This is the second installment of our three-part series "Handing Down the Genes."  Part II: "Preventing Type 2 in Children"

The good news for those with type 2 is that there are things you can do to lessen your child's risk. "It's as simple as eat less, eat smarter, and move more," says Nancy Heinrich, an epidemiologist who specializes in diabetes and the founder of Growing Healthy Kids, a Vero Beach, Florida-based non-profit organization aimed at preventing childhood obesity and diabetes.

Prost says that you can substantially reduce your child's type 2 risk by helping him or her do three things: lose 10 percent of body weight (if he/she is overweight); exercise 30 minutes per day; and incorporate lifestyle changes such as avoiding fast food, eating well-balanced meals, and getting plenty of rest (research has tied lack of sleep to insulin resistance). Adults in the Diabetes Prevention Program, a large-scale study, reduced their type 2 risk 58 percent by taking these steps.

Susan Dopart, a registered dietitian and exercise physiologist specializing in diabetes in Santa Monica, California, says that modeling healthy eating and regular exercise is the best way to ingrain such habits in your children - and it doesn't create anxiety that they'll get diabetes. Children won't follow a healthy eating plan if others in the house aren't doing the same, Grinstein says. "The only way it's going to work is if the whole family follows the healthy diet," she says. "At first children may complain, but they will gradually start to follow the pattern."

Dopart says that's because the body craves familiar foods. "When you get used to eating healthy, your tastes acclimate to that and that's what you want," she says. "If your tastes acclimate to fast food, that's what you want." Grinstein has witnessed this first-hand. She has a no-juice-at-home rule (water instead). Often her five-year-old asks for water at birthday parties now, even though juice is allowed.

The diets of many children are even less healthy than those of their parents, Heinrich says. "What we're feeding our kids are the worst possible choices," she says. "They're directing their parents to buy those things because of advertising." Dopart says that many parents feel the need to please their children by giving them food marketed as "kid-friendly," without realizing how unhealthy some of those products are. It's OK to give your kids "regular" food, she says.

Activity level is just as important as food choices. A mother from Puerto Rico told Grinstein that children there eat mainly rice and beans and aren't overweight. Why, she asked, couldn't her kids do the same? Grinstein's response was that children in Puerto Rico run around on the beach all day, while most American kids sit on a couch and watch TV.

For tips on incorporating healthy eating and exercise practices into your family's lifestyle, see below.

When (and how) to take action

If you're a parent with type 2 diabetes, be alert for signs of insulin resistance in your kids. These include being overweight and sedentary and a darkening of the skin on the back of the neck and arms, Grinstein says. If you see these symptoms, contact your pediatrician; don't wait for signs of high blood sugar. Even if your child doesn't have diabetes or pre-diabetes, the doctor can help you take preventive measures such as setting up an appointment with a nutritionist and starting a weight-loss program. Grinstein also advises enrolling your child in an activity that he/she likes that involves exercise - swimming, soccer, baseball, etc.

Type 1 parents should be aware of the many symptoms of hyperglycemia, but realize that some are more worrisome than others, Grinstein says. These include unexplained weight loss, drinking unusually large amounts for no reason (the child doesn't have a fever and hasn't been running in the park, for instance), a big increase in urination during the day, and wetting the bed when he/she hasn't done so before. An isolated incident - one bed-wetting accident, for example - should not raise alarm, Grinstein says. But if these symptoms occur regularly, you should take your child to a medical facility immediately, Prost says, because he/she could be developing diabetic ketoacidosis, which can be life-threatening.

Both Prost and Grinstein discourage testing your child's blood sugar at home, especially if he/she has no hyperglycemic symptoms. With type 1 diabetes, the genetic risk alone is not enough to warrant years of regular testing, Grinstein says. The only exception would be if you want your child to participate in clinical research aimed at preventing type 1 in at-risk groups. Presently, no treatment has proven successful at this, Grinstein notes. She says that most parents are not interested in research trials because they require frequent doctor visits, blood tests, and experimental medication.

If your child displays symptoms, call his/her pediatrician's office. If you're traveling - on vacation, for instance - and don't want to force your family into a long wait at a far-away medical center, testing your child's blood sugar yourself would be appropriate, Grinstein says.

Numbers requiring medical intervention are: Greater than 125 fasting (no food or drink in past 10 hours); 150-200 randomly or after-meal; and greater than 200 randomly (the child most likely has diabetes). Prost cautions, however, that home blood-glucose monitors are notoriously inaccurate, with error margins of 15 to 20 percent. 

I took my son to his pediatrician, who tested his urine for sugar (it was negative) and told me that bed-wetting at his age is fairly common. He hasn't lost weight; only grown taller without gaining much. So my mind is at ease - for now.

I've found that focusing on ways I can improve my family's health, mainly through better food choices and increased exercise, makes me feel better. The diet/lifestyle recommendations for children of people with type 2 diabetes are the same ones doctors and dietitians suggest for all children. And because my children have an increased risk for type 1, I want to ensure that they don't face a double challenge. Grinstein says that many kids with type 1 are now obese and insulin resistant as well, making management more difficult. "You're not going to prevent type 1," she says. "At least you can prevent type 2."

Nutrition and exercise tips

Small changes in food choices and daily activity can make a big difference in children's health - and their risk for type 2 diabetes.

Check back next Saturday for some great ways to get started, in Part III of our series.