Blood Sugar Problems (Insulin Resistance, Diabetes, etc.)

Part of An HIVer's Guide to Metabolic Complications

Another set of metabolic complications has to do with the way in which your body breaks down sugars for energy. The most well known -- and dangerous -- of these problems is diabetes, but there are others as well. Before the modern era of HIV treatment began in 1996, blood sugar problems were uncommon in people with HIV. Since then, however, they have become more common, leading many experts to believe that some HIV medications are at least partly to blame.

What Are Blood Sugar Problems?

Your cells need energy in order to perform all their functions. Your body gets this energy by using a type of sugar called glucose. Everything you eat is broken down into glucose.

Before your cells can use glucose, though, it has to be transformed into energy. Your pancreas creates a hormone called insulin that does this job. Insulin travels throughout your body, breaking down glucose into energy that your cells can use.

If any part of this process doesn't work the way it's supposed to, it can create health problems:

  • When your cells have trouble using insulin to turn glucose into energy, this is called "insulin resistance."

  • Insulin resistance can cause glucose to build up in your bloodstream, since it has nowhere to go. This results in high blood sugar levels, which doctors call "hyperglycemia" or "glucose intolerance."

  • When your pancreas notices that you have too much sugar in your blood, it creates even more insulin, not realizing that your cells are having trouble using it. The insulin then builds up in your bloodstream; doctors call this "hyperinsulinemia."

  • Eventually, your pancreas can get tired from producing so much insulin, and its insulin-making cells may start to shut down. This leads to even higher levels of sugar in your blood. If these blood sugar levels stay too high for too long, they can lead to diabetes.

The Lipo Connection

Many HIV specialists believe that blood sugar problems and body shape changes (lipodystrophy) may sometimes be related. How these two health problems may be related is still unclear, but if you already have blood sugar problems or body shape issues, be sure to talk to your doctor about how you can avoid developing the other condition as well.

What Causes Blood Sugar Problems?

Blood sugar problems can happen to anybody, whether they've got HIV or not -- in fact, 21 million people in the United States have diabetes, according to the American Diabetes Association, and many more have blood sugar problems that may eventually lead to diabetes.

Unfortunately, although we know lots of people have blood sugar problems, we don't know much about why these problems begin. Scientists believe that a number of factors -- including genetics, diet and level of exercise -- all play a role.

Also, HIV researchers have noticed that people with HIV seem to have been developing blood sugar problems at a much higher rate over the past 10 years, leading them to believe that modern HIV meds may be a cause.

Finally, some research suggests that having hepatitis C along with HIV also increases your risk for diabetes.

What Illnesses Can Blood Sugar Problems Cause?

When blood sugar problems occur, they can increase your risk for:

  • low levels of HDL, or "good," cholesterol

  • increased levels of LDL, or "bad," cholesterol

  • increased levels of triglycerides

  • heart disease or stroke

  • kidney damage

  • nerve damage

  • eye damage (in severe cases, diabetes can cause blindness)

  • sexual problems in men

  • pregnancy problems in women

Which HIV Meds Are to Blame?

Many signs point to protease inhibitors -- with the exception of the newest protease inhibitor, Reyataz -- as the main culprits. A small percentage of people with HIV have developed insulin resistance while on regimens containing other HIV meds, such as Zerit, and to a lesser extent Retrovir (which is in Combivir and Trizivir) and Videx.

How Do You Know You Have Blood Sugar Problems?

Doctors will use either of two tests to see if your blood sugar levels are normal:

Fasting Plasma Glucose Test

This is a quick, easy test that a doctor will give you after you have fasted (not eaten or drank anything) for at least eight hours. The test determines the amount of glucose that's in your blood. Any number below 100 is normal, any number above 125 means you have diabetes (but only if it's above 125 on repeated tests), and anything between 100 and 125 is called "prediabetes," meaning you're at risk for developing diabetes.

Oral Glucose Tolerance Test

This is a more complicated test that involves having a sugary drink two hours before your blood sugar is measured. Any number below 140 is normal, any number repeatedly above 199 means you have diabetes, and anything between 140 and 199 means you have "prediabetes."

Both of these tests check the amount of sugar in your blood, not the level of insulin. Although it is possible to check a person's insulin levels, different laboratories use different testing methods, so it can be hard for doctors to figure out exactly what the test results mean.

What Can You Do?

Change Your Diet

You know the drill: low-fat meals, lots of fruits and veggies, whole grains. Try your best not to gain weight, and if you're overweight, change your diet so that you can begin to lose weight. Visit a nutritionist who can help you find a suitable diet.


Exercise is even more important for you if you have diabetes. Aerobic exercise can reduce weight and improve blood sugar control. Ideally, you should exercise for an hour, five days a week.

Switch HIV Meds

Whether to switch your meds due to a glucose problem often depends on how high your sugar levels are. If you and your doctor decide you need a switch, Reyataz (even if boosted with Norvir) can be substituted for other protease inhibitors. Likewise, a protease inhibitor can be switched for either Sustiva or Viramune. Zerit can be switched to another medication such as Viread or Ziagen (or a combination pill that contains these medications).

Take Prescription Medications

Avandia and Actos are two drugs often prescribed to people with high blood sugar. They improve the way the body uses insulin to transform sugar into energy. Possible side effects include water retention and weight gain.

Glucophage, also known as Fortamet, is another drug that can be used to reduce insulin resistance in people with HIV who have diabetes. However, it, too, comes with a side effect risk: Though rare, this drug can cause a dangerous buildup of a chemical called lactate in the blood.

Finally, insulin injections are an option for helping to keep blood sugar under control. Usually, though, this step is only taken when all other options have been exhausted.

How Often Should Your Blood Sugar Be Tested?

Not Yet on HIV Treatment?
Make sure you're tested before you begin. If you already have a blood sugar problem, it's important to know so you can avoid any HIV meds that might make the problem worse.

Already on HIV Treatment?
Get your glucose levels tested three to six months after you start treatment and at least once a year after that.