Prediabetes or so-called “prediabetes” in children and adolescents means that there is a high level of glucose in the blood, but it is not yet high enough to diagnose type 2 diabetes. Here, people who suffer from this should be monitored. The situation is close; Because they can develop into this type of diabetes over time.

Blood sugar level

Glucose is the body’s primary fuel and comes mostly from the food we eat. Insulin is a hormone produced by the pancreas. The job of this hormone is to control the body’s ability to use glucose through the body’s cells and store it in body parts.

After eating, glucose enters the blood. Here, insulin allows glucose to leave the blood and enter cells so they can be used to produce energy. It keeps the blood glucose level in normal range. If the body does not produce enough insulin, or if the body’s response to insulin is poor, blood glucose levels rise.

Pre-diabetes

Prediabetes usually occurs in children and adolescents who already have some physical sensitivity to insulin sensitivity. Insulin sensitivity means that the body does not recognize insulin, which should be the main factor controlling the process of using glucose. Therefore, the body’s cells cannot absorb glucose from the blood very effectively. People who are insulin sensitive produce more insulin than usual to overcome this sensitivity.

Although the causes of prediabetes and insulin sensitivity are not yet fully understood, there appears to be a strong relationship between some of the following factors and diabetes in children and adolescents:

– Overweight or obesity.

– Family history of type 2 diabetes.

– Inactivity and physical lethargy.

If prediabetes develops into diabetes, the following symptoms appear:

– Increased thirst.

– Increased frequency of urination.

– Waking up at night to urinate.

– Fatigue.

– Increases appetite.

– Unexplained weight loss.

Here it is worth contacting the pediatrician Diagnosing diabetes

Diabetes and pre-diabetes are systematically diagnosed. Simple blood tests are used to measure:

– Blood glucose levels during fasting.

– Oral glucose tolerance test.

– Degree of accumulation of sugar in hemoglobin.

To clarify, a fasting blood glucose test is done after not eating/drinking anything but water for at least 8 hours. A blood glucose level of less than 100 mg/dL or 5.6 mmol/L is normal. A fasting glucose level between 100 and 125 mg/dL (5.6-6.9 mmol/L) indicates prediabetes. Also, diabetes. Measuring total sugar in hemoglobin (HbA1c) is another test to estimate the average level of sugar accumulation in the blood over the past three months. One does not need to fast for this test. The normal accumulation of sugar in hemoglobin is less than 5.7 percent. If the level is between 5.7 and 6.4 percent, it indicates the presence of pre-diabetes. If it is 6.5 percent or more, it indicates the presence of diabetes.

Although HbA1c levels and fasting glucose (GF) levels are excellent screening methods for assessing prediabetes and diabetes, normal levels can be falsely reassuring.

This is why the oral glucose tolerance test (OGTT) is the most reliable test available to confirm prediabetes and diabetes. It is done in the doctor’s office; Because it takes more than two hours.

Prevalence of diabetes among children

A recent clinical review by University of Virginia researchers, using criteria from the American Diabetes Association (ADA) guidelines, found that the prevalence of pre-diabetes in children is already high, especially among children and adolescents with obesity. Among them, the prevalence ranges from 21 to 40 percent, depending on the criteria used and the types of children tested.

Specifically, the University of Virginia researchers noted that these studies show that the prevalence of prediabetes in obese children varies by race/ethnicity. That’s 54 percent among African American teens, 28 percent among Hispanic teens, and 18 percent among white American teens.

They further reported that the prevalence of prediabetes was 2.5 times higher in boys than in girls.

He also noted that perhaps — but not surprisingly — the prevalence of prediabetes and diabetes will continue to increase among adolescents. For example, using a standard 8-hour fasting glucose test, between 1988 and 1994, about 2 percent of adolescents had an abnormal result (ie, prediabetes).

Between 1999 and 2000, the phenomenon grew and increased until the percentage of adolescents with the disorder reached 7 percent. But the biggest increase was seen during 2007 and 2008; It has reached 23 percent.

But researchers at the University of Virginia, however, said there was a discrepancy between the estimates obtained using the HbA1c test and the fasting glucose test. Between 1999 and 2014, 4.4 percent of U.S. adolescents had prediabetes by criteria that used fasting glucose levels, compared with 15 percent by criteria that analyzed glycated hemoglobin levels. “This suggests that some criteria may detect disturbances in blood sugar levels early in the development of the condition,” they said.

Treatment of diabetes in children and adolescents

> In the medical advice received in the “Your Health” link in “Asharq Al-Awsad”, the following question is mentioned: “I have a 9-year-old child. I analyzed his blood sugar. He had an increase of 5.8 in the normal ratio, so how can I protect him from diabetes?” And lowering the overall score? Notice that he wasn’t suffering from symptoms, but I went to check on him when I noticed he was eating a lot of sugar.

Given the unique characteristics of juvenile prediabetes and type 2 diabetes, prevention and treatment include intensive programs to change daily lifestyle behaviors, key and reliable intervention, and repeated tests every 6 months or less.

In short, for children and adolescents with any kind of problems (without physical and psychological fatigue), the approach to changing daily lifestyle behaviors combines 3 things:

– Changes in diet.

– Increasing the level of physical activity.

– Get enough hours of sleep (9 hours a day for children and adolescents).

Because changes in the nutritional system will inevitably lead to a lower level of metabolic processes in the body, so that a clear difference in blood sugar levels does not appear. But combining physical activity with it increases the metabolic rate, which has clear results in blood sugar levels. Increasing the amount of physical activity and getting enough hours of sleep at night is beneficial in increasing insulin sensitivity, regardless of the amount of fat tissue in the body.

It is known that the high amount of adipose tissue in the body increases the level of sensitivity and weakens the body to the beneficial effects of insulin in controlling blood sugar levels. The American Endocrine Society’s clinical practice guidelines recommend at least 30 minutes of moderate to vigorous physical activity each day, with a goal of 60 minutes per day. A combination of low-intensity aerobic exercise such as jogging, swimming, and resistance exercises to activate muscles is also recommended. Because it improves insulin sensitivity. Encouraging exercise and adequate sleep often doesn’t cause “big” problems for parents with their teen or child. But it appears when dealing with daily nutrition to adjust it according to a healthy pattern. Here, things need to be simplified to ensure the cooperation of the child and teenager. Parents should be role models in ensuring healthy nutrition, weight control and exercise.

The main approach recommended by the American Academy of Pediatrics, the American Heart Association, and the World Health Organization is to increase the consumption of vegetables and fruits, reduce saturated fat intake, and completely eliminate sugar-sweetened beverages. Several studies have confirmed that consuming high-fiber foods is associated with increased insulin sensitivity and improved blood sugar levels. It should be noted that a diet with a high percentage of fiber provides many beneficial effects, such as increasing satiety, slowing the absorption of carbohydrates, and adding low-energy foods to the diet.

When should blood sugar be tested in children and adolescents?

> A key question many parents want to ask themselves about the safety of their children and teens, especially if they notice weight gain or high sugar intake: When should children and teens be screened for sugar? Is it for all children and adolescents, on a regular basis, or are there restrictions?

The American Diabetes Association (ADA) and the International Society of Pediatric and Adolescent Diabetes (ISPAD) recommend that universal screening of all children and adolescents is not cost-effective, according to a review of several clinical sources. Testing only children and adolescents who are at high risk of developing disturbances in blood sugar levels.

Healthy and obese children and adolescents, after puberty or at age 10 years or older (whichever occurs first), have one or more of the following risk factors, including:

– Family history of type 2 diabetes in a first- or second-degree family member (for a child or teenager who is obese).

– The patient’s mother has a history of diabetes or gestational diabetes (GDM) during pregnancy with a child or adolescent (obese).

– High blood pressure, blood cholesterol and triglyceride disorders, conditions or symptoms related to the body’s sensitivity to insulin as a child or adolescent (obese), including polycystic ovary syndrome (PCOS) in women Small body size at birth.

Here, the recommendations of the American Diabetes Association also suggest the following: This test should be repeated at least every two or three years. Or if there is a clear increase in body weight beforehand.

They should analyze the rate of sugar accumulation in hemoglobin or measure sugar levels during fasting. To confirm a diagnosis, abnormal results must be confirmed, using the same test on a different day or evaluated with a different test.