Type 2 diabetes in kids has jumped 70% in the past decade, and complications like heart disease and kidney disease can appear much sooner than in adults.
In this episode, TRC Healthcare Assistant Editor and Clinical Pharmacist Gina Corley, PharmD, discusses managing type 2 diabetes in children and teens as its prevalence continues to rise. She covers why the disease progresses faster in kids, why lifestyle changes and drug therapy work best together from the start, and how a family-centered approach helps changes stick.
You’ll hear practical insights on lifestyle goals, metformin dosing and managing GI side effects, adding a GLP-1 receptor agonist or SGLT2 inhibitor, and when to add insulin. Plus, Gina shares what to weigh when choosing a continuous glucose monitor for a child, including prescription vs over-the-counter options, alarm features, and more.
This is an excerpt from our September 2026 Pharmacy Essential Updates continuing education webinar series.
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CE Information:
TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.
Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: When Kids Have Type 2 Diabetes: A Treatment Guide
- Chart: Drugs for Type 2 Diabetes
- Chart: Comparison of Insulins
- Chart: Continuous Glucose Monitoring
- Chart: GLP-1 and GIP/GLP-1 Receptor Agonist Interactive Comparison Chart
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Transcript:
This transcript is automatically generated.
00:00:00 Narrator
Why do kids with type 2 diabetes develop complications sooner than adults?
00:00:05 Narrator
What comes next when metformin alone isn’t enough for a child with type 2 diabetes?
00:00:13 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:19 Narrator
On this episode, assistant editor and clinical pharmacist Gina Corley breaks down managing type 2 diabetes in children and teens,
00:00:26 Narrator
from lifestyle changes and metformin to GLP-1 receptor agonists, SGLT2 inhibitors, and insulin.
00:00:33 Narrator
She shares how to tailor add-on therapy, what to tell caregivers, and other key things healthcare professionals need to know before starting or intensifying treatment in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:47 Narrator
This podcast offers continuing education credit for pharmacists and pharmacy technicians.
00:00:51 Narrator
Please log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:00:58 Narrator
None of the speakers have anything to disclose.
00:01:01 Narrator
Catch new episodes of Clinical Capsules every second and fourth Tuesday, bringing concise, actionable insights from TRC experts straight to your ears.
00:01:09 Narrator
Let’s dive in.
00:01:16 Gina Corley
And as our article says, you’ll have more opportunities to help manage type 2 diabetes in children and teens as its prevalence continues to rise.
00:01:27 Gina Corley
So today we’re going to go over some lifestyle modifications for kids with diabetes along with drug options, including GLP-1 agonists, when to add insulin, and certain caveats when it comes to monitoring blood glucose in these patients.
00:01:44 Gina Corley
But first, let’s start off with a little bit of background information.
00:01:48 Gina Corley
Over the past decade, we’ve seen a 70% increase in the prevalence of type 2 diabetes among children and adolescents, which is a pretty alarming number.
00:02:00 Gina Corley
This means that you’ll have significantly more opportunities and responsibilities to help manage this condition in your pediatric patients.
00:02:09 Gina Corley
And this trend is especially concerning because children with type 2 diabetes face an earlier onset of serious complications compared to adults.
00:02:21 Gina Corley
Things like vision problems, heart disease, kidney disease, and nerve damage can appear much sooner in children because the disease progresses faster.
00:02:32 Gina Corley
Managing type 2 diabetes in kids requires a family-centered approach, as we need to engage parents and caregivers to create lasting behavioral changes.
00:02:45 Gina Corley
So as pharmacists and techs, we play a critical role in promoting lifestyle changes, ensuring appropriate drug therapy and medication adherence, and helping families monitor for complications before they become severe.
00:03:01 Gina Corley
So when it comes to type 2 diabetes treatment for kids, we want to recommend lifestyle changes and drug therapy upfront.
00:03:09 Gina Corley
Using both approaches together is more effective than either one on its own.
00:03:15 Gina Corley
And starting both upfront gives patients a better chance of improving blood glucose control.
00:03:21 Gina Corley
So before we get into meds, let’s discuss lifestyle changes.
00:03:27 Gina Corley
We want to encourage healthy eating habits like choosing foods that are lower in fat and calories but higher in fiber.
00:03:36 Gina Corley
Things like fruits and vegetables, whole grains, low-fat dairy, and little to no sugar-sweetened beverages.
00:03:43 Gina Corley
Next, we want to recommend 60 minutes of moderate to vigorous aerobic activity daily.
00:03:50 Gina Corley
And of course, combining activity with a healthy diet can help lower weight.
00:03:55 Gina Corley
Our goal is to reduce weight by 7-10% in patients who are overweight or obese.
00:04:02 Gina Corley
And then finally, encourage limiting non-academic screen time to less than two hours per day since excess screen time is associated with sedentary behavior and poor dietary habits.
00:04:15 Gina Corley
But lifestyle changes alone often don’t provide enough glucose lowering.
00:04:22 Gina Corley
Now switching gears here, when it comes to drug treatment, we almost always want to start with metformin.
00:04:28 Gina Corley
And usually we can initiate metformin by itself if A1C is less than 8.5% and there’s no diabetic acidosis or ketosis.
00:04:41 Gina Corley
And then for patients with an A1C of greater than or equal to 8.5% with no acidosis with or without ketosis, we usually want to start with metformin and insulin.
00:04:54 Gina Corley
But for this presentation, we’re going to focus on the standard treatment regimen for patients with an A1C less than 8.5%, while keeping in mind that we want to aim for an A1C goal of less than 6.5% in most kids.
00:05:09 Gina Corley
So let’s talk a little bit more about metformin since this is going to be our first-line oral medication for most kids with type 2 diabetes.
00:05:18 Gina Corley
We start here because metformin is weight-neutral, low-cost, taken orally, and has a long track record of safety and efficacy in both adults and kids.
00:05:30 Gina Corley
Patients should start with 500 milligrams by mouth twice per day and increase by 500 milligrams per week as needed, with a max dose of 2,000 milligrams per day.
00:05:41 Gina Corley
I also wanted to point out that metformin comes in a 500 milligram per 5 ml oral solution, which is a great option for kids who have difficulty swallowing tablets.
00:05:54 Gina Corley
Of course, we always want to make sure patients and caregivers know about side effects.
00:05:59 Gina Corley
And the most common ones with metformin are gastrointestinal, things like diarrhea, nausea, and vomiting.
00:06:08 Gina Corley
These are especially common when first starting the medication or when increasing the dose, which is why you’ll see doses for metformin titrated slowly each week.
00:06:20 Gina Corley
And then if GI side effects are persistent, switching to the extended release formulation can also help.
00:06:28 Gina Corley
But what happens if metformin just isn’t enough by itself to control blood sugar?
00:06:35 Gina Corley
About 50% of kids with type 2 diabetes will need another drug in addition to metformin.
00:06:42 Gina Corley
And it’s important to add therapy early when indicated.
00:06:48 Gina Corley
So if metformin isn’t enough to get there by itself, we can suggest adding on a GLP-1 or SGLT2 and then later adding insulin if needed.
00:06:59 Gina Corley
Be aware that with the GLP-1 agonist or SGLT2 inhibitors, guidelines don’t prefer one class over another.
00:07:08 Gina Corley
And so we can tailor the choice based on dosing frequency, goals, and things like that.
00:07:15 Gina Corley
So the approved GLP-1 options for kids ages 10 and up include tirzepatide or Mounjaro, dulaglutide or Trulicity, and liraglutide or Victoza.
00:07:30 Gina Corley
Tirzepatide and dulaglutide are both dosed once per week, so you may see these prescribed more often.
00:07:37 Gina Corley
On the other hand, liraglutide is dosed once per day.
00:07:40 Gina Corley
The benefits of using a GLP-1 include greater A1C reduction along with greater potential weight loss.
00:07:48 Gina Corley
However, there are also some downsides.
00:07:51 Gina Corley
For instance, some kids may be a little wary of needles and therefore may be less inclined to take these meds since they’re injectable.
00:08:00 Gina Corley
GLP-1s also come with more gastrointestinal side effects, such as nausea, vomiting, and stomach pain, and these can sometimes be severe.
00:08:11 Gina Corley
And then GLP-1s are also typically more costly than most of our oral options for diabetes.
00:08:19 Gina Corley
In terms of SGLT2 inhibitors, the approved options for kids ages 10 and up include empagliflozin or Jardiance, dapagliflozin or Farxiga, or canagliflozin or Invokana.
00:08:34 Gina Corley
These are all oral options and are usually well tolerated.
00:08:39 Gina Corley
Although I did want to point out that these all come as tablets and not in a suspension or solution form.
00:08:47 Gina Corley
So if patients have trouble swallowing tablets, they may need to go to a compounding pharmacy to get this made into a liquid form.
00:08:55 Gina Corley
SGLT2s also have a modest A1C reduction compared to GLP-1s, and they can also increase risk of urinary infections.
00:09:05 Gina Corley
So we want to instruct caregivers to tell kids to let them know if they experience symptoms such as burning while urinating or having a strong and frequent urge to urinate.
00:09:17 Gina Corley
But what if adding on a GLP-1 or SGLT2 inhibitor to metformin still is not enough?
00:09:25 Gina Corley
If this is the case, the next step is usually to add insulin.
00:09:30 Gina Corley
But first, I want to point out that you may see a GLP-1 and SGLT2 inhibitor combined before initiating or intensifying insulin.
00:09:41 Gina Corley
And this is typically due to the potential for weight gain or hypoglycemia or low blood sugar that insulin can sometimes cause.
00:09:50 Gina Corley
But if patients can’t get their blood sugar under control using multiple meds, then insulin is often the next step.
00:09:58 Gina Corley
So when adding insulin, we’ll usually start with a basal or long-acting insulin, such as glargine or degludec, that is usually given as a weight-based dose once per day.
00:10:10 Gina Corley
And then, of course, we want to monitor blood glucose and A1C regularly for these patients.
00:10:17 Gina Corley
Now, if fasting glucose is in goal range but A1C remains high, or if there is evidence of high blood sugar after a patient eats, that’s usually a good indicator that you need mealtime insulin coverage.
00:10:30 Gina Corley
So that’s when we would look at adding a short or rapid-acting insulin before meals.
00:10:36 Gina Corley
Short-acting options include Humulin R or Novolin R, and then rapid-acting insulins include lispro, aspart, or glulisine.
00:10:45 Gina Corley
And then Afrezza is an inhaled, rapid-acting insulin that’s been approved for kids ages 6 and up.
00:10:53 Gina Corley
You’ll likely see more injectables still being used for now, but this may be a suitable option for patients who won’t take injectables.
00:11:02 Gina Corley
It costs $490 per 90 cartridges of four units each.
00:11:08 Gina Corley
And then lastly, I wanted to touch on using continuous glucose monitors or CGMs when it comes to pediatric patients.
00:11:16 Gina Corley
We only want to offer these if kids or caregivers can use them safely.
00:11:21 Gina Corley
So things like knowing how to apply the sensor, interpreting the readings, responding appropriately to high and low alerts, troubleshooting device issues, and things like that.
00:11:33 Gina Corley
We also want to watch for the differences among products and double check approved ages.
00:11:40 Gina Corley
So for example, the Dexcom G7 monitor is approved for patients aged 2 and up, but the Dexcom G7 15-day is only for patients 18 and up.
00:11:52 Gina Corley
And then Stelo is the first OTC continuous glucose monitor for patients aged 2 and up that don’t use insulin.
00:12:00 Gina Corley
But we want to weigh the pros and cons here since this monitor does not have alarms and also measures glucose in a much narrower range.
00:12:08 Gina Corley
So because diabetes is a very broad topic, I wanted to direct you to some of our resources where you can get more information.
00:12:17 Gina Corley
First, our chart, drugs for type 2 diabetes, takes you through a lot of the different drug classes and highlights dosing for adults and pediatrics, cost per month, average A1C reduction, hypoglycemia risk, and more.
00:12:33 Gina Corley
And then our comparison of insulins chart breaks down the options for rapid, short, intermediate, and long-acting insulins, and also goes over cost stability and gives guidance on when and how to inject these products.
00:12:49 Gina Corley
And then lastly, our continuous glucose monitoring chart showcases some popular CGM brands and goes over them in more detail, and you’ll find information about things like sensor life, water exposure, and data sharing, and even which devices are compatible with air travel security systems.
00:13:10 Gina Corley
All right, well, that wraps up type 2 diabetes with kids, and it’s all yours again, Vickie.
00:13:17 Vickie Danaher
Thanks, Gina.
00:13:18 Vickie Danaher
So the question I pulled out here is about the inhaled insulin Afrezza.
00:13:25 Vickie Danaher
And I know you mentioned that it comes in a pack of, I think, 90 cartridges of four units each.
00:13:32 Vickie Danaher
One of our listeners wants to know if you could tell us more about how this inhaled insulin is dosed in kids.
00:13:42 Gina Corley
Yeah, sure.
00:13:42 Gina Corley
So kids with type 2 diabetes who are insulin-naive will want to start with four units inhaled by mouth at each meal.
00:13:51 Gina Corley
So a pack of 90 cartridges would last for one month, assuming that a patient ate three meals per day.
00:13:58 Gina Corley
Now, of course, patients may need to adjust the dose based on their metabolic needs and blood sugar levels, but we can think of a pack of 90 4-unit cartridges as a monthly supply to start.
00:14:11 Vickie Danaher
Great.
00:14:11 Vickie Danaher
Thanks, Gina.
00:14:12 Vickie Danaher
Yeah, that’s really a unique dosage form.
00:14:14 Vickie Danaher
So I’m glad you could clarify that a bit more here.
00:14:17 Vickie Danaher
And I know our insulin chart, like you mentioned before, has more information about formulations and storage and so forth if needed.
00:14:26 Narrator
Thanks for listening.
00:14:27 Narrator
We hope today’s episode gave you practical insights you can use right away.
00:14:31 Narrator
Now that you’ve listened, pharmacists and pharmacy technicians can receive CE credit.
00:14:36 Narrator
Just log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:14:43 Narrator
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00:14:48 Narrator
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00:14:55 Narrator
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00:15:12 Narrator
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00:15:14 Narrator
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