Hi, I have very high insulin level and resistance and c peptides. glucose is high normal. what does this all mean and what are the risks and symptoms? does this mean that i am diabetic or that i am at risk of diabetes? how does this relate to the condition of my liver, which has elevated alt and ldh enzymes?

what dietary restrictions are there and what recommendations regarding diet? can diet alone control this and what would be the consequences if i ate the occasional desserts and bars of chocolates?

i am 35 pounds overweight since being infected a couple of years ago, all on my stomach and waist. but, my butt and legs have not atrophied yet... no history of diabetes in my family, so assume this must be disease related?

thanks v. much!

A high insulin level, especially in chronic HIV infection, is relatively common and something that anyone with long-term infection should consider in planning diet strategies. While this does not necessarily qualify for a diagnosis of diabetes, it does increase your risk for that diagnosis in the future. There are many risk factors, including family history, but also including disease, medications, smoking/drinking, activity levels, and others. Also, there are so many reasons for slightly or transiently elevated liver enzymes, you may want to talk with your clinical team to get the skinny on what may be causing that in your particular case.

There aren't any real "restrictions" to recommend in the diet, but there are positive steps you can take to emphasize those things that will help to reduce the effects of insulin resistance and a high insulin level. The diet recommendations would be very much like what is recommended for a diabetic diet. If you can, keep in mind that what we refer to as a "diabetic diet" may really be an optimally healthy eating plan for most people.

For this type of diet recommendations there are a couple of schools of thought:

1. Distribute carbohydrate calories throughout the day and balance those calorie sources with other sources (protein and fat)

2. Same as above and add in: emphasize those carbohydrate sources that have less effect on blood sugar and insulin response and reduce carbohydrate sources that have a more dramatic effect on insulin and blood sugar levels.

In the first scheme, you would fit in your carb-containing desserts to the plan to distribute carbs evenly throughout the day. In the second scheme, you might do the same, but add in choosing the occasional chocolate bar over the Easter peeps (nearly pure sugar).

The fact that you are a bit overweight has the potential to complicate the control of insulin sensitivity, so you may also want to talk with your dietitian about a slow-weight loss strategy that includes aerobic exercise.

My advice: sit down with a dietitian who can look over what you have been doing and help you to make feasible changes to achieve what you want and continue enjoying one of life's great pleasures: food!

Best wishes!