context: Years ago, it was rare to hear about a child with type 2 diabetes. Doctors used to think kids only got type 1. It was even called juvenile diabetes for a long time. Not anymore. Now, according to the CDC, more than 208,000 people younger than 20 have this disease. That number includes both type 1 and type 2 diabetes. Here's what you need to know if your child is diagnosed. You've probably heard diabetes and high blood sugar mentioned together. Here's what happens. Your digestive system breaks down carbohydrates into a type of sugar called glucose. Your pancreas creates a hormone, known as insulin, that moves glucose from your blood into your cells, where it's used for fuel. In type 2 diabetes, the cells in your child's body don't respond to the insulin, and glucose builds up in her bloodstream. This is called insulin resistance. Eventually, the sugar levels in her body get too high for it to handle. That could lead to other conditions in the future, like heart disease, blindness, and kidney failure. Type 2 diabetes is most likely to affect kids who are: Girls Overweight Have a family history of diabetes American Indian, African- American, Asian, or Hispanic/ Latino Have a problem called insulin resistance The single biggest cause of type 2 diabetes in children is extra weight. In the U. S., nearly 1 out of every 3 children is overweight. Once a child gets too heavy, she's twice as likely to get diabetes. One or more of these things may contribute to extra weight or obesity: Unhealthy eating Lack of physical activity Family members (alive or dead) who've been overweight Rarely, a hormone problem or other medical condition As with adults, type 2 diabetes is more likely to affect children who carry extra weight around the middle. At first, there may be no symptoms. Over time, you may notice: Unexplained weight loss Hungry or thirsty a lot, even after eating Dry mouth Peeing a lot Fatigue Blurred vision Heavy breathing Slow healing of sores or cuts Itchy skin Numbness or tingling in the hands or feet Take your child to the doctor if you notice any of these symptoms. The first step is to get your child to the doctor. He can tell if she's overweight based on her age, weight, and height. He'll test her blood sugar to see if she has diabetes or prediabetes. If she does have diabetes, it may take a few extra steps to find out if it's type 1 or type 2. Until he knows for sure, he may give her insulin. Once he confirms it's type 2 diabetes, he'll ask you to help her make lifestyle changes. He may suggest she take a medication called metformin. It and insulin are the only two blood sugar-lowering medicines approved for kids younger than age 18, but others are being studied. Your child should get a hemoglobin A1c test every 3 months. This test measures her average blood sugar levels over that period. She'll need to check her blood sugar: When she starts or changes treatment If she doesn't meet her treatment goals If she has to take insulin If she takes a sulfonylurea drug The doctor will teach you both how to test blood sugar and tell you how often. Most experts suggest three or more times a day if she's on insulin. If she's not, she can check less often, but should do it after meals. She can use a traditional finger stick test or a continuous glucose monitor. You can take her to see a dietitian, who can help you create a meal plan. She should also get exercise for at least 60 minutes every day. Limit her screen time at home to less than 2 hours a day. The same steps used to treat type 2 diabetes in children can also prevent it. Reduce calories, unhealthy fats, and sweets in your child's diet. Make sure she gets physical activity each day. Studies show that exercise has a dramatic effect on reducing insulin resistance. These are two important ways to help your child get down to and stay at a healthy weight and normal blood sugar levels. Children -- especially teens -- may have a tough time making changes to prevent or manage type 2 diabetes. Here are some ways you can help: Talk with your child honestly about health and weight. Be supportive. Encourage her to speak up about her concerns. Don't separate your child for special treatment. Your entire family can benefit from making changes in diet and activity. Make changes slowly. Just as it took time for diabetes to develop, it will take time to achieve better health. Do more activities your child enjoys. Lower the amount of time your family spends watching TV or playing video games. If your child refuses to follow her plan, try to find out why. Teens, for example, are dealing with hormone changes, demands on their time, peer pressure, and other things that seem more important to them than their health. Set small, easy-to-reach goals. Plan special rewards for your child when she meets each goal. Then move on to the next. Talk to a diabetes educator, doctor, dietitian, or other diabetes professional for more ideas on how to help your child become healthier. By working together, you, your child, and her diabetes health care team can be sure she remains healthy for years to come.