How to spot and treat prediabetes in kids

Prediabetes, the precursor to type 2 diabetes is on the rise in teens. According to a 2023 study by the Centers for Disease Control and Prevention (CDC), 1 in 3 teens in the U.S. has prediabetes.

Luckily, lifestyle changes can be enough to stop and even reverse the disease.

“Helping your child form healthy food and exercise habits at an early age is the best way to reduce their risk of prediabetes,” says Dr. Sowmya Krishnan, M.D., a pediatric endocrinologist with Children’s Health℠ and a professor at UT Southwestern Medical center. “But if you suspect they’re already at higher risk for prediabetes, talk to your doctor right away – early intervention is key to avoiding long-term health issues.”

Understanding prediabetes and diabetes

Diabetes is a disease affecting how the body processes food, specifically sugars. Without proper treatment, it causes high levels of sugar in the bloodstream, which can lead to serious problems like heart disease, stroke, kidney damage, amputations and vision problems.

There are two types of diabetes:

1. Type 1: This autoimmune disorder cannot be prevented or cured and may develop at any age. With this form of diabetes, the body cannot produce insulin, a hormone that helps process sugar (glucose). People with type 1 diabetes need to take insulin for their lifetime.

2. Type 2: This metabolic disorder can be prevented but there is no cure. With this form of diabetes, the body is able to produce some insulin but might not make enough of it or may not use it correctly. Regular medication or insulin injections are needed to keep blood sugar levels under control.

Prediabetes is when the body is having trouble making or using insulin. Blood sugar levels are higher than they should be, but not yet high enough to be considered type 2 diabetes. If left untreated, prediabetes typically develops into type 2 diabetes, but improving diet, exercise and overall health can help stop or reverse the disease.

“Our goal is to give patients the tools they need to stop their prediabetes from progressing,” explains Kristina Cantu, M.D., an endocrinology fellow at Children’s Health. “Fortunately, even small lifestyle changes can make a big difference. We have many resources available to support families who want to help their child lose weight, feel better and live a healthier life.”

How to spot prediabetes

Prediabetes typically develops without warning signs, so it’s important to be aware of who is at risk.

Prediabetes risk factors

Children and young adults who are overweight or obese are at higher risk for prediabetes.

Other risk factors include:

• Unhealthy diet. Eating too many processed foods that are high in fat and sugar, like candy, chips and sodas.

• Lack of exercise. Not getting enough physical activity on a regular basis.

• Family history. If family members have type 2 diabetes or if the child’s mother had gestational diabetes during pregnancy.

Prediabetes symptoms

Prediabetes is tricky to spot because there are usually no symptoms. If you think your child might be at risk, be sure to see your doctor for routine checkups and ask them about prediabetes screening. Simple blood tests can help determine your child’s risk.

Some children with prediabetes have darkening or thickening of skin around creases, like on the neck, armpits, knuckles or between fingers. This is called acanthosis nigricans and it may indicate insulin resistance. Let your doctor know if you see this kind of change on your child’s skin. It can be helpful to keep a journal of any changes you notice and when they first appeared.

If prediabetes isn’t caught early and progresses to type 2 diabetes, symptoms become more obvious. See your doctor right away if your child has:

• Blurry vision

• Weight loss without trying

• Increased thirst or hunger

• Increased urination

• Sores or infections that are slow to heal

• Extreme tiredness (fatigue)

How is prediabetes diagnosed?

A prediabetes diagnosis is confirmed based on results from blood tests that can easily be performed in your doctor’s office or a lab. However, unless a child is overweight or has symptoms, screening for diabetes isn’t a standard part of routine well-child checks. That’s why it’s important to talk to your doctor if your child has other risk factors.

Screening tests include:

• A1C test. The most common prediabetes test that measures average blood sugar levels over the past 3 months. An A1C below 5.7% is normal; 5.7-6.4% is the range for prediabetes.

• Fasting plasma glucose (FPG) test. Checks blood sugar levels after not eating for 8 hours.

• Random plasma glucose (RPG) test. Checks blood sugar levels at any time of day, regardless of food intake.

• Oral glucose tolerance test (OGTT). Tests how much sugar is in the blood before and after drinking a sugary drink.

If your child doesn’t have prediabetes but is at increased risk for the disease, your doctor will want you to keep up with regular checkups.

How to treat prediabetes

The best way to treat prediabetes is by making healthy lifestyle changes that will help manage or reverse the condition.

• Weight loss and management. Ask your child’s doctor what a healthy weight range is for your child’s height and build. Weight control is less about reaching a certain number and more about making sure your child’s weight isn’t limiting their activity level or compromising their overall health.

• Eat a balanced diet. Fuel your child’s body with nutritionally rich foods like lean meats and dairy, whole grains, fruits and vegetables.

• Eat less junk food. Avoid foods like candy and sweetened drinks that are high in sugar and low in nutrients.

• Increase activity. Exercise lowers blood sugar and helps your child’s body use insulin more effectively. Make physical exercise a regular part of the day by going to a park, playing a sport or even just by being more active around the house. Most organizations recommend 1 hour of moderate physical activity every day for children between 6-19 years of age.

It can feel hard for kids to make big changes all at once, so starting with small, manageable goals is a good approach. For example, start by replacing one soda with flavored seltzer water or offering apple slices and peanut butter rather than potato chips for a snack.

If diet and exercise changes aren’t enough to manage your child’s prediabetes, your doctor may also talk to you about medications that can help treat the condition.

How to support a child with prediabetes

It’s much easier for children to change their diet and exercise habits if their whole family is making the changes with them.

Adding more activity and nutritional meals into your family’s day-to-day life can be a great way to bond, have fun together and improve everyone’s overall health. It will also set your child up to make healthier lifestyle choices as an adult. There are many ways to do this, including:

• Be active together. You don’t have to go to a gym to get exercise. You can do simple, fun activities together like taking a walk after dinner, following along to a dance video or playing at a playground.

• Make it easy to choose healthy foods. Set your child up for success by limiting the amount of junk food and sugary beverages that are available in the house. You may enjoy shopping and cooking together as a family.

• Incorporate healthy eating habits. Try to sit down for meals together whenever possible and serve reasonable portions. Cut back on mindless snacking, such as while watching TV.

• Keep a positive attitude. Promote diet and exercise changes as a way to feel stronger and healthier, rather than focusing on weight loss or fitting into smaller clothes.

Other resources available

Children’s Health offers many programs designed to help families make healthy lifestyle changes.

• Get Up & Go. A variety of programs that encourage kids and their families to improve their food and exercise habits.

• COACH Program for Childhood Obesity and Weight Management. The Center for Obesity and its Consequences in Health (COACH) offers the only comprehensive childhood obesity program in North Texas. It is dedicated to improving the health and wellness of children with obesity and weight-related complications.

• Children’s Health Clinical Nutrition. As one of the largest pediatric nutrition teams in the region, the registered dietitians at Children’s Health offer expert help to families who have special dietary needs or goals.

Learn more

Schedule a consultation with a pediatrician to discuss your child's risk factors and get appropriate screening. Children's Health Primary Care offers comprehensive health care for children from birth through young adulthood. Our pediatricians combine quality, compassionate care with evidence-based practice to meet your child's medical needs. Learn more and find a pediatrician.

Children’s Health Endocrinology specializes in hormone-related conditions, including pediatric diabetes. Learn more and find an endocrinologist.