Diabetes and pre-diabetes are serious conditions in which people have high levels of glucose in their blood. Almost 24 million Americans have diabetes and at least 57 million 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 get into your cells, you need insulin. Insulin is a hormone made by the pancreas.

If your body has a problem making or using insulin, glucose can’t get into your cells. As a result, glucose stays in the blood 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 no longer makes 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 the body doesn't respond to the insulin normally
• 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, usually occurring after age 45

• Occurs in some women during pregnancy

• 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’s 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

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 milli grams 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

In January of 2010, the American Diabetes Association recommended another test called A1C as an additional way to diagnose diabetes and pre-diabetes. The A1C test is already used to monitor blood glucose levels. One advantage of this test is that it doesn’t require fasting.

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. Adults with diabetes are at high risk for heart disease. In fact, at least 65 percent of people with diabetes die from heart disease or stroke.

Some of the other possible 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 glucose 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. 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, glucose can’t 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 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.

Pre-diabetes
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 5 to 7 percent weight loss (about 10 to 14 pounds in a person who weighs 200 pounds) lowered the rate of 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, the 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 HIV+ women on 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 6 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 monitored at regular medical check ups for glucose. 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 unborn babies. Women who take PIs during pregnancy should have their glucose levels monitored very closely.

Some HIV+ people experience lipodystrophy. Lipodystrophy includes 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.

Since HIV+ people may already have a number of risk factors for diabetes, as well as heart disease and stroke, it is important to be aware of all of these conditions.

Have regular medical check ups and lab work that includes a glucose test. As well as checking and, if necessary, managing glucose levels, monitor other factors that can contribute to the risk of heart disease and strokes. These include high blood pressure and cholesterol and triglyceride levels.

If you have high blood pressure, make sure it is treated. A healthy diet and exercise can help with high cholesterol and triglyceride levels as well as high glucose. Finally, giving up smoking is one of the best things you can do for your heart and your health.

HIV+ people with diabetes can work with their health care providers to achieve good diabetes control as well as management of HIV and other health concerns. 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 overall health.

See TWP info sheets: Lipodystrophy and Body Changes, Exercise, Nutrition, Caring for your Heart, and Smoking.