Diabetes and pre-diabetes are serious conditions in which people have high levels of sugar or glucose in their blood. According to the Centers for Disease Control and Prevention (CDC), almost 26 million Americans have diabetes and at least 79 million adults over 20 have pre-diabetes.

Glucose is a type of sugar. It is used as fuel by the body. When you eat, your body converts the 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 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. 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:

• The pancreas does not make any insulin
• You must take insulin every day to survive
• Usually begins in childhood or adolescence

• Your pancreas makes some insulin (but usually not enough), and/or the body does not respond normally to the insulin your body does make
• Some people with type 2 diabetes are able to control it with diet and exercise, many others need diabetes medication, and some need insulin
• Most common form of diabetes

• Diabetes that starts during pregnancy due to hormones that prevent insulin from doing its job
• Most women with gestational diabetes are able to control their diabetes and prevent harm to themselves and their babies; women with gestational diabetes tend to have large babies
• Most often, blood sugar levels return to normal after delivery

• Blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes
• Having pre-diabetes puts you at increased risk for developing type 2 diabetes
• Type 2 diabetes can often be prevented or delayed by making changes to your diet and increasing exercise

Symptoms of diabetes include:

• Extreme thirst
• Need to urinate frequently
• Unexplained weight loss
• Hunger
• Blurry vision
• Irritability
• Tingling or numbness in the hands or feet
• Difficulty healing
• Extreme fatigue

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 there are not always obvious symptoms of diabetes, it is important to have regular lab tests to check if your glucose levels are high. The most common glucose tests are:

• Fasting glucose test: measures the glucose in a blood sample taken when you have not had anything to eat or drink (except water) for at least eight hours
• Random glucose test: measures the glucose in a blood sample taken when you have been eating on your usual schedule
• Glucose tolerance test: you take a fasting glucose test and are then given a drink with a measured amount of glucose in it. Several more glucose measurements are taken at specific time intervals after you have had the drink
• Hemoglobin A_1C test: measures your average blood sugar or blood glucose over the last two to three months. This test does not require fasting. It is used to monitor diabetes control as well as to help diagnosis it.

To find out if you have diabetes or pre-diabetes, it is generally recommended that you 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 any of the following test results, confirmed by retesting on a different day:

• A fasting blood glucose level of 126 milligrams per deciliter (mg/dL) or higher
• A random blood glucose level of 200 mg/dL or higher, along with symptoms of diabetes
• A glucose tolerance test level of 200 mg/dL or higher
• An A_1C over 6.5%

Anyone can get diabetes. However, certain factors may increase your risk, such as:

• Taking certain protease inhibitors (PIs)
• Being over 40
• Being overweight or obese
• A family history of the disease
• A poor diet
• Not exercising regularly
  
• A lot of fat around the belly (sometimes called ‘central obesity;’ having an apple-shaped body)
• Hepatitis C or liver damage
• High cholesterol
• High blood pressure

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. Some of the serious complications of diabetes are:

• Blindness
• Kidney failure
• Blood vessel disease that requires an amputation
• Nerve damage (neuropathy)

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 keeping their weight down, 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 diet and exercise, 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 is aware of all the medications you take.

People with pre-diabetes are likely to develop type 2 diabetes within 10 years 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 10 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.

High glucose levels can be a side effect of HIV drugs. Specifically, certain protease inhibitors (PIs) 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.

Some studies show that women living with HIV (HIV+) who take PIs are three times more likely to develop diabetes than HIV+ women on non-PI drug combinations or HIV-negative women. In fact, up to six percent of all people on PIs have diabetes.

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 HIV+, develop gestational diabetes during pregnancy. This is of particular concern to HIV+ women 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 HIV+ people experience changes in the location of their body fat ( lipodystrophy). Lipodystrophy syndrome sometimes comes with a number of health problems including high glucose levels as well as 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.

While diabetes is a serious condition, HIV+ people with 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:

• Regular medical check-ups and lab work that includes a gluclose test
• Control blood pressure and fat levels in your blood in order to lower risk for heart disease and stroke
• Eat a healthy diet (See TWP info sheet on Nutrition)
• Exercise regularly (See TWP info sheet on Exercise)
• Stop smoking (See TWP info sheet on Smoking)

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.