When you eat, your body converts the food into fuel. This fuel is called glucose (sugar). Your body uses glucose for energy.

Insulin, a hormone produced by the pancreas, controls your blood sugar levels. If your body has a problem producing or using insulin, glucose levels get too high (hyperglycemia) and cause the symptoms of diabetes.

There are several types of diabetes:

Type 1 diabetes:

• Your pancreas does not make enough insulin
• You must take daily insulin (shots or pills) to survive
• Usually begins in childhood or adolescence

Type 2 diabetes:

• Your body makes plenty of insulin, but doesn't respond to it normally
• Diet and exercise are often enough to keep this diabetes under control, but it may require medication
• Most common form of the disease, usually occurring after age 45

Gestational diabetes:

• Occurs in some women during pregnancy

In some cases, there are no obvious symptoms of diabetes, so it’s important to monitor your glucose levels. A high glucose level can be a sign of diabetes. Your doctor can monitor your glucose levels with a fasting glucose test or a glucose tolerance test.

Other symptoms of diabetes include:

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

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

• Taking 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
• Hepatitis C or liver damage
• High cholesterol
• High blood pressure

Diabetes can lead to serious illness and even death. Some of the possible complications of diabetes are:

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

High blood sugar can be a side effect of HIV drugs. Specifically, the PIs can cause insulin resistance. If you are insulin resistant, you may not have diabetes yet. However, if left untreated you will likely develop it.

Recent studies show that HIV+ women on PIs are three times more likely to develop diabetes than HIV+ women on non-protease inhibitor drug combinations or HIV- women. In fact, up to 6 % of all people on PIs have diabetes.

If you need to take PIs for your HIV treatment, be aware of the possible side effects. Get monitored at regular medical check ups for glucose, cholesterol, and blood pressure problems.

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 unborn babies. Women who take PIs during pregnancy should monitor their glucose levels very closely.

If you have signs of insulin resistance, your doctor 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 doctor before stopping any HIV drugs.

If you have diabetes or insulin resistance, you may be referred to a specialist called an endocrinologist. It is helpful if your endocrinologist is knowledgeable about HIV.

Diabetes is a treatable disease. Most people with diabetes can live normal lives. However, diabetics must monitor their blood sugar as often as possible.

Many diabetics control their diabetes by changing their diet. It is important to watch your weight and eat healthy. This means reducing the amount of sugar and starchy foods (carbohydrates) you eat, such as bread, potatoes, rice, and corn.

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. It is also important to exercise regularly and quit smoking.

Those people who cannot control their diabetes with diet and exercise will need to use oral medications such as Avandia (rosiglitazone) or Glucophage (metformin) and/or insulin.

It is important to find out if you have diabetes. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test if:

• You are 45 or older
• You are HIV+
• You are overweight

Diabetes is a serious disease but one that can be controlled. If you have HIV and diabetes you can work with your doctors to achieve good diabetes control as well as management of your HIV. To reduce the chance of drug interactions, make sure your doctor is aware of all the medications you take.

Keeping diabetes under control (or decreasing your risk of getting diabetes) involves lifestyle changes. While this is difficult, it will give you the best chance of good health.

1		Aberg, J. (2002). Insulin resistance, glucose tolerance: What does it all mean? 9th Conference on Retroviruses and Opportunistic Infections, Seattle: Retrieved July 2003 from from http://www.natap.org/2002/9retro/day35.htm.
2		Justman, J.E., et. al.(2003). Protease inhibitor use and the incidence of diabetes mellitus in a large cohort of HIV-infected women. Journal of Acquired Immune Deficiency Syndrome, 32. 298-302: Retrieved July 2003 from http://www.natap.org/2003/april/040203_4.htm