal times, you’ll eat less frequently and consume fewer calories.

Portion control, structure and better food choices are the focus of our program.

What about exercise?

We want kids to exercise where they are. For some kids that’s dancing in their room, for some it’s a Zumba class, and for others it’s push-ups or planks or walking home from school. They can join a gym if they want, but it’s not necessary. Any or all of these activities count as exercise, and whatever exercise you enjoy and can do consistently is the right exercise.

Some kids use apps to keep track of their workouts. We work with our patients to set goals, but we don’t have a minimum that they have to reach or they’ll get kicked out. Some programs do that, but we don’t.

Can you share a success story with us?

A 7-year-old girl came in who was obese and sedentary. Her family didn’t want to change their eating habits, so we thought compliance would be a problem. Month over month nothing happened but she consistently did her exercises, tracking them using a fitness app.

Over time, she became very tall and got interested in basketball. She’s now at normal weight, playing basketball for her school team, and is not at risk for diabetes.

This is a very positive program. We don’t prescribe diet pills, require that our patients follow meal plans or lose a certain amount of weight or get kicked out.

We say that the patient is in control, and they can succeed.

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