Ellie Figueroa, 18, knows about the risks of diabetes.

      Complications of the disease killed her grandmother at 67. Diabetes was the reason her friend's mother had a toe amputated; it is slowly making another family friend go blind.

      But when Ellie was diagnosed with diabetes at 16, she was in such denial, she recalled recently, that after a few months she stopped injecting herself with the insulin her doctor prescribed. It was six months before she told her doctor -- six months of high blood-sugar levels working the slow damage that, over time, makes diabetics prone to heart disease, blindness, nerve damage and other complications.

      Ellie could get by without insulin -- avoiding immediate harm but increasing her long-term risk -- because, like a growing number of children and adolescents, she has Type 2 diabetes, the kind that until recently was called ``adult-onset'' because it almost never struck young people. In Type 1 diabetes, the body completely ceases to make insulin -- a hormone vital to controlling sugar levels in the bloodstream -- and stopping injections could land a patient in the hospital within hours. But people with Type 2 often have no symptoms because their bodies produce at least some insulin. As a result, they can go undiagnosed until complications strike.

      ``I wish I felt bad. I wish I felt some symptoms,'' Figueroa said on a recent Friday night, as she juggled cell phone calls from her friends from Lawrence High School and sparred with her mother over whether or not she eats too many french fries.

      If her diabetes announced itself more aggressively, she said, that might help her stick more closely to her doctors' advice to exercise, cut back on fat and carbohydrates, and monitor her blood sugar. But, as it is, part of her still doesn't believe she has a disease: ``You question in your mind: `Are these doctors, like, playing with me here?' ''

      The difficulty of remaking a teenage life based on an abstract future risk is just one of the challenges facing Ellie and other young people who are part of what doctors call one of the most alarming -- and most preventable -- trends in children's health.

      Over the last 20 years, Type 2 diabetes has increased approximately tenfold among children and adolescents. Diabetes specialists are calling the increase an epidemic, driven by a rise in childhood obesity. For the one in four children who are now overweight, the extra weight tends to overtax the body's insulin-making machinery. And doctors fear that in 20 years, the Type 2 cases being diagnosed today will produce a generation of young adults with advanced diabetes complications -- cardiovascular disease, kidney failure, amputations.

      The good news is that weight control and exercise can prevent most cases of Type 2 diabetes, and can stabilize or even cure it in its early stages. But, while young people may have the most to lose, they also face particular hurdles in dealing with Type 2 diabetes.

      Testing of medications in children hasn't kept pace with the mushrooming epidemic, so most children with Type 2 are treated with insulin shots, even though many adults have access to the less onerous option of oral medication. Fast-food and soda advertisements target children, while school cafeterias offer few healthy options and physical education programs have been cut.

      The slowly progressing nature of the disease makes it hard to motivate adults -- let alone children and teenagers -- to view it as enough of an emergency to warrant difficult lifestyle changes, said Dr. Lori Laffel, director of pediatric and adolescent diabetes care at the Joslin Diabetes Center.

      And the stakes are high. A study presented in June to the American Diabetes Association found that of 51 Native American teenagers diagnosed with Type 2 before age 17, by their early 30s, three had kidney failure, one was blind, and two had died of heart attacks while on dialysis.

      ``If you're talking about children beginning at age 10, then by age 30, at the very height of reproductive and creative and work life, is when they'll be facing those kinds of life-threatening problems,'' said Vivien Morris, director of the Massachusetts Overweight Prevention and Control Initiative, part of a group of public-health advocates, schools and insurers that last month launched a plan to survey the extent of the problem in Massachusetts and improve screening efforts and educational programs.

      There are no national data on how many children are affected by Type 2, but the anecdotal evidence is everywhere. Researchers have put the figure between 8 and 45 percent of children with diabetes, depending on what population is studied. Black, Latino, Native American and Asian children are at higher risk, as are those with a family history of diabetes, but the strongest determining factor is weight: 85 percent of children diagnosed with Type 2 are overweight.

      Type 2 now accounts for up to 15 percent of pediatric diabetes patients at Children's Hospital in Boston, and 10 percent at Joslin Diabetes Center up from a tiny handful 10 years ago. At a recent diabetes-prevention class at the Charles Sumner Elementary School in Roslindale, an educator from the Greater Boston Diabetes Society asked 20 fourth-graders if they had a relative or friend with diabetes, and nearly every hand shot up.

      There is an urgent need for such prevention programs, a group of Massachusetts health groups concluded last month. But designing them is challenging: Nutritionists want to spread healthy messages without embarrassing overweight children. And they have to combat the double bind that teenagers -- especially girls -- face in finding the right attitude toward food.

      ``Images of female beauty have become thinner and thinner, through the media, and, on the other hand, the media is pushing increased consumption of high-calorie foods continuously,'' said Dr. David Ludwig, director of the Optimal Weight for Life program at Children's Hospital. ``It's really a recipe for disordered body image and poor self-esteem.''

      Another challenge, he said, is for parents to strike the right balance between setting dietary limits and examples, and letting older children make age-appropriate decisions.

      All these issues are on display at the Figueroa household, where Ellie's diagnosis was followed by the discovery that her father, Evangelio, also had Type 2 diabetes. Ellie's mother, Marisa, a computer technician, tries to help. She makes a low-fat version of her husband's favorite rice and beans. She offers to take Ellie to the gym with her earlier in the morning.

      But, on a busy Friday night, the two are wrangling, with Ellie defending what she calls her gradual approach to exercising and dieting. ``When she was 18, she was a toothpick,'' Ellie said, pointing at her mother. ``I've always been a big girl.''

      Ellie seems far from insecure. Rather, she bluntly talks about what's hard for her. Her friends are mostly boys, and, she said, ``They eat everything.'' Especially at the Wendy's in Methuen, where her weakness is fries. ``You could catch us there every day at 11 p.m.''

      The job she's working in order to pay for community college in the fall doesn't help her diet. It's at a Boston Market, where everything is ``buttery.'' And injecting herself with insulin ``felt wrong,'' she said. ``It hurts my soul.''

      Laffel, Ellie's physician, said she appreciates that honesty: ``I would rather know than have somebody try to please me and tell me they were taking it.'' She entered Ellie in one of two clinical trials at Joslin that are testing oral medications in children.

      Doctors are just now starting to study how best to treat and prevent Type 2 diabetes in children. But Laffel said Ellie's struggles are typical -- and understandable.

      Lately, one thing that helps is to talk to her friend's mother, who had her toe amputated and reminds Ellie to check her blood sugar. ``That's one person I'll listen to,'' Ellie said. ``She's going through it.''

Source:  The Boston Globe.