Increasingly type 2 diabetes is being diagnosed in obese adolescents especially those who are predisposed by family history or ethnicity.

Strong family history, female sex, IUGR(small bay due to intrauterine growth retardation) and uncontrolled gestational diabetes in mother are risk factors for adolescent type 2 diabetes.

>50% of these teenagers are at risk of metabolic syndrome in young adulthood with high lipid levels, hypertension, CV diseases and early onset myocardial infarction.

Adolescents diabetics are often asymptomatic and picked up during routine evaluation
Typical presentation can be with polyuria, polydipsia and generalised ill feeling, weakness and fatigue. 80% present with pigmentation around neck. Sores and cuts that heal slowly, dry itchy skin

Treatment of diabetes – oral drugs like metformin are effective, insulin may be required, diet should have 30% fat, 50% carb and rest protein. Blood glucose should be regularly monitored
Regular exercise and reduction of weight to achieve ideal goals is very essential.
Causes of hyperglycemia in patients under treatment –  insufficient dose of medication, illness, infection, overeating, emotional stress.

Causes of hypoglycemia –  Excess dose of medication, eating too little or skipping meals, diarrhea, vomiting, emotional stress. Symptoms include hunger , irritability, headache, weakness, rapid pulse , palpitation cramps, convulsions, loss of bladder control and loss of consciousness.

Importance of physical activity
Regular physical activity is important for good health, especially if you’re trying to lose weight or to maintain a healthy weight.

• Increased physical activity burns more calories coupled with decreased caloric intake makes you lose weight.
• Most weight loss occurs because of decreased caloric intake. However, evidence shows the only way to maintain weight loss is to be engaged in regular physical activity.
• Most importantly, physical activity reduces risks of cardiovascular disease and diabetes beyond that produced by weight reduction alone.

Physical activity also helps to :

• Maintain weight.
• Reduce high blood pressure.
• Reduce risk for type 2 diabetes, heart attack, stroke, and several forms of cancer.
• Reduce arthritis pain and associated disability.
• Reduce risk for osteoporosis and falls.
• Reduce symptoms of depression and anxiety.

Getting Started with Physical Activity for a Healthy Weight
any precautions to take before becoming more active?
People with chronic diseases, such as a heart condition, arthritis, diabetes, or high blood pressure, should talk to their doctor about what types and amounts of physical activity are appropriate.

Get Motivated!

• Look for opportunities to reduce sedentary time and to increase active time. For example,
• Set aside specific times for physical activity in your schedule to make it part of your daily or weekly routine.
• Start with activities, locations, and times you enjoy. For example, some people might like walking in their neighbourhood in the mornings; others might prefer an exercise class at a health club after work.
• Try activities with friends or family members to help with motivation and mutual encouragement.
• Start slowly and work your way up to more physically challenging activities. For many people, walking is a particularly good place to begin.
• When necessary, break up your daily activity goal into smaller amounts of time. For example, you could break the 30-minute a day recommendation into three 10-minute sessions or two 15-minute sessions. Just make sure the shorter sessions are at least 10 minutes long.

Strategies for Overcoming Obstacles to Physical Activity
If you’re just getting started, you might face certain obstacles that seem difficult to overcome. A few examples of common obstacles and strategies for overcoming them are shown in the following table.

Get the entire family moving
With the participation in all types of physical activity declining dramatically as a child’s age and grade in school increases, it is important that physical activity be a part of regular family life. Studies have shown than lifestyles learned as children are much more likely to stay with a person into adulthood. If sports and physical activities are a family priority, they will provide children and parents with a strong foundation for a lifetime of health.

Benefits to the body

• Builds and maintains healthy bones, joints and muscles
• Controls weight and body fat
• Improves appearance
• Increases muscle strength, endurance and flexibility
• Improves ability to fall asleep quickly and sleep well
• Reduce risk of diabetes, high blood pressure and heart disease later in life
• Builds and improves athletic skills

Mental Benefits

• Increases enthusiasm and optimism
• Organized sports foster team work and friendship
• Boosts self-esteem
• Reduced anxiety, tension and depression

10 Steps to Better Health for Kids

• Start your day with breakfast
• Drink lots of water
• Eat 5 or more fruits and vegetables every day
• Make your snacks healthy
• Don’t overeat – beware of portion distortion
• If you drink milk make it low-fat or non-fat
• Get active for an hour every day – do what moves for you: walk, swim, bike, dance
• Spend less time on your computer, watching TV or playing video games
• Treat your body right – it lasts a lifetime
• Volunteer – it gets you moving and feels great

Encourage your child to be physically active?
“Content Source: American Academy of Pediatrics.”

Did you Know?

• Children on average spend nearly 3 hours a day watching TV
• Very few children and teens, aged 12 to 21 regularly exercise
• Physical education is rarely mandated to be offered in schools
• More than 15% of all school children are considered overweight
• Overweight teens have a 70% chance of becoming overweight or obese adults
• 85% of children diagnosed with type 2 diabetes are either overweight or obese
• Sleep apnea occurs in approximately 7% of the children who are obese

What is Influenza (Flu)?
The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness.
Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.

Symptoms of Flu
Symptoms of flu include:

• Fever (usually high) , headache , extreme tiredness , dry cough , sore throat
• Runny or stuffy nose, muscle aches
• Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

Complications of Flu
Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

How Flu Spreads
Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Preventing Flu: Get Vaccinated
Key Facts About Flu Vaccine
The single best way to protect against the flu is to get vaccinated each year.

The “flu shot”-is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months.

Each vaccine contains three influenza viruses-one A (H3N2) virus, one A (H1N1) virus, and one B virus. The viruses in the vaccine change each year based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year.

About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

Note: This vaccine is available in India.

When to Get Vaccinated
October through February is the ideal time to get vaccinated.

Who Should Get Vaccinated
In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, it is recommended that certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications.

People who should get vaccinated each year are:

• People at high risk for complications from the flu, including:

• Children aged 6 months until their 5th birthday.
• Pregnant women.
• People 50 years of age and older.
• People of any age with certain chronic medical conditions.
• People who live in nursing homes and other long term care facilities.

• People who live with or care for those at high risk for complications from flu, including:

• Household contacts of persons at high risk for complications from the flu
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
• Healthcare workers.

Who Should Not Be Vaccinated
There are some people who should not be vaccinated without first consulting a physician. These include.

People who have a severe allergy to chicken eggs , People who have had a severe reaction to an influenza vaccination in the past , People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously, Influenza vaccine is not approved for use in children less than 6 months of age, People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

Vaccine Effectiveness
The ability of flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or “match” between the virus strains in the vaccine and those in circulation.

Vaccine Side Effects (What to Expect)
Different side effects can be associated with the flu shot and LAIV.
The flu shot: The viruses in the flu shot are inactivated, so you cannot get the flu from a flu shot.

Some minor side effects that could occur are

• Soreness, redness, or swelling where the shot was given
• Fever (low grade)
• Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no problems from it.