Normally blood glucose is distributed to your body’s tissues under the control of insulin. Glucose is then used as ‘fuel’ to meet the energy required by your body. In some cases, this process is disturbed and more insulin is needed for the tissues to take up glucose from the blood. The tissues are said to be ‘resistant’ to insulin, leading to a condition called insulin resistanceA diabetes-like condition in which, while adequate amounts of insulin are produced by the pancreas, the body does not respond normally to the action of insulin. In the wider community, insulin is related to obesity, while in HIV it may be related to lipodystrophy.; which is more common with increased abdominal fat, buffalo hump and in HIV-positive people on treatments.
Insulin resistance can lead to diabetes[Diabetes mellitus] A disorder in which sugars in the diet cannot be metabolised into energy due to a lack of the enzyme insulin. Late-onset diabetes mellitus may be a long-term side effect of some anti-HIV drugs., a condition where blood glucose becomes quite high.
The incidence of type II, or mature onset, diabetes increases with age. As a result, as people with HIV livelonger due to improved treatments, the incidence of type II diabetes amongst people with HIV has significantly risen.
Independent of ageing, people with HIV are at increased risk of type II diabetes. Factors associated with this risk are:
- being on the protease inhibitor class of drugs for treatment of HIV
- a higher prevalence of some of the risk factors for diabetes amongst people with HIV.
It has not been demonstrated that HIV itself and its associated changes to the body directly result in increased risk of diabetes.
Preventing diabetes is important for people with HIV because it leads to increased risk of cardiovascular disease (for which people with HIV are already at increased risk) and in the longer term is associated with the development of a number of diabetes-related conditions.
What can you do?
Have your risk of diabetes regularly monitored by your GP in conjunction with your HIV doctor
Factors associated with increased risk of diabetes are:
- use of protease inhibitors
- severe changes to body fat distribution
- hepatitis C infection
- age >45 years
- being overweight (Body Mass Index >25 kg/m²)
- having a waist measurement > 94cm for men & > 80cm for women
- physical inactivity
- a close relative who has diabetes
- a previously diagnosed metabolic disturbance
- a history of vascular disease
- indigenous, asian, indian background
- blood fatA fat. changes (low levels of HDL or high levels of triglycerides).
Your doctor will assess your risk by a history and by regular glucose tolerance tests.
If you get diagnosed with “pre-diabetes” then it is time to act
Pre-diabetes is where you have an impaired glucose tolerance test result, the levels are higher than normal but not high enough to be diagnosed as diabetes.
- without intervention or change, pre-diabetes will eventually become diabetes
- by acting now you can prevent or significantly delay pre-diabetes becoming diabetes
- a diagnosis of pre-diabetes may also lead to your doctor recommending you change your HIV medications.
Know and implement the essential elements to preventing pre-diabetes progressing to diabetes
Follow a healthy diet: for diabetes prevention this means reduced fat intake and eating a wide range of high fibre foods that have a low ‘glycemic index’ (see www.healthinsite. gov.au/topics/Glycaemic_Index for further information).
A pre-diabetes diagnosis is the perfect time to seek help from an experienced dietitian to develop a meal plan that will work for you.
Exercise regularly: either 30 minutes of moderate intensity exercise (brisk walking) at least five days per week, or three to four 20-minute sessions of vigorous exercise a week.
Ahead of Time: A practical guide to growing older with HIV