Generation Diabetes: Why the Youngest Type 2 Diabetes Patients Are the Sickest

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By : dLife Editors

Gail Punongbayan, pictured above, was first diagnosed with type 2 diabetes at age 14.

Wearing a maroon sweatshirt with “San Leandro Rebels” emblazoned on the front, 17-year-old Punongbayan didn’t flinch when a physician’s assistant drew blood.

“One, two, three, four, showtime!” Jonathan Ramos, a physician’s assistant at UCSF Benioff Children’s Hospital, called out as he pricked Gail’s finger to smear a bright red drop of blood on a small card to check her blood sugar.

The high school junior knows the routine. For four years, she’s been going to the children’s diabetes clinic at UCSF Benioff Children’s Hospital in Oakland, California, every three months for checkups.

At this one, Ramos first checks her height, then her weight and blood sugar. The routine may seem normal, but Gail’s condition is actually extremely abnormal for kids or teens her age.

Or it used to be.

Today, Gail is part of a growing number of kids and teens living with type 2 diabetes. Despite their young age, many of them are experiencing complications and disease progression four times faster than adults with the same condition, setting off alarm bells for the diabetes experts treating them.

From 0 to 5,300 Cases a Year

Stories like Gail’s are no longer a rare occurrence. The Centers for Disease Control and Prevention (CDC) estimated in 2012 that there were 5,300 new pediatric type 2 cases diagnosed that year in the United States.

That number is far lower than the 17,900 kids receiving diagnoses of type 1 diabetes, but it’s a big increase from essentially zero, which was the case in 1990.

The increase mirrors the trend of rising type 2 diabetes cases across the United States. Currently, almost one-third of the country, or 100 million people, have diabetes or prediabetes, estimates the CDC.

There are two main types of diabetes: type 1 and type 2. In type 1 diabetes, the immune system attacks the pancreas, rendering it unable to produce insulin.

In type 2 diabetes, the pancreas still makes insulin, but the body has become more resistant. This can happen for a variety of factors, like diet, obesity, or genetic predisposition. The pancreas will keep making more and more insulin, but eventually, the organ can become worn out. In some cases, it stops producing insulin.

Experts have linked the skyrocketing rate of childhood obesity as one factor for the sudden spike of pediatric type 2 diabetes cases. The CDC estimates 1 in 5 school-age children are obese. That’s triple the number from the 1970s.

But obesity isn’t the only factor in the rise of childhood type 2 diabetes cases. After all, there were children with obesity before 1990. But virtually none of them developed this disease.

Dr. Jane Lynch, FAAP, chairperson for the section on endocrinology at the American Academy of Pediatrics and professor of pediatrics at the University of Texas, San Antonio, said multiple factors over decades have put children at risk.

These factors include a rise of gestational diabetes, changes in food processing, and less activity time for children.

“We also know there was a much higher rate of gestational diabetes and moms with diabetes having children,” she said. “And we know there’s a genetic predisposition to developing type 2 diabetes.”

Additionally, Lynch says that changes in the American diet — including more processed food full of fat and sugar — has put kids at risk. A high-fat, high-sugar diet diminishes the body’s sensitivity to insulin, which processes blood sugar, leading to pressure on the pancreas.

“We know that the diet really changed during those years. We’re doing a lot more processed food, glucose, and serving sizes,” she said.

Another less obvious factor is air pollution. A study published this year in The Lancet: Planetary Health estimates that 150,000 diabetes cases every year in the United States could be linked to air pollution.

 The Danger for Adolescents

Many of these young people receive diabetes diagnoses at the beginning of puberty, when a flood of human growth hormone is released, rendering the body less sensitive to insulin.

Gail received her diagnosis at 14.

“The growth hormones that you make to grow rapidly in adolescence antagonizes insulin,” Lynch explained. “So, the mix of hormones during adolescence, of the pubertal hormones and the growth hormones, are just unique and different from adults.”

Getting a diagnosis at 13 or 14 also means teens are grappling with a chronic and potentially dangerous illness, just at the time when they might want to assert more independence from their parents.

The rest of the article is available at

This article is written by: Gillian Mohney.  Image by: Gabriela Hasbun.