Diabetes and HIV
June 25, 2018
Table of Contents
Diabetes and pre-diabetes are serious conditions in which people have high levels of sugar or glucose in their blood. The World Health Organization (WHO) reports that 422 million people worldwide had diabetes in 2014. In the US, according to the US Centers for Disease Control and Prevention (CDC), over 29 million people have diabetes and at least 86 million adults over 20 have pre-diabetes (blood sugar levels are higher than normal, but not high enough to be diagnosed with type 2 diabetes). Diabetes is a major cause of blindness, amputation, kidney failure, and cardiovascular disease.
Glucose is a type of sugar that is used as fuel by the body. When you eat, your body converts food into glucose. The glucose then goes into your bloodstream and is carried throughout the body to provide energy to all of your cells. In order for glucose to move from your bloodstream into your cells, you need insulin. Insulin carries the glucose, or sugar, in your bloodstream into your cells. Insulin is a hormone made by the pancreas.
If your body has a problem making or using insulin, the glucose in your bloodstream cannot get into your cells. As a result, glucose stays in the blood (high blood sugar) and the cells do not get enough glucose. A diagnosis of pre-diabetes or diabetes is made when glucose stays at higher than normal levels (also called hyperglycemia).
There are several types of diabetes:
Type 1 Diabetes (Insulin Dependent)
Type 2 Diabetes (Non-insulin Dependent)
Metabolic syndrome is not a type of diabetes, but a cluster, or group, of conditions usually associated with being overweight or obese. Metabolic syndrome is also called Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome. This group of traits puts people at risk for heart disease and type 2 diabetes. A person has metabolic syndrome if they have three of the following five traits:
Symptoms of diabetes include:
Symptoms typically occur when glucose levels have gotten very high. If you are diagnosed while diabetes is in its early stages, you may not have any symptoms.
Since diabetes does not always have obvious symptoms, it is important to have regular lab tests to check if your blood sugar or glucose levels are high. The most common glucose tests are:
To find out if you have diabetes or pre-diabetes, you will usually have a fasting glucose test. A glucose tolerance test may be ordered to help diagnose diabetes and as a follow-up to a high fasting glucose level.
A diagnosis of diabetes can be made based on either of the following test results, confirmed by retesting on a different day:
Anyone can get diabetes. However, certain factors may increase your risk, such as:
High glucose levels can be a side effect of HIV drugs. Specifically, certain protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs) can make it difficult for insulin to get glucose into the cells. This is called insulin resistance. It can lead to pre-diabetes and diabetes.
The PIs that can cause diabetes include:
The NRTIs that can cause diabetes include:
Some studies show that women living with HIV who take PIs are three times more likely to develop diabetes than women living with HIV on non-PI drug combinations or HIV-negative women. In fact, up to six percent of all people on PIs have diabetes. Recently, scientists have shown that PIs increase the chances of women getting diabetes if they have certain genes that make them more likely to develop diabetes. This research may lead to more personalized HIV drug treatment that takes into account a person's genetic makeup.
If you need to take PIs for your HIV treatment, be aware of this possible side effect. Get your blood sugar checked at regular medical appointments. If you have high glucose levels, your health care provider may recommend that you change your HIV drugs. Some studies have shown that switching to a combination that does not include a PI can help bring these levels under control. Switching is not an option for everyone and you should speak to your health care provider before stopping any HIV drugs.
Many women, whether or not they are living with HIV, develop gestational diabetes during pregnancy. This is of particular concern to women living with HIV who must take PIs to prevent transmitting HIV to their babies. Women who take PIs during pregnancy should have their glucose levels followed very closely.
Some people living with HIV experience changes in the location of their body fat (lipodystrophy). Lipodystrophy syndrome sometimes comes with a number of health problems, including high glucose levels, unwanted changes in body fat, and increases in fat (cholesterol and triglyceride) levels in the blood. These conditions have been linked with diabetes, heart disease, and strokes.
Diabetes can lead to serious illness and even death. It is a major cause of heart disease and stroke, and the seventh leading cause of death in the US. Worldwide, the World Health Organization (WHO) predicts that diabetes will become the seventh leading cause of death by 2030. Some of the serious complications of diabetes are:
Although diabetes can be a very serious disease, it can be treated. It is important to manage diabetes by checking your blood glucose regularly and keeping it under control. Many people control their glucose levels by maintaining a healthy weight, changing their diet, and increasing exercise.
A healthy diet for people with diabetes involves reducing sugar and starchy foods (carbohydrates), such as bread, potatoes, rice, and corn. If possible, see a registered dietitian to help you plan your meals. Many AIDS service organizations have registered dietitians on staff who will see you free of charge.
Sometimes, despite eating well and being physically active, blood sugar levels cannot be controlled without the help of medications and/or insulin. There are a number of medications available that lower blood glucose levels. Because the medications act in different ways, they may often be used together.
Some of the diabetes medications may interact with HIV drugs. To reduce the chance of drug interactions, make sure your health care provider knows about all medications you take.
People with pre-diabetes are likely to develop type 2 diabetes unless they take action. The good news is that if you have pre-diabetes, you can do a lot to prevent or delay diabetes.
Studies have shown that people can lower their risk of developing diabetes by losing weight through diet and increased physical activity. One study found that diet and exercise leading to five to seven percent weight loss (about ten to 14 pounds in a person who weighs 200 pounds) lowered the chances of getting type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising (mostly walking) at least 30 minutes a day, five days a week.
While diabetes is a serious condition, people living with HIV and diabetes can make lifestyle changes and work with their health care providers to control their diabetes and prevent many of its complications.
Steps to staying healthy:
Diabetes is a common disease. Many people with diabetes can live full, active, healthy lives. If you start by taking these steps, you will be well on your way to living well with diabetes.
[Note from TheBody: This article was created by The Well Project, who last updated it on June 7, 2018. We have cross-posted it with their permission.]
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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