What is diabesity?

Carlie's Angels

With a strong support team, teen takes charge of her diabetes

When Carlie Hurtt, 14, was diagnosed with type 2 diabetes in the fall, she felt overwhelmed and alone.

But with the help of a supportive team, including her family, school and health care providers, Carlie has taken charge of her health with positive lifestyle changes.

Sudden and alarming symptoms

Carlie had just started her freshman year at Campus High School in Haysville. She had been ill and was feeling continually sluggish, but wrote if off to the stress of adjusting to a new environment and class schedule. Soon, however, there was no ignoring her symptoms.

"I was fatigued and constantly thirsty," Carlie says. "I didn't feel at all like I used to and I knew something was wrong."

In early September, she went to see her Via Christi Clinic pediatrician, Luke Nichols, MD, who drew blood and ran some tests.

Carlie was home napping when the doctor's office called with the results and told her to go directly to the emergency room. Her blood tests showed a blood sugar (glucose) level of 415, more than four times normal; and toxic amounts of ketones, a byproduct of her body making too little insulin to absorb the sugar in her blood. Left untreated, that condition might have led to a diabetic coma.

She was diagnosed with type 2 diabetes, a condition in which the body doesn't use insulin properly, and admitted to the intensive care unit.

Crash course in living with diabetes

Carlie spent the next four days as an inpatient as her endocrinologist, dietitians and a caring nursing staff worked fervently to get her glucose levels under control and educate her about the seriousness of her diagnosis.

She learned what diabetes is, how diet and exercise affect it, and how to check her blood glucose levels, give herself required insulin injections and manage her condition.

She also learned that she was not the only teenager coping with type 2 diabetes, typically considered an adult disease, and that weight and inactivity may have played a part in her developing it at such a young age.

A team effort

Carlie has had to make changes to adapt to her new challenge, including modifying her diet. Fortunately, she has an amazing support team to help.

"My mom and dad are making sure I'm not doing this by myself, so they have been watching their diet right along with me. My grandparents, too," she says.

Going grocery shopping has become an educational process, says Carlie's mother, Jennifer Hurtt. "It's really opened our eyes to calorie intake and carbohydrates — things she didn't think about before. We read labels, and Carlie plans her meals and snacks for the next two weeks."

The nurse at Campus High has been supportive, too. She helps Carlie check her blood sugars at school and she introduced Carlie to a group of students who also have diabetes so she would know others who share her challenge. Jennifer says it was comforting for Carlie, and for her, to know Carlie had peers to talk to when she had questions.

Carlie and her family also work with a health care team, including Dr. Nichols and a pediatric endocrinologist, to monitor and make adjustments if necessary. "Dr. Nichols said, 'We will take care of our girl,'" says Jennifer. "He took ownership of the condition and has been very supportive."

Carlie doesn't deprive herself of the foods most teenagers love, but she has smaller portions and limits starchy items like pasta and mashed potatoes. She also walks or does some form of exercise each day. She checks her blood glucose levels before each meal and two hours after she eats. To help regulate her glucose levels, she takes daily oral medication and injects insulin several times a day, including each morning and after meals.

The biggest challenge, Carlie says, is giving herself insulin, "because I am chicken when it comes to shots."

"It was pretty intimidating at first," she says, "but I've kind of gotten used to it."

Other challenges, says her father, Mike Hurtt, include planning what she'll eat when they dine out, viewing calorie and carbohydrate content of menu items online, and the logistics of having her insulin and glucose meter with her at all times. Carlie has taken on this responsibility from the beginning, Mike says, carefully calculating one unit of insulin per each eight grams of carbohydrates she eats.

Today, Carlie is successfully maintaining her blood sugar target of 70 to 120. Her goal is to eventually get off the fast-acting insulin and require just one long-acting injection each day. She is committed to managing her health and hopes she can be an inspiration to other teens with type 2 diabetes.

Type 2 diabetes epidemic among the young

Type 2 diabetes is on the rise among children in the U.S. The disease — formerly called adult-onset diabetes — now affects four times as many youths as it did 20 years ago.

The culprit? Excess weight, according to the Center for Disease Control and Prevention. Thirty-five percent of teenagers and 18 percent of those 12 and younger are now overweight or obese. Unlike type 1 diabetes — in which the body produces no insulin at all and lifelong insulin therapy is required — type 2 diabetes occurs when the body fails to properly use or make enough insulin, the hormone that moves blood sugar (glucose) into cells where it is converted to energy. Excess fat hinders the cells' ability to use insulin to bring sugar in from the bloodstream, causing glucose to build up in the blood. This condition is called insulin resistance and is the first step on the road to diabetes.

An estimated one in six overweight teenagers now has prediabetes, a blood glucose that is higher than normal, or between 100 and 125, which frequently leads to type 2 diabetes. So strong is the connection between obesity and diabetes that a new word, "diabesity," has been coined by the medical community.

Since obesity and diabetes both contribute to serious health problems, the combination of the two further increases the risk of heart attack, stroke and kidney failure as affected children reach early adulthood. Further, research indicates type 2 diabetes progresses more rapidly in youths and they develop diabetes-related complications faster than their adult counterparts, according to the National Institutes of Health.

A third of children with diabetes already have high blood pressure and a third have elevated cholesterol, two major risk factors for heart disease.

"It's difficult to see type 2 diabetes moving from a disease of our grandparents to a disease of our children," says Dany Zayour, MD, an endocrinologist with Via Christi Clinic. The health consequences for the youths are serious and our society, schools and the health care system are not prepared for this rapidly growing problem, he says.

What is diabesity?

The epidemic of diabetes and obesity occurring together is "diabesity." Obesity is a major contributor to type 2 diabetes because it can cause insulin resistance, the first step on the road to type 2 diabetes.

Which youths are at the highest risk?

  • Family history of type 2 diabetes
  • Being overweight (a body mass index of more than 25)
  • Sedentary lifestyle
  • Prediabetes (an above-normal fasting blood glucose of 100- 125 mg)
  • Abnormal cholesterol and/or triglyceride levels
  • Family history of high blood pressure or cardiovascular disease
  • Nonwhite ancestry
  • Children entering puberty, due to the body's hormonal changes

People with prediabetes can help prevent or postpone type 2 diabetes by:

  • Making healthier food choices
  • Getting 30 minutes of exercise daily: In addition to helping control weight, exercise can improve insulin sensitivity, making it easier for the body to convert glucose into energy Losing weight

 

 
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