Type 2 diabetes threatens more and more children

By Rachel Uranga, Staff Writer

Sweat trickling down his neck, baby-faced Delvin Arroyo struggled to hold a 15-pound weight high over his head.

It was no small achievement.

Last year, the 153-pound 12-year-old couldn't run a city block. He had high blood pressure, and his doctor diagnosed him with borderline type 2 diabetes. Linked to obesity, the chronic life-altering disease can lead to blindness, heart disease and limb loss.

Delvin was scared and depressed, so his mother placed him in a weight-loss program that has him engaging in more strenuous physical activity. He has since shed 20 pounds, cutting his chance at developing type 2 diabetes -- a disease once only found in adults.

"This is saving my life," Delvin said recently, as he was getting his exercise clothes ready for class. "I am doing this for my health."

His journey is one that thousands of children will have to take if health officials are to stave off the rising tide of type 2 diabetes.

Linked to obesity, the chronic and costly condition has been expanding along with American waistlines. Though the number of children with the disease appears statistically small, experts consider its presence ominous.

"We are at a devastating point in our history," said Dr. Francine Kaufman, former president of the American Diabetes Association and author of "Diabesity," a look at the speed with which diabetes, hypertension and other obesity-related diseases are afflicting children. "One in three children born in 2000 will have diabesity in their lifetime."

Nationally, one in five deaths is caused by diabetes -- most related to type 2 diabetes. And it costs the nation billions -- $132 billion in 2002 -- in direct and indirect medical costs, not to mention loss of productivity and higher levels of depression among diabetics.

It disproportionately affects Latinos, African-Americans, American Indians and Pacific Islanders. And the numbers are expected to surge -- changing the everyday habits of millions.

Type 2 occurs when the body fails to produce enough insulin -- the hormone that helps the body's cells use and burn sugar-- or the cells ignore insulin. Unlike type 1 -- which occurs when the body fails to produce insulin -- type 2 is often preventable in children.

It can be curbed through diet, medication and daily blood sugar checks. But it can also worsen with catastrophic consequences, including kidney failure.

Up until the 1990s, type 2 diabetes was thought to occur only in adults. But that changed as clinicians started noticing a wave of overweight adolescents coming to emergency rooms in diabetic-like comas.

"There was a great deal of disbelief," said Dr. David Geffner, a clinical professor of medicine at UCLA. "My pediatric colleagues were shocked that children had the adult form of diabetes and that it could happen in kids."

In response, doctors loaded these children up on insulin as they did with children with type 1 diabetes. Some children were injecting themselves several times a day because of the high dosages they were prescribed. But their bodies couldn't process the insulin in the same way as type 1 children do. Instead, the type 2 diabetics gained more weight, compounding the problem.

A group of physicians finally convinced the scientific community that the hormones in children as young as 10 could be altered due to their lifestyle -- much like their adult counterparts.

"It has become a silent epidemic," Geffner said. "If we don't do something now, these children are going to die younger than their parents."

Though there are no current statistics on the number of kids with type 2 diabetes, experts tracking the phenomenon estimate at least 40 percent of the new patients diagnosed every year have type 2 diabetes. That's about one in 1,000 children. And many more overweight kids, like Delvin, are considered pre-diabetic.

Delvin, like most pre-diabetic children and type 2 diabetics, never thought he was at risk until a doctor observed the tell-tale darkened skin around his neck.

Also known as black neck or "Acanthosis nigricans" -- a common symptom of diabetes -- the dark skin signals the body's resistance to insulin. It's often the first inkling parents get their child either has or may be at risk to developing diabetes.

"When I first heard I was really surprised," said Delvin's mother, Senobia Arroyo, a Van Nuys housekeeper. "For me, his health is the most important thing."

The disease has altered their life. The single mother of two -- who has a family history of type 2 diabetes -- now cooks dinner every day, no matter how tired. She peels the skin of the chicken for Delvin and his 8-year-old sister and prepares lunches with salad and vegetables. And, despite sporadic pleas from Delvin, burgers from In-N-Out are out of the question.

Such a plan comes at a cost. Arroyo's grocery bills have doubled, and she struggles to stretch her paycheck. The $1 bag of potato chips she used to buy was half the price of a bag of Delvin's favorite Fiji apples. And the expensive fresh foods wilt or rot more quickly than canned foods she used to buy.

"At times, it's hard," she said. "We can't afford an amusement park anymore or things like that. It is worth it though."

Her gasoline bill has also spiked. Five times a week, she treks 30 miles across town to a Beverly Hills skyscraper, where her son attends Power Play, a Medi-Cal-covered weight-loss program for children.

Studies have shown that pre-diabetics who lose 5 to 10 pounds and exercise 30 minutes a day can reduce their chances of developing the disease by more than half.

Parents, school districts and private insurers, as well as federal and state governments sensitive to the disease's rising cost, are slowly beginning to pump millions of dollars into fitness programs like Power Play.

Inside a carpeted seventh-floor office overlooking Wilshire Boulevard, portly adolescents pedal exercise bicycles, catch weight balls and sweat away the pounds they have spent most of their childhood accumulating.

As Delvin holds the 15-pound weight over his head, trainer Thomas Martin, eggs the class of six on.

"Come on, all the way up," he says, as the children groan.

Dr. Lydia Hazan, founder of the program, estimates that six out of 10 of her clients are pre-diabetic.

Many regularly devour sodas and chips, weigh more than 200 pounds, rarely exercise and have diabetic parents.

"We have a crisis on our hand," Hazan said. "And we are behind the ball."

Delvin is one of the lucky ones. He got help early and is sticking to the program. Hazan said she has watched children 15 years old starting to go blind after failing to follow up with their diagnosis.

Clinic workers say it's not uncommon for patients to stray. Kiauni Martin, a 15-year-old sophomore at Fremont High School in South Los Angeles, never gave the idea a thought. Last year, a doctor diagnosed the 230-pound basketball player with type 2 diabetes.

She takes pills twice daily and must check her own blood level when she goes to bed and when she wakes. She has cut out Hot Cheetos and sour Gummy Bears and become an sort of informal ambassador of the disease at her school.

"I am doing this knowing that I will live another day," she said. "I want everyone to know it can be prevented, but if you have it you will be OK."

Rachel Uranga, (818) 713-3741   rachel.uranga@dailynews.com