Diabetes may not be on your radar as a parent, especially if there’s no history of it in your family. But during the last two decades, the number of people younger than age 20 living with type 1 diabetes has increased by 45 percent, while the number with type 2 has increased by a startling 95 percent, according to the Centers for Disease Control and Prevention (CDC).

How do you know if your child is at risk? “The most powerful tool we have is that parents know their kids best,” says pediatric endocrinologist Patrick Rizzuto, MD, assistant professor at Rutgers Robert Wood Johnson Medical School. “If you notice any unusual behaviors, such as a child drinking more or losing weight, see your pediatrician right away.”

Here’s what you should know about diabetes and how it affects kids:

Type 1 diabetes is a chronic condition that typically appears in adolescence when the pancreas produces little to no insulin. Treatment is aimed at maintaining normal blood sugar levels. “With type 1 diabetes, the issue is that the body isn’t making sufficient amounts of the hormone insulin anymore because the immune system has gotten confused,” says Rizzuto. “The body begins attacking and destroying the cells in the pancreas that produce insulin.” Without insulin, blood sugar can’t get into the cells to provide energy, but instead builds up in the bloodstream. Type 1 diabetes can also be diagnosed in adults.

The symptoms of type 1 aren’t easy to spot at first. “Looking back after a diagnosis, you may say, ‘Oh, that was a sign,’ but it’s so subtle that you may not notice right away,” says Diane Difazio, a pediatric endocrine nurse practitioner at Children’s Regional Hospital at Cooper University
Health Care. “The onset is more acute. Parents usually will see signs develop within a matter of a few weeks, rather than a few months.” Symptoms include excessive thirst, increased urination (especially waking up at night to pee) and unexplained weight loss. Kids also may be irritable or lethargic due to dehydration.

If the condition goes unchecked for too long, the body begins to burn fat for energy, which produces chemicals called ketones. When ketones build up, they make blood more acidic, creating a potentially life-threatening condition called diabetic ketoacidosis, or DKA, which develops rapidly within a matter of hours to days. “About a third of kids are in DKA when diagnosed,”
says Rizzuto. DKA causes the GI tract to become inflamed, so symptoms may include loss of appetite, stomach pain, uncontrolled vomiting, deep and rapid breathing and even loss of consciousness. This is an emergency and children must be seen immediately.

Type 2 diabetes is a chronic condition where the body doesn’t produce enough insulin or resists insulin. It’s the most common form of diabetes. In the past, kids were seldom diagnosed with type 2 diabetes, which is why it was formerly known as adult-onset diabetes. However, about a third of
kids are overweight nowadays, which is related to the increase in kids with type 2. “This type is more common overall. The issue is that the body can make insulin but doesn’t respond to it,” says Rizzuto. As long as enough insulin is produced by the pancreas, blood sugar levels remain normal but eventually the pancreas can’t keep up.

Kids with type 2 usually don’t have any symptoms, although some kids develop patches of thick, dark skin called acanthosis nigricans on the folds of the neck, the armpits and the belly button, says Difazio. Parents may think it’s that their kids aren’t washing well, but this is a telltale sign of insulin resistance. Kids may also have silent symptoms such as high blood pressure or high cholesterol.

The risk factors for type 1 aren’t well understood, though there seems to be a genetic link. “With a thorough history, you may find a child has family members with other autoimmune conditions such as lupus, thyroid disorders, rheumatoid arthritis or celiac disease,” says Rizzuto. “But there’s nothing compelling such as obesity like there is with type 2 diabetes.”

With type 2 diabetes, risk factors for kids are more evident, says Difazio. Those include being overweight, having a family member with type 2 diabetes, being born to a mom with gestational diabetes and inactivity (exercise helps the body use insulin better, decreasing insulin resistance).

First, pay attention to what your kid eats and drinks. Make sure kids are drinking mainly water, not sugary drinks and sodas. “Juice is not healthy. It’s just pure sugar,” says Difazio. Instead of putting your child on a diet, encourage them to prepare meals with you so they can learn what healthy eating looks like. Try to eat with mindfulness. For example, eat meals together at the table, not in front of the TV or computer.

It’s also important to get the whole family moving. Put on music and dance together, play active video games, shoot some hoops or take a family walk or bike ride after dinner, says Difazio. Finally, limit screen time, which contributes to too many sedentary hours (for parents, too!).

Because kids with type 1 aren’t making insulin themselves, they’ll need to take insulin in injections at each meal, as well as daily long-acting insulin. But kids with type 1 don’t require dietary modifications and can eat the same amount of carbohydrates as their siblings do, says Rizzuto. For kids with type 2, weight loss, dietary modifications and medications provide management of the condition.

But technology has also improved treatment for both types. “There have been so many advances to make things easier for families,” says Difazio. “For example, there is a continuous glucose monitor that checks glucose readings so kids won’t have to prick their fingers every time they eat. There are also closed loop insulin pumps that connect to these meters and deliver insulin based on those readings.”

A new diagnosis of type 1 or 2 diabetes can feel overwhelming to families but you won’t go it alone because you’ll have support from your child’s endocrinologist and pediatric endocrinology team. “We also work closely with school nurses so everyone knows how to help the child,” says Difazio.

Parents sometimes feel like they’re somehow to blame that kids have developed diabetes. A diagnosis “comes with genetics and our environment,” says Rizzuto. “The important thing is to get help when you need it.”

—Arricca Elin SanSone is a New York-based health and lifestyle writer.