Absolutely! Katy Q&A: Endocrinology and Diabetes

 Experts: Dr. Tracy Patel, Dr. Lynda Lin and Robyn Klenk, NP from pediatric endocrinology at Texas Children’s Hospital West Campus.

 Endocrine related illnesses impact more than just overweight children. Though the obesity epidemic in children is an unfortunate reality and more children than ever are facing adult-like

diseases such as type 2 diabetes, there are a number of other disorders related to the endocrine system that could have a detrimental impact on children that parents should be aware of.

Q: What is a pediatric endocrinologist?

A pediatric endocrinologist is a medical subspecialist who focuses on the evaluation and treatment of children of all ages who have diseases and disorders of the endocrine system.

Q: What common illnesses and diseases does the Endocrinology/Diabetes Clinic at Texas Children’s Hospital West Campus treat?

One of the most common diseases we treat is diabetes. We also evaluate, diagnose, treat and conduct follow up care for patients with a variety of other endocrine disorders, such as growth and pubertal problems, congenital adrenal hyperplasia, hypoglycemia, thyroid disease and hyper- and hypocalcemia.

Q: What’s the difference between Type 1 and Type 2 diabetes?

Dr. Robyn Klenk

In children with Type 1 diabetes, the pancreas does not produce insulin, a hormone which is necessary to maintain a normal blood glucose level. This deficiency of insulin results in hyperglycemia – or high blood sugar. In Type 2 diabetes a child’s body is insulin resistant – in other words, the body does not respond to the insulin that is being made.

Type 1 diabetes is more common in children and symptoms include fatigue, frequent urination (including bedwetting), extreme thirst and hunger, as well as unexplained weight loss.

Type 2 diabetes occurs more often in those who are overweight or obese. It is commonly diagnosed in adults, but with the rise in childhood obesity, it is now being diagnosed in children and adolescents. It has been found to be hereditary and certain ethnic groups have a higher risk of developing Type 2 diabetes. Specifically, those of African-American, Mexican-American, American Indian or Asian/Pacific Islander descent have a higher risk than other ethnicities.

Symptoms of Type 2 diabetes are similar to those of symptoms of Type 1. A major clinical feature associated with Type 2 diabetes, which is not shared with Type 1, is acanthosis nigricans – a darkening and thickening of the skin around the neck or under the arms that won’t wash off.  This is a sign of insulin resistance.

 Q: What is a normal blood sugar level for my child? How is my child screened for or diagnose with diabetes?

Your child’s blood sugar levels can vary depending on whether they have been fasting or have recently eaten. Some common tests used to screen for diabetes are:

Fasting Blood Sugar (Fasting is considered as having no food or beverage, except water, for eight hours.)

A normal fasting blood sugar is between 70 and 100 milligrams per deciliter (mg/dL).

A fasting blood sugar between 100 and 126 mg/dL could indicate prediabetes or impaired glucose tolerance.

A fasting blood sugar greater than 126 mg/dL may indicate a diagnosis of diabetes and needs to be further evaluated.

Hemoglobin A1c (HbA1c): This is a blood test that reflects your child’s average blood sugar level over the past three months. For patients with diabetes, this test demonstrates how well your child’s blood sugar is being controlled.

Two Hour Oral Glucose Tolerance Test (OGTT): This is the gold standard test to make the diagnosis of diabetes. It is typically done in the morning after eight hours of fasting. A standard dose of glucose is ingested by mouth and blood levels are checked two hours later.

Talk to your pediatrician if you have questions or concerns about your child’s blood sugar or ask to be referred to a pediatric endocrinologist.

Q: How do I know if my child has a growth hormone disorder?

Growth hormone is produced by the pituitary gland in the brain. If too much growth hormone is being produced, this could cause your child to have accelerated growth. Signs and symptoms of growth hormone excess include being at a higher growth percentile for their age, glucose intolerance/insulin resistance, high blood pressure, sleep apnea and potential bone issues.

Alternatively, if your child’s pituitary gland is not making adequate amounts of growth hormone, they experience poor growth rate and tend to be at the lower growth percentile for their age.  Other symptoms could include increased fat around the midsection and face, delayed onset of puberty and delayed tooth development.

Your pediatric endocrinologist can help evaluate, diagnose and address any issues your child may have with regards to growth.

Q: What is the difference between hypo- and hyperthyroidism?

Both are disorders of the thyroid gland. Thyroid hormone functions to regulate the body’s metabolic processes. In children, it also plays an important role in growth and development.

In children with hypothyroidism, the thyroid gland does not produce enough thyroid hormone.  Children with hypothyroidism experience fatigue, constipation, cold intolerance, poor growth and weight gain, among other symptoms.

Children with hyperthyroidism produce excessive amounts of thyroid hormone. These children can experience fatigue, diarrhea, heat intolerance, weight loss and anxiety.

If you are concerned about any of your child’s potential symptoms ask your pediatrician to refer you to a pediatric endocrinologist or call the Endocrinology/Diabetes Clinic at