Diabetes mellitus or high blood sugar (glucose) occurs in two forms: type 1 and type 2. Type 1 typically occurs at younger ages and almost always needs insulin injections to control. Type 2 is more common in older adults and usually can be controlled with less aggressive treatment.
Most studies have found an increase in the frequency of diabetes in older adults with HIV. For example, one study found that there was a 10 % increase in diabetes in older adults with HIV compared to a 6 % increase in people without HIV. These findings have led physicians to check for diabetes in older adults with HIV and start treatment early to prevent serious complications.
WHAT HAPPENS IF DIABETES IS NOT TREATED?
Both forms of diabetes are the result of low insulin, which normally controls the amount of sugar in our bodies. An excess of sugar can cause damage to the eyes, heart, kidneys, and feet.
A person with HIV has the same risk factors that everyone has including aging, obesity, and genetics. However, older adults are at higher risk for diabetes and its complications due to chronic inflammation associated with HIV, periods of low CD4 counts, and possibly the presence of other viruses. People who were treated with the older HIV drugs may also have an increased risk for diabetes.
What you can do with your doctor
ASK IF YOU SHOULD BE TESTED FOR DIABETES
Weight change, frequent urination, excessive thirst, and other symptoms can indicate diabetes. There are two blood tests to diagnose diabetes. A value of 6.5% or higher on the A1C test is suggestive of diabetes. HIV patients may need a more sensitive test called Fasting Blood Sugar that requires fasting. A value of 126 or higher on this test may suggest diabetes. It is recommended that these tests be done before starting HIV treatment and at regular intervals afterwards.
What you can do yourself
FOLLOW TREATMENT STRATEGIES: MEDICATIONS AND LIFESTYLE CHANGES
Older adults with HIV and diabetes should follow the recommendations of the American Diabetes Association. Changes in lifestyle are often needed, including education about diet and exercise. Weight loss for those with obesity can have a major positive effect. Regular exercise is extremely important for people with diabetes, as it is for all people with HIV. Your healthcare provider may change your HIV medication if it is affecting your blood sugar.
A common diabetes medication that may be prescribed is metformin. Unless you have kidney problem or the medication doesn’t work, there are other medications that can be prescribed. However, if you have other comorbidities or showing signs of being “frail,” it is important to be aware of your pill burden. Taking too many medicines can be a problem. Your healthcare providers may also check for possible diabetes complications that can occur with other comorbidities.
For guidelines on diabetes medications, check the American Diabetes Association: www.diabetes.org.