April #111 : Diabetes and HIV - by David Gelman, MD

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Table of Contents

Absolutely Andy

Work With Me!

Bushed To The Limit

Don't Cry for Me, Preventionista

Legal Eye

Milestones

The Rubber Report

Tiny Toons

Saving Lives-or Face?

On The March

Booked & Noted

Vax Is Back

One a Day: You've Come A Long Way

Diabetes and HIV

Lentil Health Day

April Showers

Office Visit

Not A Gym Bunny?

Generics Hit Home

Why...

Founder's Letter

Mailbox

Cabin Fever

Woman To Woman

Holy Makeover!



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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April 2005

Diabetes and HIV

by David Gelman, MD

Sugar woes can sour treatment plans

Prediabetes (a.k.a. insulin resistance) hits about 70 percent of HIVers; 5 percent have the real thing. These conditions don’t make life sweeter—or treatment decisions simple.

WHAT IS IT? Diabetes (shared by 18.2 million Americans, including one in 10 African Americans) means your body doesn’t absorb and use insulin—a hormone that helps get the energy from food into cells—correctly. As a result, blood glucose (sugar) levels skyrocket, gradually endangering circulation, nerve and kidney function and even vision. Prediabetes, which often graduates to diabetes, sends your blood sugar spiking after you eat (but not when you fast).

WHAT’S MY RISK? A December, 2004 Journal of AIDS study report can help you and your doc calculate your risk of diabetes.

It showed:
• Obesity and family history are the two top risk factors.
• Liver inflammation, common in HIVers (look for elevated liver enzymes on your blood test), expands your diabetes risk. Common contributors: active hep C, alcohol and liver-stressing
HIV meds like nukes (think d4T) or non-nuke Viramune.

Other risk raisers:
• Protease inhibitors can disrupt insulin and lead to diabetes.
• Lipoatrophy can muck with
glucose regulation: Lost fat cells result in low levels of sugar-regulating hormones.

WHAT CAN I DO?
1. Test: A fasting glucose test checks for diabetes. A glucose-tolerance test looks for prediabetes by pouring you a sweet drink, then drawing your blood two hours later.
2. Prevent: Exercise regularly and keep your weight (and body mass index) normal. A nutritionist can help cook up a diet plan you can stick to. Hold the doughnuts.
3 Treat: Multiple meds—Glyset, Precose, Prandin, Starlix—help keep prediabetes from progressing. Pop ’em before eating to stop after-meal blood-sugar surges. Glucophage is another one (unless you’ve got elevated liver enzymes or kidney problems). Take it from here, sugar.




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