Talkabout recently spoke to writer and activist David Menadue about his diabetes diagnosis.
Had you heard of an increased risk of diabetes for people with HIV who take HAART? Or other risk factors such as age or weight?
I had associated diabetes with obesity, which is clearly not the case for me or many people with HIV -- as well as some others in the population who are quite slim. I heard about diabetes as a side-effect of HIV treatments in the late ‘nineties when all the research about lipodystrophy was being revealed.
At that stage though, I noticed that the researchers thought the numbers of people who would be affected would be small - like less than 5% of people with HIV on treatments, from memory. I think it must be higher than this now, just given the number of friends with HIV who have the condition these days (and I guess they are also older and in more of a risk category for diabetes, anyway).
How did you become aware you had diabetes?
A brief history: I was getting up several times a night to urinate. I was thirsty and drinking a lot of water during the day. At first I thought it could be associated with having a dry mouth, which I've been told some HIV treatments can cause. But when my doctor checked (in 1999) I was a borderline diabetic.
Over the next few years, whilst I remained on protease inhibitors it became worse as my lipids and bad cholesterol went up. I took pills like Lipitor and fish oil capsules to reduce the lipids and cholesterol with some success. My doctors suggested dietary changes and I was briefed by the hospital dietitian about the way to reduce my risk of developing diabetes-- eat less fat and avoid fried foods, I was told. - Much more important to do this, than to completely cut out sugar, although that is important too.
Despite my best efforts at improving my diet (which wasn't too bad anyway I was told), by about 2001 I was considered diabetic and placed on two pills twice a day (Gliciazide) to help contain my blood sugar levels. After some time my blood sugar levels went up again and another treatment was added (Pioglitazone) which has been very helpful. So I take three pills in the morning, and two at night. My regular visits to my diabetes doctor (every three months) show me with haemogloblin AIC (3 month average of your levels) below the magic marker of "7" which is an important indicator of how well you are controlling your diabetes.
Any side effects from the medication?
I don't know if the treatments have side-effects as they would be gastric-related like my HIV ones. Who knows what is causing what. I think they may cause some gastric side-effects.
What was your feeling when you received the diagnosis?
I was uncertain what it meant. After having HIV and surviving a few AIDS-defining illnesses, I thought a common chronic illness like diabetes would be easy to live with.
After some time with diabetes, whilst I have learnt to live with it, I find it possibly has a greater impact on my daily life than HIV (at least HIV as it is now managed). You have to think about what you put in your mouth every time you go to eat. You look for the low fat choices on the menus (often none there!) and pricking your finger every day (to check your blood sugars) is like a daily rating of whether you have been a good boy or not--thinking, "I shouldn't have had that piece of chocolate cake yesterday" or "Why didn't I say no to that pizza last night?" My doctors are happy with the control I have over my diabetes now but I am careful with what I eat -- I don't want the circulation problems, the high risk of heart attack and serious feet problems which come with badly managed diabetes.
So you do feel it’s more difficult to manage then HIV?
At the moment I would say diabetes is more difficult to manage than HIV. My AIDS defining illnesses in the past were harder to manage and scarier because of the real fear of imminent mortality but, with treatments for HIV as we know them in 2007, I think diabetes takes up more of my thinking and daily preparation, particularly in thinking about food choices. Even so, if my viral loads went up, or T-cells went down, I guess I would panic about my HIV management just as much, if not more. For the moment things are going well with both.
So the diagnosis has changed your lifestyle?
Significantly. I think about everything I eat, avoiding high fat or sugary foods whenever I can. That having been said, you can include some "high glycaemic index" foods (ones which are higher risk for your sugars) in a meal if you balance that with several low glycaemic index ones. (Glycaemic index is a concept all diabetics have to get their head around-- there are lists to learn from. Some foods like mashed potato are high glycaemic index but low fat icecream or low fat yoghurt are not high glycaemic foods if eaten in moderation.)
I exercise several times a week at a gym. Apparently weight resistance exercise at a gym is good for diabetes as well as a lot of daily walking. Anything that keeps your circulation happening is a must, I gather.
Do you feel as well informed about diabetes as about HIV?
After a few years of talking to diabetes specialists and dietitians I feel quite well informed about diabetes now. I guess I know as much about it as I do about HIV.
