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Side Effects of HIV Medicines

HIV and Diabetes

(Last updated 12/15/2014; last reviewed 12/15/2014)

Key Points

  • Diabetes is a disease in which levels of blood glucose (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is our main source of energy. There are two types of diabetes: type 1 diabetes and type 2 diabetes
  • Use of some HIV medicines may increase blood glucose levels and lead to type 2 diabetes. Other risk factors for type 2 diabetes include a family history of diabetes, being overweight, and lack of physical activity.
  • People with HIV should have their blood glucose levels checked before they start taking HIV medicines. People with higher-than-normal glucose levels may need to avoid taking some HIV medicines and use other HIV medicines instead.
  • Blood glucose testing is also important after starting HIV medicines. If testing shows high glucose levels, a change in HIV medicines may be necessary.
  • Type 2 diabetes can often be controlled with a healthy diet and regular exercise. A healthy diet includes vegetables, fruits, and lean meats and is low in processed foods high in sugar and salt. Regular exercise means being active for a half an hour on most days of the week. Sometimes, in addition to a healthy diet and regular physical activity, medicines are needed to control type 2 diabetes.

What is diabetes?

Diabetes is a disease in which levels of blood glucose (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is our main source of energy. 

Diabetes can cause serious health problems, including heart and blood vessel disease, nerve damage, blindness, and kidney disease. Fortunately, diabetes can be controlled with diet, exercise, and medicines.

How does diabetes develop?

Glucose is carried in the blood to cells throughout the body. A hormone called insulin helps move the glucose into the cells. Once in the cells, glucose is used to make energy. When the body has trouble moving glucose into the cells, glucose builds up in the blood and can lead to diabetes.

There are two types of diabetes: type 1 diabetes and type 2 diabetes.

In type 1 diabetes, the body’s immune system attacks and destroys the cells that produce insulin. Lack of insulin causes glucose to build up in the blood.

In type 2 diabetes, the body can't produce enough insulin or use it effectively to move glucose into the cells. Type 2 diabetes is more common than type 1 diabetes. 

What are the risk factors for type 2 diabetes?

Risk factors for type 2 diabetes include age over 45, a family history of diabetes, being overweight, and lack of physical activity. People whose family background is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American are at greater risk of type 2 diabetes.

In people with HIV, use of some HIV medicines may increase blood glucose levels and lead to type 2 diabetes. The risk of type 2 diabetes is also greater in people who are also infected with hepatitis C.

What HIV medicines increase the risk of type 2 diabetes?

Some HIV medicines in the nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor (PI) drug classes may increase the risk of diabetes. 

NRTIs: 

  • didanosine (brand name: Videx)
  • stavudine (brand name: Zerit)
  • zidovudine (brand name: Retrovir). Zidovudine is one of the HIV medicines in the combination drugs Combivir and Trizivir. (Combination drugs include two or more different HIV medicines in one pill.)  
PIs:
These HIV medicines seem to make it harder for the body to respond to and use insulin (insulin resistance). Insulin resistance leads to high blood glucose levels, which can result in type 2 diabetes.
 

What are the symptoms of diabetes?

The symptoms of diabetes can include:

  • Unusual thirst
  • Frequent urination 
  • Extreme hunger 
  • Unusual weight loss or weight gain 
  • Extreme fatigue and irritability 
  • Frequent infections 
  • Blurred vision 
  • Tingling or numbness in the hands and feet
  • Slow healing of cuts or bruises

How is diabetes diagnosed?

A common test used to diagnose diabetes is the fasting plasma glucose (FPG) test. The FPG test measures the amount of glucose in the blood after a person has not eaten for 8 hours.

People with HIV should have their blood glucose levels checked before starting treatment with HIV medicines. People with higher-than-normal glucose levels may need to avoid taking some HIV medicines. 

Blood glucose testing is also important after starting HIV medicines. If testing shows high glucose levels, a change in HIV medicines may be necessary.

Can diabetes be treated?

Type 2 diabetes can often be controlled with a healthy diet and regular exercise. A healthy diet and daily exercise can help a person reach and maintain a healthy weight.

A healthy diet includes lots of vegetables, some fruit, and lean meats and is low in processed foods high in sugar and salt. To learn more, watch this presentation on Diabetes and Meal Planning.

Regular exercise means being active for a half an hour on most days of the week.

Sometimes, in addition to a healthy diet and regular physical activity, medicines are needed to control type 2 diabetes. (Treatment for type 1 diabetes always includes taking insulin.) 

People with HIV who have diabetes may need to avoid taking some HIV medicines and use other HIV medicines instead. 

If you have HIV, talk to your health care provider about your risk for diabetes. Ask your health care provider about the link between HIV infection and HIV medicines and diabetes and about testing for diabetes. 

How can I learn more about diabetes?


This fact sheet is based on information from the following sources: