Teen learns to tackle Type 2 diabetes

Mariana Arellano likes to go to birthday parties as much as her high school pals. But when it comes to snacking, she doesn’t go anywhere near the soda, cookies or candy.

She waits for the sugar-free cake.

“My friends are always trying to make me feel included,” said Mariana, a 17-year-old junior at Coral Reef Senior High School in south Miami-Dade. “They make it easier being diabetic.”

Mariana is one of scores of teens learning to manage Type 2 diabetes — the most common form of diabetes, affecting 90 to 95 percent of the 26 million Americans with diabetes. With Type 2, the pancreas does not produce enough insulin or the body cannot process the insulin adequately. When that happens, the body’s cells cannot function properly, affecting the eyes, kidneys and increasing the risk of heart attack and stroke. The condition is a byproduct of America’s growing population of overweight and obese adults — and kids.

Mariana was diagnosed as prediabetic at 15. A sedentary lifestyle, coupled with a diet replete with sodas, chips, pizza and chicken nuggets, caught up to her. At 5 feet 5 inches tall, she weighed 135 pounds.

At first, Mariana didn’t pay too much attention to her diagnosis. Detecting Type 2 diabetes in children is difficult, as kids initially have no symptoms or mild symptoms, according to the Centers for Disease Control and Prevention.

“She went about her life as she normally did, even though she knew she had prediabetes,” said Martina Castro, Mariana’s mother, who works as a receptionist at an accounting office. “We started getting into fights about what she should be eating and what she shouldn’t.”

It all changed one day when Mariana began feeling light-headed at school.

“It was scary,” Mariana said. “My pinkies all the way up to my elbow would get numb, like they had fallen asleep. But they wouldn’t wake up.”

Mariana was sent to the emergency room at Jackson Memorial Hospital South, where she had her blood sugar tested. It was over 400, in the range of a diabetic coma. Normal blood sugar levels should be under 120.

She was no longer pre-diabetic. She was diabetic.

It was Mariana’s wake-up call.

She started seeing Dr. Janine Sanchez, director of pediatric diabetes at Jackson.

Sanchez’s message: Type 2 diabetes can be managed by exercising, eating well and maintaining a healthy weight. Historically, Type 2 diabetes affected older adults who had sedentary lifestyles. But it’s increasingly being diagnosed in overweight children, and taking a more aggressive form due to children’s changing bodies.

“Fifteen years ago, getting a young patient like Mariana was rare,” Sanchez said.

First thing to change for Mariana: her eating habits.

She began packing lunches for school, making turkey sandwiches with light mayo, rounding out her meal with fruit (kiwi and mango are her favorites) and veggies (carrot and celery sticks). Out: chips, cookies and lunchroom vending machines. In: protein, fruit, veggies and the salad bar.

“She started making different choices in her meals, ones that didn’t involve junk food,” Castro said.

Next up: Changing her sedentary lifestyle. Today, Mariana runs 1.5 miles from her house to the gym five days a week. At the gym, she lifts weights, runs on the treadmill and rides the stationary bikes.

She has lost more than five pounds.

More importantly, her health markers have dramatically improved. When she began working with Sanchez, Mariana’s blood sugar levels were off the charts, coming in at a whopping 11.9 percent through a hemoglobin A1C test, which measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated).

At 11.9 percent, Mariana’s rate was about twice the norm for diabetics. She was headed for serious health problems.

Today, her levels are at 6.7 percent.

Sanchez, who has worked with children managing their diabetes for more than 15 years, says Mariana’s improvement is rare. Less than 25 percent of her patients make that kind of dramatic change in their blood sugar levels.

“It unfortunately doesn’t happen enough,” Sanchez said.

Sanchez believes that Mariana, if she continues eating healthy and working out, can ultimately be weaned from insulin. Insulin can contribute to weight gain, loss of fatty tissue at the injection site and allergic reactions like swelling.

“Our goal is to get to the point where the diabetes disappears and get her off the insulin,’’ Sanchez said.

To keep off insulin, Mariana will have to continue her transformed ways. She has a lot of support — her parents and her twin brother Francisco are also on a low-carb and no-fat diet.

Still, it hasn’t been easy.

“The hardest thing was to go out with my friends to a restaurant and choose the right thing to eat,” Mariana said.

Her menu choices usually include a leafy salad or grilled chicken.

Dr. Alejandra Cordovez, a registered nutritionist at the Diabetes Research Institute at the University of Miami, says she has seen patients as young as 6 diagnosed with pre-diabetes. With younger children, how successful they are at sticking with their diet depends a lot on their parents, she said.

“Once they’re in their teens, they’re battling their parents in terms of independence,” Cordovez said. “It all depends on their state of mind.”

Today, Mariana, a rising senior, is working on applying to college. Her diabetes has become an incentive to stay in Florida, but Mariana says she won’t let it get in the way of her future.

“My parents have always wanted me to be independent, regardless of my diabetes,” she said.

This story was originally published May 20, 2013 at 6:16 PM.