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Side Effects of HIV Medicines

HIV and Diabetes

(Last updated 5/7/2014; last reviewed 5/7/2014)

Key Points

  • Diabetes is a disorder that makes it hard for the body to process glucose (sugar) for growth and energy. Glucose comes from the breakdown of the foods we eat. People who have diabetes may have too much glucose in their blood.
  • Use of some HIV medicines may increase blood glucose (also called blood sugar) and lead to diabetes. Other risk factors for 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.
  • Diabetes can be controlled with a healthy diet, regular exercise, and medicines. 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 diabetes.

What is diabetes?

Diabetes is a disorder that makes it hard for the body to process glucose (sugar) for growth and energy. Glucose comes from the breakdown of the foods we eat. People who have diabetes may have too much glucose in their blood. 

If not controlled, diabetes can lead to serious complications, 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. Type 1 diabetes develops when the body does not make any (or enough) insulin. In type 2 diabetes, the body makes enough insulin but can’t 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 diabetes?

Risk factors for diabetes include a family history of diabetes, being overweight, and lack of physical activity. In people with HIV, use of some HIV medicines may increase blood glucose and lead to type 2 diabetes.

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 following 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 insulin resistance and diabetes?

Usually the symptoms of insulin resistance are mild and may not be noticeable. Symptoms of insulin resistance may include:

  • Drowsiness, especially after meals
  • Intense mood swings or extreme hunger after eating sugary snacks or high carbohydrate meals
  • High cholesterol and triglyceride levels (high levels of fat in the blood)
Most people who are insulin resistant are overweight or obese and carry their fat around the abdomen (stomach area). Dark patches of skin on the neck and armpit area are another symptom of insulin resistance.   

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 called a fasting glucose test. The 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?

Diabetes can be controlled with diet, exercise, and medicines. 

A healthy diet includes lots of vegetables, some fruit, 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. Diet and exercise can help a person reach and maintain a healthy weight. 

Sometimes, in addition to a healthy diet and regular physical activity, medicines are needed to control diabetes. Controlling diabetes in people with HIV may include avoiding some HIV medicines and using 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: