November 18, 2010
The epidemic of childhood obesity is making the prevalence of diabetes in children increase. Do you know the warning signs? Do you know the difference between Type I and Type II Diabetes? Read a transcript of the E-Health Connect Chat with Dr. Barbara Marshall, Pediatric Endocrinologist, with Mary Bridge Children’s Hospital & Health Center.
The epidemic of childhood obesity is making the prevalence of diabetes in children increase. Do you know the warning signs? Do you know the difference between Type I and Type II Diabetes? Read a transcript of the E-Health Connect Chat with Dr. Barbara Marshall, Pediatric Endocrinologist, with Mary Bridge Children’s Hospital & Health Center.
Chat Host
12:59 PM
Welcome to MultiCare's E-Health Connect Chat. We will get started in a couple minutes.
Chat Host
1:00 PM
Today's topic is Pediatric Diabetes with guest speaker Dr. Barbara Marshall.
Chat Host
1:01 PM
Dr. Marshall is a Pediatric Endocrinologist at Mary Bridge Children's Hospital and Health Center.
Chat Host
1:02 PM
Let's get started. Dr. Marshall, what exactly is an endocrinologist?
Dr. Barbara Marshall
1:03 PM
An endocrinologist specializes in hormones. People most commonly identify this with diabetes, thyroid and growth & development.
Dr. Barbara Marshall
1:05 PM
I treat any type of hormone disorder, such as hypothyroidism, hyperthyroidism, growth hormone deficiency, and any disorders related to puberty and pituitary gland.
Chat Host
1:05 PM
What exactly is Diabetes?
Dr. Barbara Marshall
1:06 PM
Diabetes is when the body cannot produce enough of the hormone insulin to allow the body to properly use sugar as fuel.
Dr. Barbara Marshall
1:07 PM
Type I diabetes is due to autoimmune distruction of the pancreas which is the organ that produces insulin.
Dr. Barbara Marshall
1:07 PM
Type II diabetes occurs when the body produces insulin, but not enough, usually due to insulin resistance.
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1:08 PM
What is the prevalence of each type in children?
Dr. Barbara Marshall
1:08 PM
About 15,000 children are diagnosed with Type I in the U.S. and 3,700 with Type II.
Chat Host
1:09 PM
What are the symptoms that a parent should be looking out for?
Dr. Barbara Marshall
1:09 PM
Symptoms include increase in thirst, increased urination, unexplained weight loss, and in later stages fatigue and vomitting.
Chat Host
1:10 PM
At what age do symptoms of diabetes typically show in children?
Dr. Barbara Marshall
1:11 PM
Type I can occur at any age, but typically we see this in toddlers or adolescence. Type II is typically seen in older adolescence, but as we are seeing an increase in childhood obesity, we are seeing it diagnosed in earlier ages.
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1:12 PM
What kinds of tests would a child have to determine if they have diabetes?
Dr. Barbara Marshall
1:12 PM
Diabetes can be diagnosed with fasting blood sugar, two random elevated blood sugars, or a glucose tolerance test.
Chat Host
1:12 PM
And those are all blood tests?
Dr. Barbara Marshall
1:13 PM
Yes, these are all blood tests.
Chat Host
1:13 PM
What kind of treatments are available for type I diabetes?
Dr. Barbara Marshall
1:13 PM
Type I diabetes can only be treated with insulin and insulin can only be given via injection. So, children take multiple daily injections, or via insulin pumps.
Andrea Ray-Anderson RN
1:14 PM
Why isn't the A1C test used more regularly to diagnose diabetes?
Dr. Barbara Marshall
1:15 PM
A1C was recently accepted in diagnosis for diabetes in adults, but it has not been standardized for children. You can use it, but studies show we miss some children with diabetes by using this test.
Chat Host
1:16 PM
What treatments are available for type II diabetes?
Dr. Barbara Marshall
1:17 PM
The cornerstone of Type II diabetes is lifestyle modification. Even moderate weight loss and exercise decreases insulin resistance. We also use oral medications that increase insulin sensitivity and some require injected insulin.
Chat Host
1:17 PM
Are there natural treatments for diabetes?
Dr. Barbara Marshall
1:20 PM
For Type I diabetes, the only treatment is insulin. For Type II, again healthy diet and exercise. Cinnamon has been studied as a blood sugar stabilizer but the findings are inconclusive.
Andrea Ray-Anderson RN
1:21 PM
As a school nurse, I have been regularly checking for acanthosis nigrecans on students. Do you feel this is a good idea?
Dr. Barbara Marshall
1:22 PM
Yes. acanthosis nigrecans is a darkening and thickening of the skin, usually around the neck and under the arms that is a marker for insulin resistance. These children should be referred to their doctor.
Chat Host
1:23 PM
Question from Twitter @MultiCareHealth: What type is it when you produce too much insulin and the body doesn't absorb it?
Dr. Barbara Marshall
1:24 PM
That would be Type II. In Type II, insulin levels are often higher than normal, but due to insulin resistance, not high enough to regulate the blood sugar.
Andrea Ray-Anderson RN
1:24 PM
Great. So should I continue year after year referring them, or rely that the doctor will continue annual checks?
Dr. Barbara Marshall
1:25 PM
It never hurts to consistently refer a child as you feel necessary. And also recognizing and encouraging lifestyle changes.
Chat Host
1:26 PM
How much of a risk factor is family history? Are there any other major risk factors?
Dr. Barbara Marshall
1:28 PM
Family history is a minor risk factor for Type I diabetes. For example, there's only about 10% risk of a diabetic parent having a child with Type I diabetes. It's much bigger factor in Type II diabetes. Other populations at risk are African Americans, Pacific Islanders, Native Americans, and Hispanics, but the biggest risk factor is obesity regardless of ethnicity.
Chat Host
1:28 PM
Is there a cure for diabetes?
Dr. Barbara Marshall
1:29 PM
There is no cure for Type I diabetes. In some patients, particularily in children, healthy eating and weight loss can manage Type II diabetes.
Chat Host
1:30 PM
What resources are available for parents and children who are living with diabetes?
Dr. Barbara Marshall
1:32 PM
At Mary Bridge, we offer Diabetes Education and there are also local support groups. Many children go to Diabetes Camp in the summer and JDRF - Juvenile Diabetes Research Foundation raises money to find a cure and offer other education and support for families. Visit marybridge.org for more information about these resources.
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1:33 PM
How many of these resources are typically covered by insurance?
Dr. Barbara Marshall
1:33 PM
Insurance usually covers diabetes education and nutrition counseling. They may cover the cost of camp and there are usually fund raisers to assist with these costs.
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1:33 PM
Where does Mary Bridge provide these services?
Dr. Barbara Marshall
1:34 PM
Mary Bridge Children's Health Center offers Endocrine Clinic at our Tacoma, Olympia, Puyallup and Silverdale clinics.
Chat Host
1:35 PM
What are the consequences for untreated diabetes?
Dr. Barbara Marshall
1:36 PM
Poor diabetes control increases long term risk of vision problems, kidney damage, vascular disease, and heart disease.
Chat Host
1:38 PM
That is all the time we have for today. Thank you so much Dr. Marshall.
Dr. Barbara Marshall
1:40 PM
If you have any questions or concerns about a child, please consult with your pediatrician or primary care provider and they will determine if a referral is right for your child.
Chat Host
1:41 PM
Thanks for joining us today. Log-in again December 7th at 12pm for a Holiday Survival Guide with Registered Dietitian Claire Kjeld.
Dr. Barbara Marshall
1:41 PM
Thank you for the opportunity to discuss pediatric diabetes.