Complementary and Integrative Medicine Approaches for The Treatment of Type 2 Diabetes in Pediatrics

Type 2 Diabetes is of increasing concern in the United States. Current statistics show that 39,000 American children and adolescents have type 2 diabetes, with many more suffering from type 1 diabetes. Both situations are escalating to levels that raise a red flag. Integrative practitioners are sounding the alarm on the importance of lifestyle medicine and nutrition and addressing the root causes of these conditions. Institutes like John Hopkins have formed an integrative holistic prediabetes team to address this issue in young children with early warning signs. Taking a proactive approach to this rising health concern is one way we can prevent the progression.

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What is Childhood Diabetes Type 2?

This is a chronic blood sugar dysfunction condition. Type 2 Diabetes (T2D) is a disorder of the metabolism that develops when the body cannot make or use insulin properly to process blood glucose. The role of insulin is to help glucose leave the bloodstream and get into the cells for utilization. When it's unable to get into the cells due to insulin dysfunction, it floats around in the blood leading to elevated blood glucose levels, which contributes to the symptoms of diabetes.

Type 2 Diabetes Symptoms in Pediatrics

Type 2 diabetes typically has a gradual progression that goes unnoticed by the child and parents. Some symptoms that may present include:

• Skin infections and wounds that do not easily heal
• Needing to urinate often
• Frequent bladder infections
• Weight loss despite increased appetite
• Excessive thirst
• Blurred vision
• Weakness or fatigue
• Irritability and other mood changes
• Nausea and vomiting
• High levels of glucose evidenced in the blood and urine when tested
• Tingling or the loss of feeling in the hands or feet

What Causes Type 2 Diabetes in Children?

The following causes may be contributing to the development of type 2 diabetes in children:

Genetics & Risk Factors

The primary cause of pediatric type 2 diabetes is unknown. There is some clinical evidence that it is more common in those with a strong family history, plus additional risk factors. One of the most substantial risk factors is being overweight. Listed below are other contributors.

Inactivity & Diet

The less movement a child has in life, the more likely they are to increase their risk of developing childhood diabetes. Consuming a diet high in processed sugars, meats, and sugary beverages also increases the risk of developing type 2 diabetes. Poor dietary choices can also lead to inadequate nutrient intake, often leading to micronutrient deficiencies. Preschool age to adolescence is an incredibly vital age range for optimal nutrient intake for growth processes and disease prevention, like diabetes.

Age, Sex, Ethnicity & Race

Young females are more prone to this condition than males. People of American Indian, Asian American, Black, or Hispanic descent are at a higher risk than other races or ethnicities.

Preterm Birth or Low Weight at Birth

Premature birth can contribute to the increased risk ratio. One study found that preterm birth before 35 weeks gestation put these children at an increased risk of developing T2D in adulthood. Low birth weight (less than 5.5 lbs) and high birth weight (greater than 8.8 lbs) have been correlated to developing type 2 diabetes later in life.

Health Conditions

If the mother had gestational diabetes while pregnant with the child, the child could be at a higher risk for developing T2D. In adolescence, Polycystic Ovarian Syndrome (PCOS) is caused by insulin resistance, so this condition is also associated with an increase in a child's odds of developing type 2 diabetes. Lipid levels are also essential to monitor. Having low HDL cholesterol or high triglycerides present are both independently contributory to the development of T2D.

Functional Medicine Labs to Test for Root Cause of Childhood Type 2 Diabetes

The following labs can help assess the root causes of childhood type 2 diabetes:

Routine Bloodwork

Although blood draws may not be ideal for young children, certain tests can only be done via a blood draw. In order to make this as smooth as possible, seeking out a phlebotomist who is trained in and has experience with pediatric blood draws is advisable. It's also nice to have it be a calm environment and provide comfort for your child during the process. With that being said, a Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) are two tests that can assess wellness, metabolic function, electrolyte status, liver function, blood glucose, and kidney function. Kidney function can be impacted by diabetes, so it is a vital organ to monitor if diabetes is of concern. In addition to a CBC and a CMP, a Lipid Panel will look at blood lipid levels. This will determine if common markers such as HDL and triglycerides, which are risk factors for T2D, are out of range for health and wellness.

Urinalysis

If your child cannot perform blood tests, a Urinalysis can provide some insight. A Urinalysis is beneficial for evaluating kidney function and whether ketones or glucose are present in the urine, which are signs of diabetes. It is often used to diagnose a UTI while also necessary to diagnose and monitor kidney disease and diabetes.

Nutrient Testing

Micronutrients are essential for proper blood sugar regulation. If a child is not getting proper micronutrients through their diet, this could negatively impact insulin and the body's ability to regulate blood sugar. SpectraCell Laboratories offers a Micronutrient Test that evaluates 31 micronutrients, many of which can play a role in type 2 diabetes.

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Additional Labs to Check  

Oral 2-hour Glucose Tolerance Test

This test involves drinking a glucose-heavy beverage and testing blood sugar levels. Periodic blood draws are then done over a span of two hours of drinking the beverage. This test looks at blood sugar levels in that two-hour window. Levels over 200 mg/dL (11.1 mmol/L) indicate diabetes.

Continuous Glucose Monitoring

This technology is becoming more popular due to its efficiency in getting continuous blood sugar readings. A CGM, short for Continous Glucose Monitor, is an ideal option for adolescents who can tolerate the device being on their arms for extended periods. These monitors adhere to your arm and detect glucose levels in your body every 15 minutes. The key feature is that you or your child can follow trends recorded by the CGM. This can be an excellent monitoring tool and has been reported to "improve diabetes-related satisfaction by people with diabetes and parents of children with diabetes." Monitoring in this manner objectively shows how dietary and lifestyle factors impact your child's diabetic state. This can be a much more compliant tool for children who require multiple finger-prick tests to monitor blood sugars.

PCOS Evaluation

If PCOS is suspected in an adolescent female, a thorough workup may include glucose/insulin testing, hormone testing (specifically androgen/testosterone testing), and an ultrasound to assess the ovarian follicles.

Conventional Treatment for Type 2 Diabetes in Pediatrics

Pediatric onset T2D is predominately treated through conventional medicine. While primary recommendations are focused on dietary changes and lifestyle, two medications are FDA-approved and often utilized in children with T2D. These two medications are metformin and insulin. Metformin is prescribed to children ten years of age and older who are diagnosed with type 2 diabetes. Dosing for this prescription drug starts at 500 mg/day and is then slowly titrated up to the max dose of 2,000 mg/day over a four-week period.

Insulin therapy is required for children experiencing ketoacidosis or ketosis (life-threatening signs of insufficient insulin) or who have plasma glucose levels at 250 mg/dL or higher. Insulin is also warranted if a child's A1C maker is greater than 9%.

Complementary and Integrative Medicine Treatment Options for Type 2 Diabetes in Pediatrics

Treatment for type 2 diabetes should be family and individually focused. In order for the child to succeed, their parents and siblings should be supportive and on board with lifestyle interventions. The American Academy of Family Physicians recommends family involvement, nutritional counseling, and exercise counseling all be an active part of a child's treatment plan.

Diabetic Diet Plan for Children

Sticking to a whole-foods and nutrient-dense diet is critical. Emphasizing complex carbohydrates over simple carbs and monitoring carbs based on insulin needs is essential in stabilizing blood sugar. The dietary focus should be on smaller portions, eating higher fiber food and lower unhealthy fats, eliminating sugar-laden beverages, and consuming at least five servings of fruits and vegetables daily. The "Plate Method" is often recommended. It entails using a 9-inch dinner plate where half of it is filled with nonstarchy vegetables, one quarter is a lean protein, and the last quarter is a complex carbohydrate like rice or potatoes.

The Mediterranean Diet has been recommended amongst adults with type 2 diabetes, as it is an ideal nutrition plan that can help control blood sugar levels. Clinically speaking, this type of diet could also benefit children since it incorporates many of the above-mentioned dietary focuses.

Exercise for Children with Type 2 Diabetes

It's recommended that adolescents get daily exercise to manage diabetes. Moderate to high-intensity physical activity for 60 minutes daily is the minimum requirement. For those receiving insulin, monitoring for hypoglycemia and administering insulin when appropriate will be essential. If your child lives a sedentary lifestyle, here are some goals to work them up to. Children age 3 to 5 years old should be physically active throughout the day. In comparison, children and adolescents 6 to 17 years old should incorporate aerobic exercises and muscle and bone strengthening in their 60-minute daily physical activity. Limiting screen time and encouraging family movement is an excellent way to help your child stay motivated and committed.

Supplements and Herbs For Children With Type 2 Diabetes

The following supplements have been shown to assist in the holistic treatment of type 2 diabetes in children:

Inositol for Type 2 Diabetes

Although it has not been heavily studied in the pediatric population, inositol is considered a generally safe supplement. It's used primarily in those with PCOS who have insulin resistance. In a pilot study, patients with T2D benefited from taking a combination of myo-inositol and d-chiro-inositol twice a day in conjunction with their glucose-lowering medication. Results revealed a decrease in both fasting blood glucose and HbA1c levels. Exploring options for inositol with pediatric type 2 diabetes is a consideration to discuss with your child's holistic doctor.

Alpha-Lipoic Acid for Type 2 Diabetes

ALA is an antioxidant that can reduce oxidative stress, which can impact diabetic patients. This compound can also improve insulin sensitivity in as little as four weeks. The oxidative stress that occurs in people with diabetes includes small and large vascular changes due to increased free radical formation and diminished antioxidant ability, which impacts the body at a cellular level. Other benefits of ALA include supporting biochemical pathways involved in diabetic neuropathy. This compound can be taken as a supplement and is also found in foods like tomatoes, broccoli, and spinach.

Minerals and Vitamins for Type 2 Diabetes

Many patients with type 2 diabetes benefit from micronutrient (vitamins and minerals) supplementation due to chronic depletion. Chromium is a common trace element used to support glucose tolerance. Chromium works with insulin, making it easier to move glucose into the cells. A deficiency in chromium can lead to glucose intolerance or a deficiency in macronutrient absorption. The recommended dose is 30-100 ug for adolescents, but it's best to work with an integrative doctor that monitors specific dosing with you. Zinc is an additional mineral that aids in lowering blood glucose while supporting healthy cholesterol levels. The recommended daily allowance (RDA) for zinc is categorized by age. For example, a child from ages 4 to 8 years old is recommended to take 5 mg per day of zinc. A list of foods that contain zinc can be found here.

B Vitamins, specifically niacin, folate, and pyridoxamine, all have a role in modulating insulin sensitivity. Obtaining a micronutrient test and supplementing as needed could help manage T2D. Magnesium deficiency is often associated with type 2 diabetes. This nutrient is also a co-factor in many enzymatic functions in the body, including regulation of insulin signaling, the insulin receptor processes, and insulin-mediated glucose uptake.

Cinnamon for Type 2 Diabetes

A meta-analysis study looking at cinnamon found promising results. When taking doses ranging from 1g to 6g per day over a multi-month duration, results showed a decrease in HbA1c and fasting blood glucose. Cinnamon is a great option when looking to address glycemic index naturally. It's been postulated that cinnamon can regulate insulin signaling pathways, thus inducing an insulin-like effect. Insulin allows glucose into the cells, so improving its function can help decrease blood glucose. This then goes on to increase glucose uptake in muscles and fat tissue, promotes glycogen synthesis in the liver, and decreases gene expression of the regulating factor of gluconeogenesis (synthesis of non-carbohydrate glucose) in the liver.

Integrative Nutritionist Specialist for Type 2 Diabetes in Pediatrics

Working with a nutritionist or dietitian who will take a whole-person root cause approach is the ideal way to go. Functional nutrition is a holistic style of nutrition that looks at bio-individuality rather than applying standard nutrition guidelines to each and every patient. Certified Nutrition Specialists (​CNS®) take a similar approach, focusing on personalized nutrition. For T2D pediatric patients, it is essential that the whole family is on board. In working with an integrative practitioner, your family can formulate a plan that works in everyone's best interest.

Yoga and Tai Chi for Type 2 Diabetes in Pediatrics

Both of these are mind-body movement activities that can benefit an individual's quality of life. Studies have shown improvements in insulin, triglycerides, weight, and decreased stress in those with diabetes who practice yoga. Tai chi also shows promising results, as one study revealed it could lower fasting plasma glucose, HbA1c, and insulin resistance and decrease body mass and total cholesterol.

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Summary

Functional medicine and integrative healthcare have much to offer in addressing the rising concern of type 2 diabetes in our pediatric population. Starting in the home- with lifestyle modifications, dietary changes, and improved physical activity- we can collaborate to halt the progression of T2D in affected children. Learning to rely on mind-body practices and self-motivation can be an encouraging way to get your child active and on track toward health. For a root cause approach utilizing some of the diagnostic tools mentioned above, seek out a holistic and integrative team to be on your side.