On learning she had Type 2 diabetes and would need to adopt a healthy diet for the rest of her life, Lavon Swygert did the only thing that felt natural.
The 13-year-old hid at home and gorged on potato chips.
"I'm not going to lie," she said. "There were, like, 12 little packs of Pringles."
Lavon's response underscores why doctors are so troubled by the sharp increase in Type 2 diabetes that is emerging among Minnesota adolescents and teens. It reveals the medical toll that doctors have long feared from the nation's youth obesity epidemic. Worse, it pairs a disorder that can be managed only by disciplined diet and exercise with a young, impulsive population that likes to snack.
More than 20,000 adolescents and teens in the United States now have Type 2 diabetes, compared with almost none 20 years ago. And the worst might be ahead. Diagnoses of the disease among young people could climb 400 percent by 2050, according to a federal estimate released this month, because the disease is tied to the rising rate of childhood obesity.
Type 2 diabetes, diagnosed mainly in adults until now, is the gradual erosion of the body's production of insulin, which leaves excess sugar in the bloodstream and gives rise to a host of complications and organ failures. It's among a growing number of adult health problems that are increasingly afflicting kids, including hypertension and high cholesterol.
"It's like your child has the body of a 70-year-old man," said Dr. Claudia Fox, an obesity specialist at the University of Minnesota Amplatz Children's Hospital.
Part of the problem is that Type 2 diabetes often comes with relatively few initial symptoms, so teens can go years without a diagnosis. Even when the problem is discovered, as in Lavon's case, teenagers often don't initially feel the consequences of straying from diets and treatments.
"Adolescence ... is difficult, regardless," said Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association. "So this regimentation that is expected of diabetes patients becomes even more difficult."
Trouble is, there is growing evidence that the disease has a "memory effect," so that early neglect produces complications years later. Researchers at the University of Minnesota are currently looking for ways to motivate diabetic teens to take better care of themselves.
"We are very concerned [that] as these children age," Ratner said, "we are going to see a remarkably increased rate of cardiovascular disease and kidney disease and eye disease."
Hundreds of kids?
Children have long been diagnosed with Type 1 diabetes, an autoimmune disease in which the body produces no insulin to remove sugar from the bloodstream. Cases of that disease are on the rise as well, for reasons that aren't fully understood.
But there is little confusion over the emergence of Type 2: Obesity is the culprit. The broad availability of fast food and high-fat meals, combined with inactive lifestyles, has pushed Minnesota's rate of obese kids from 15 percent in 1995 to 25 percent today.
The toll of the disease is often harshest on children in poverty who can't afford good food or medical care. One measure is the number of Minnesota children taking metformin, a pill that controls blood sugar by suppressing the liver's glucose production. A decade ago, only four children receiving fee-for-service Medicaid benefits in Minnesota took metformin for diabetes. Now, the number is more than 270.
Lavon's case shows how poverty can complicate the disease. Her mother, Amy Pike, can't work due to a disability, so the family is homeless and staying with friends in Anoka. Many healthy foods are unaffordable, especially at the end of the month, when the family is out of food stamps.
Lavon said school lunches aren't always the healthiest. She often breaks up chicken wraps to eat just the lettuce.
Whether Lavon makes her doctors' appointments depends on whether her mom has money to gas up the car.
"How do you help that, you know?" said Fox, who diagnosed Lavon last summer at the U obesity clinic. "And she's just one of the kids. ... There are probably hundreds of kids who are homeless who use [convenience stores] as their kitchen" and don't know they have diabetes or are at risk for it.
Fox worries about new patients like Lavon. Half never return to the obesity clinic after their first visit. Some doubt they can follow the doctor's orders. Others feel ashamed, a big obstacle to treatment. Parents feel humiliated, thinking they caused their children to suffer the disease.
But blaming parents and kids, especially those in poverty, is wrong, Ratner said. "Society doesn't view Type 2 diabetes as a serious disease, but rather as a self-inflicted disease. That is very unfair."
Lose a foot?
Lavon is a natural storyteller, whether she is talking or drawing. She feels comfortable discussing diabetes with friends but gets hurt by whispers and "fat jokes" around the Anoka Middle School for the Arts.
Her mom and sisters try blunt humor to scare her into good health. When caught eating bad foods, Lavon hears, "You're going to lose your foot!" It's a reference to the circulatory problems and amputations that can result when diabetes isn't managed.
"You think about someone losing a foot, you think about veterans," Lavon said.
The lack of symptoms makes discipline difficult, she admitted; on Halloween she inhaled Reese's Peanut Butter Cups after taking her sister trick-or-treating.
"It is a serious disease," Lavon said.
"But you don't take it seriously," her mom exclaimed.
Around Thanksgiving, Lavon snuck a few chocolates and felt "like my stomach was caving in on itself." Whether it was diabetes or plain indigestion, it was one of the first times Lavon was scared by her own health.
Even so, she hasn't returned to the obesity clinic. She fears the finger prick of the glucose monitoring device, so she doesn't use that either.
Doctors have seen these struggles for years in children with Type 1 diabetes, as they become teenagers and take control of their own diets. Adolescents often feel a "why-me" self-pity that hinders good decision-making, said Dr. Brandon Nathan, a U specialist in childhood diabetes. He is testing a new online approach to teach and motivate children with Type 1 diabetes to take charge of their care and hopes it could work for children with Type 2 diabetes as well.
There are some signs of hope. Evidence suggests that Minnesota's child obesity rate has plateaued, and a recent national report found declining obesity rates in New York and other major cities.
Preventing diabetes in children is critical, Ratner said, because many adult treatments don't work for them.
A national study, nicknamed TODAY, showed that many children with Type 2 diabetes needed insulin injections because metformin and lifestyle changes didn't work. The problem is, insulin has the side effect of added weight gain.
Jeremy Olson • 612-673-7744