HIV and diabetes are both routinely described as “manageable conditions.” But for the estimated 10 percent of HIV-positive people who also have diabetes, that description may get old fast. Handling either one takes work; put them together and the task can seem, well, unmanageable. (Among some positive people—African Americans and Latinos, for example—diabetes rates are even higher.) Diabetes, in which your body produces insufficient insulin or can’t use insulin properly to convert food into energy, has been linked to some HIV meds. But the main culprits are heredity and being overweight. Recent research shows new dangers for those who don’t control the two diseases—including lower hepatitis C cure rates for those who are also coinfected.

All of this makes handling the duo crucial. The task often begins with counting pills and juggling lab tests: Positive folks with diabetes may swallow meds not just for HIV but for diabetes as well. Moreover, they must monitor not only viral loads and CD4 counts, but also cholesterol, blood pressure and blood sugar (fasting blood sugar levels should be between 80 and 100). Controlling these helps stave off such diabetes complications as eye, heart and kidney disease and circulatory problems.

The next step is taken outside the doctor’s office. Diet (alone or together with exercise) has been shown effective at helping control diabetes as well as some of the effects of HIV. Many Americans’ diets, however, are heavy on carbohydrates (which most directly affect blood sugar), cholesterol (bad for your arteries) and saturated fats (these can send your blood-fat levels soaring). With a nod to the real world and without taking away your favorite foods, we offer two mealtime alternatives—an “ideal” menu and a compromise. Read on, feel better:

BREAKFAST

Say that you eat: A McDonald’s sausage McMuffin (or a deli scrambled eggs, bacon and cheese sandwich), coffee with cream, OJ.

Here’s the problem: Eggs, sausage and cheese are awash in cholesterol and saturated fats. Large portions of white bread or muffins load you up with refined carbohydrates. Saturated fats and cholesterol raise heart disease risk; an animal study even suggested that fatty diets may speed HIV progress. Orange juice is high in carbs, with no fiber—the combo may cause a faster rise in blood sugar levels.

Ideal substitute: An egg-white omelet with green peppers and onions, ½ cup grits, a small biscuit (about 2 ½ inches) with 1 tsp. margarine; 17 small grapes (3 oz.); coffee or tea with artificial sweetener and 2 tbsps. skim milk. Total: about 50 grams of carbs.

Or compromise: Omit one of the three fatty,   cholesterol-laden items—eggs, cheese or sausage. Eat half the sandwich for breakfast and the other half two hours later as a snack, to keep blood sugar from rising too high all at once. Limit juice to 4 oz. Add fiber by trading white bread for a whole-grain slice or muffin.

LUNCH

Say that you eat: A cheeseburger with fries or a deli tuna fish hero with chips.

Here’s the problem: Again, lots of fat and cholesterol—and where are the veggies?

Ideal substitute: Two slices rye or whole-wheat bread with 3 oz. sliced roast beef and 1 tsp. mayo. A half cup coleslaw (made with low-fat mayo). Fruit cocktail (½ cup) or, better yet, fresh fruit, and a calorie-free beverage.

Or compromise: Omit cheese from the hamburger; eat only half the bun; add coleslaw or another vegetable. Or have a veggie-and-tuna wrap; add carrots for extra fiber.

DINNER

Say that you eat: Spaghetti, meatballs and Parmesan cheese, or Popeye’s fried chicken dinner.

Here’s the problem: Both of these are fatty, carb-heavy meals—even before you add bread and dessert.

Ideal substitute: Four oz. baked, fresh, lean ham with 1 small baked sweet potato (3 oz.) and ½ cup cooked turnip greens. A small whole-wheat roll with 1 tsp. margarine. For dessert: ½ cup unsweetened applesauce and a calorie-free beverage.

Or compromise: Have a smaller portion (1 cup) of pasta and replace half the meatballs in the sauce with veggies; hard as it is, take the fried skin off at least half the chicken—and add a tossed green salad or broccoli.

SNACK

A between-meal snack can keep your blood  sugar levels on an even keel. Just make sure you don’t pack more than 15 to 20 carbs into your snack. And if you think we’re just talking about raw celery sticks, try this: nachos constructed with 9 baked tortilla chips (1 oz); 1 oz. low-fat cheddar cheese and ¥ cup salsa. Wash it down with a calorie-free beverage (water will do just fine). Life is sweet.   


5 TIPS FOR MANAGING DIABETES

Diabetes often begins as pre-diabetes, characterized by high blood sugar levels.
By Constance Brown-Riggs

Some dietary tactics and exercise can help slow its development into the real thing—and help those already living with diabetes too:

1. Eat fresh fruit and veggies
Why: Diabetes commonly raises blood pressure and heart disease risk. Many fruits and veggies are rich in potassium, which may help control blood pressure.
Try: bananas, cantaloupe, oranges, plantains, potatoes, tomatoes, squash, lima beans, peppers and spinach.

2. Find more fiber
Why: Dietary fiber helps rid your blood of cholesterol, boosting heart health in the process.
Try: brown rice, buckwheat, oatmeal, whole wheat or corn bread— three or more servings daily.

3. Slow down and chew!
Why: Eating more slowly will help you eat less—and lose weight.
Try: putting your fork down between bites and chewing food at least 20 times before swallowing.

4. Cook the low-fat way
Why: Frying provides the greatest—and most dangerous—amounts of saturated fat.
Try: broiling, baking, stir-frying, steaming or grilling your food.

5. Don’t overeat
Why: Too much of even healthy foods can overload you with cholesterol, fats and carbs.
Try: weighing your food or measuring it by dividing your plate into zones: one quarter for starch; one quarter for protein (meat, fish or beans); and the remaining half for vegetables.


STEP UP TO THE PLATE
How to find your very own nutritionist or dietician
By James Wortman

1. The International and American Associations of Clinical Nutritionists will put you in touch with a certified clinical nutritionist (CCN) in your area. Call 972.407.9089 or click your way to iaacn.org.

2. Your local AIDS service organization (ASO) can refer you to a nutritionist specializing in HIV; some have nutritionists on staff. The ASO directory at POZ.com can help locate one nearest you.

3. While Medicaid coverage varies from state to state, Medicare covers prescribed medical nutrition therapy for people with diabetes or kidney disease. Ask your doctor if you qualify.