My Child has Prediabetes! What Should I Do? How to Navigate This Serious Medical Concern

As a dietitian, I take the diagnosis of prediabetes in a child very seriously. When I receive a referral for another preteen with prediabetes, my heart sinks. I am concerned for the child's health in the long run. I worry that their age-appropriate immaturity will make lifestyle change less likely. I am concerned that parents balancing the many responsibilities of raising children might let this issue fall to the side.

Why Prediabetes in a Child is a Big Deal

Prediabetes is not a distinct phenomenon from type 2 diabetes. Blood sugar control is on a continuum. Normal glycemic control is at one end, prediabetes in in the middle, and diabetes is on the other end. Although the exact points where someone moves into prediabetes and then into diabetes are based on risk of disease progression and complications in populations, for an individual in question, there is no practical difference between values that are just before and just after the cutoffs for prediabetes and diabetes.

Sometimes parents tell me that it is not a concern yet, because their child does not have diabetes. I want these parents to understand that their child has the disease process of diabetes already underway, and they just have not crossed the threshold that in populations, is correlated with increased risk. Additionally, when a child has prediabetes, it is just a matter of time until that threshold is actually crossed.

Diabetes complications are also seen in some people while they still have prediabetes. If they do not have complications while still in prediabetes, when nothing is done, the natural course of the disease is to worsen. That means that prediabetes in a child is very likely to become diabetes.

The complications of diabetes are caused by the cumulative affects of elevated blood sugar over time. The concern of a blood sugar of 250 is not that right now it is elevated. Rather, it is a problem when blood sugars are elevated for months and years. The earlier a person starts to have elevated blood sugars, the younger they will be when they start to develop diabetes complications. If someone has prediabetes at age 10, they could likely have diabetes by age 18, and they may start to have complications by age 25 or 30.

To understand the serious nature of diabetes complications, I want to share them with you. Diabetes complications include kidney disease, needing dialysis, vision problems, blindness, nerve damage, needing limb amputations, heart attacks, strokes, cognitive decline, and hearing impairments. These are not problems that happen in rare instances. Most people with diabetes for a number of years will start to develop some of these complications.

What to do About Prediabetes in Your Child

As the caregiver, I want you to feel empowered to take good care of your child with prediabetes. There is a lot you can do, and you can help halt the progression of the disease and improve their numbers.

• Keep your child in the loop. Use age appropriate information to explain to your child what prediabetes is and how they can improve their health. If you are usure how to do this, enlist your child's healthcare providers.

• Get help. Ask your pediatrician to refer your child to an endocrinologist and dietitian. These healthcare professionals can guide you, answer the questions you have, and provide practical ideas to help improve your child's health.

• Do it as a family. Trying to change one child's health habits while keeping status quo for the other children is a recipe for failure and disaster. The family as a whole can become more active and improve nutrition.

• Adjust their environment. If your home has food that is not appropriate for your child and inadequate opportunities to be active, do what you can to make their environment more conducive to healthy behaviors. Don't purchase food that is not ideal for your child. Have healthy food available. Put them places where they can be active--take them to the playground or get simple sports equipment to play outside.

• Get all their caregivers on board. Talk to the adults who care for your child. This may be the child's other parent, their grandparents, relatives, teachers, and childcare providers. If they understand what your child needs, they will also be able to help your child.

• Keep a positive attitude. Keep the focus of health behavior change on how it is beneficial to your child and their body--it will make them stronger, give them more energy, and help them be healthy. No need to scare your child about diabetes complications.

Acting When Your Child Has Prediabetes

The most important thing you can do as the child's caregiver is to act. Don't ignore your child's prediabetes and hope it goes away. Don't wait until the numbers reach diabetes level to be concerned. Use this as an opportunity to adjust your family's habits and improve your child's health.