Show The Herald Journal Logan Utah Tuesday April 22 2003 — C3 doaMes soaring among children BOSTON (AP)— Once a true medical oddity children with adult diabetes are becom- results from a misguided attack by die immune system on the insulin-makicells in the pancreas Victims stop making insulin completely so convert sugar to they cannot ’ energy But type 2 has always been a disease of people in their 50s 60s and beyond: Their bodies still make insulin just not enough They may go for years without realizing they have it i Around the country doctors rise in say Joslif’s childhood type 2 over die past decade U typical Is it because they are looking harder or doing a better job of separating type 2 from type 1 ? Not likely they say “It’s not because we missed a lot of cases” says Dr ng ing commonplace Doctors blame die twin evils of too much food and too little exercise and fear a tragic upswing in disastrous diabetic complications as this overweight generation reaches adulthood At hospitals everywhere boys and girls who range from chubby to hugely obese are being diagnosed in unprecedented numbers with type 2 diabetes Most are barely into their teens Some are as young as 6 This disease used to be called adult-onsdiabetes since it rarely occurred before middle age But over the past decade it has slowly become clear this is now a disease of the young as well Just how frequently is uncertain since nationwide statistics are still being gath- ered Nevertheless doctors are convinced they seethe leading edge of a dangerous shift one that will inevitably lead to kidney failure blindness heart attacks amputations and more as these young people live another 10 or 20 years with their diabetes “There is an epidemic of type 2 diabetes in youth absolutely" says Dr Lori Laf-f-el head of the pediatric unit at Boston’s Joslin Diabetes Center “Over the years we always saw an occasional child with type 2 It was a handful a year” But in the early ’90s the pattern changed Out of the blue it seemed large children usually accompanied by overweight parents began to show up with type 2 diabetes During the early ’90s Joslin’s totals increased five times Since then they have doubled again Until this shift almost all diabetes in children was type 1 what was called juvenile diabetes In many ways it is a different disease Type 1 10-fo- ld et Phillip Lee head of pediatric endocrinology at UCLA “We just didn’t see it Now referrals of type 2 are almost 50 percent of our diabetes cases” Why? Doctors have little doubt They blame inactivity and overeating The hours on end in front of the tube for instance and the sodas in school vending machines (Swilling four of those a day is nothing special for many kids one doctor notes and adds up to 1000 calories close to half of a boy’s daily needs all from sugar) Virtually all children with type 2 are overweight although this hardly makes ' them unique The Centers for Disease Qmtrol and Prevention recently estimated that 15 percent of all US children and teenagers — and nearly a quarter of black and Hispanic youngsters — weigh too 20-oun- : much Still the ones with diabetes tend to be especially big tall for their age and large all over Twelve-year-olweigh 250 pounds Invariably their parents are heavy too “These are not little kids” says Dr Morey Haymond head of diabetes care at Texas ds “If it Head Con inued from Cl said when an impact to the head causes the brain to hit against the skull forward to back or side to side If a player sustains a con-cussion and it's not recognized for what it is he or she can incur lifelong harm First of course the athlete may be paralyzed or even die on the spot With less severe concussion the athlete may suffer permanent or temporary deficits in thinking and move-meAnd yet even the less severe concussions deserve ' serious attention because the deficits in thinking and movement can be cumulative if they are not allowed time enough to heal However there is another less well known effect -- r- secondary impact syndrome a delayed sceversion of the: worst-cas- e nario If a person has a second concussion before the first is completely healed it may be mortal “You are at risk with a sec- ond concussion Even a minor hit to the head it can cause huge swelling in all the blood vessels in your brain and you die within minutes It’s 100 percent mortality It’s irre- nt versible” Finoff asserted “People think of concussion as a minor injury ‘OK you’ve rung your bell shake it off go on out there’ The people who are saying that are putting that athlete at risk of death” But concussions are tough to identify The person may or may not lose consciousness may or may not show a change in their thinking or cognition may or may not have obvious motor difficulties There is also the common belief that you can tell if it’s serious by looking at the size of the person’s pupils: If they differ from each other in size or reaction to light the common wisdom goes that spells trouble It does spell trouble said Finoff but it will not help diagnose concussion ‘ causes your pupils to blow on one side that’s somebody who’s about to die Looking at the pupils is not a sensitive indicator” he said According to Mildenberget USU’s head athletic trainer ' for 28 years most athletic trainers use no objective criteria at all to judge whether a player coming off the field has sustained a concussion “The reason is that there is no faith in the criteria that are out there” he explained Mildenberger and Finoff traded off summarizing the confusing situation Fourteen different protocols have been proposed since 1973 The three most widely used to grade severity of concussion not only use different criteria but conflict in interpreting tfie severity As if that weren’t confusing enough all three differ in judging whether and how long to keep a play out varying between 15 minutes and seven days In contrast the a Finoff-Mildenberg- er protocol calls for measuring neuro-cognitifunction such as concentra- tion short-ter- m and long-tomemory and orientation yvith two simple tests Then after a recovery period those tests are used again to determine “functional return” that is when the athlete may play again The Standard Assessment of Concussion (SAC) test was created by Michael McCrea a neuropsychologist Although no one bills it as a substitute for a neuropsychological evaluation it is a practical tool for sideline use said Finoff and Mildenberger And instead of costing $1000 pa athlete $100 covers all 285 USU varsity athletes But just as important as cost is the sensitivity of the test They cited a recent study which looked at 33 suspected concussions in 568 athletes The preliminary evaluation that would have been performed under the otha concussion protocols were normal “So all those people would have been allowed to return to play that day But three of ve m full-fledg- ed Children’s Hospital “Even the is a big kid for his age” Nearly all of them have a skin condition called acanthosis nigricans velvety dirty-lookidark patches around the neck and other skin folds They are a sign of insulin resistance an inability to respond efficiently to insulin which is common in the overng weight In girls the insulin resistance often triggers hormone upsets that result in facial hair acne and ovarian cysts Young blacks and Hispanics have more of this kind of diabetes than do whites Their extra weight alone may ' explain some of it although expats believe these minori- ‘ ties also may have an extra genetic tendency toward diabetes that is compounded by their weight Many who do not have outright diabetes still have abnormalities that put them at high risk for diabetes Doctors estimate that for every youngster with type 2 four or five others have what’s called syndrome X or metabolic syndrome a combination of obesity insulin resistance bad cholesterol counts high triglycerides and high blood pressure “Unless we make a significant alteration in their lifestyles they will likely Cesar Lopez 8 right arid Valentino Marron 11 left participate in an exercise program for overweight at Children's Hospital Los Angeles Some of the children in the program have diabetes children “The horizon is really progress to a deteriorating course of insulin resistance and diabetes” Kaufman Francine Dr says chief at Chilendocrinology dren’s Hospital Los Angeles and president of the American dark” says Dr Jorge Calles-Escand- on a Wake Forest Uni- -' versify endocrinologist “We know what happens to adults pre-diabe- with type 2 diabetes who don’t take care of it properly They die prematurely They have heart attacks strokes blindness renal failure There is no reason to believe this will be different for adoles- Diabetes Association Adults with type 2 diabetes face many complications that shorten or worsen their lives although these can be reduced or prevented with medicines weight loss and exercise Since the problem is so new no one knows exactly what will befall those who start the disease in their teens rather than their 50s But many fear the complications will emerge in early adulthood cents” One follow-u- p study sug- gests he is right Researchers from the University of Manitoba tracked down 5 1 people ' mostly in their 20s and 30s who had been diagnosed with type 2 diabetes as children Two had died on kidney dialy sis and three otherswere still on it One woman had lost a toe to amputation while another had gone blind In an attempt to find out how many young Americans actually have the disease the CDC will count all the diabetes cases among 6 million people under age 20 for five years It expects 6000 to have it at the start and 800 more to be diaghosed annually 30 percent of them type 2 “Whatever we get will be an underestimate of the true disease” says the CDC's Dr Desmond Williams since the study will not go looking for youngsters with diabetes only of-the- ' record those who come to doctors' attention The diabetes association recommends testing children for type 2 diabetes if they are overweight and have two other risk factors such as a parent with the disease signs of insulin resistance or if they are black Hispanic or Ameti-ca- n Indian Nevertheless outside of big hospital obesity clinics experts say this kind of testing is rare Pediatricians and fanti- ly physicians simply are not trained to think about adult diabetes in the young and without obvious symptoms children are likely to be missed 1 them had a reduction in their SAC test showing they were cognitively affected” said Finoff Another study identified 36 people with concussions who had normal neuropsychological testing on the sideline but all of them had abnormalities of balance That is where the second part of Finoff’s and Mildenboga's protocol comes in: the Balance Error Scoring System (BESS) developed at the University of North Carolina Athletes take three consecutive stances with eyes dosed first on a firm surface and then on a foam surface which is more difficult The whole test takes only four or five minutes to do and all the trainer needs to take to the field is a piece of foam These objective tests require baseline information Mildenberger said baseline testing with SAC and BESS methods takes only 10 to 15 minutgs per athlete so about 30 hours for USU athletes and about 8 hours pa year as new athletes come in Then they set up the baseline scores on a spreadsheet that accompanies the trainer to the field The third part of their concussion protocol is judging whether the athlete has recovered enough to return to play And naturally the system must include after-car- e if an athlete is sidelined with a con- - cussion Mildenberga said that the practice nationwide is often to send the concussed athlete home completely on his or ha own ' Their protocol calls for reliathlete a to releasing the able person possibly a roommate whom they educate about do’s and don’ts to help recuperation Finoff and Mildenberga presented their protocol twice this winter once at the National Association of Athletic Trainers Symposium in Bozeman Mont and once at a Rocky Mountain Trainers seminar in Ogden with calls for further presentations Because it is equally practicable at a high school level they presented their system atPre- -' stop High School last week AP Photo - : Four eyes twice for one great price! 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