Living with Diabetes

Dyslipidemia

People with Diabetes are at high risk of developing health problems such as, heart disease, stroke, or abnormal cholesterol levels. Cholesterol is a form of fat, which is produced in the liver. Some common dietary sources of cholesterol are milk, cheese, eggs and meat. It is an essential building block of the cell membrane, hormones and vitamin D. Cholesterol is required in limited quantities in the body; any abnormal changes may lead to health problems such as heart disease, or stroke.
 
Cholesterol travels through the blood in two kinds of lipoproteins; they are the Low-Density Lipoproteins (LDL), and the High-Density Lipoproteins (HDL). It is important to have healthy levels of both. 

 

Triglycerides (TG) are another kind of blood fat. They are formed when a person consumes a certain amount of calories which will not be utilized immediately, and will be stored in the fat cells. When the body requires energy, TG will be released in the blood. However, constant consumption of larger amounts (more than usual) of carbohydrates and fat will lead to an increase in TG levels. Consequently, the chance of a heart disease will increase as well.
 
Cholesterol tests and goals

You will not feel any symptoms when your cholesterol level is high. Hence, you will need to get your   levels checked regularly. It is recommended that you check your lipid profile at least once a year. A lipid profile test is a simple blood test, which measures your LDL cholesterol, HDL cholesterol, total cholesterol, and triglycerides (TG).
Talk to your doctor about your cholesterol target goals. Because you have Diabetes, your treatment will focus on lowering your LDL with consideration to the rest of your lipid types. The following table shows some general guideline:

Type of Cholesterol The Target Value For Most People with Diabetes
Bad Cholesterol (LDL) Less than 2.6 mmol/l (100 mg/dl)
Good Cholesterol (HDL) Men: Higher than 1.03mmol/l (40 mg/dl)
Women: Higher than 1.30 mmol/l (50 mg/dl)
Triglycerides Less than 1.7 mmol/l (150 mg/dl)

 

Over the last few decades, research has demonstrated an association between increased incidence of coronary heart disease (CHD) (narrowing of the blood vessels due to plaque formation) and abnormal lipids (fats) profile, i.e. (↑Cholesterol, ↑LDL, ↓HDL). Therefore, the treatment goal is to prevent new or recurrent coronary heart disease (CHD) by improving the lipids’ profile. 
 
A successful management plan would be composed of therapeutic lifestyle changes alternatively known as TLC (healthy diet, increased physical activity, and weight reduction if needed), in addition to medications. However, following a healthy lifestyle without initiating therapy might be sufficient for some patients. These patients should not have had any CHD, high cholesterol levels, or significant family history. It will take three months before evaluating the efficacy of TLC. 
 

Healthy eating

Healthy eating is important to lower your cholesterol, and to help you lose weight. Healthy eating tips:

Physical activity

One aspect of TLC is physical activity. Research has showed that exercise decreases LDL and TG, and it increases HDL levels to the desired goals. It is highly recommended at a rate of 30 minutes/day (3-4 days of the week). Patients should consider a prior evaluation of their condition by a healthcare provider to ensure safety and efficacy of the exercise plan. 
 
Note:

 

Medication therapy

TLC might not be sufficient at some point for certain patients, thus, healthcare providers would intervene. A medication to improve the lipid profile will be initiated, and the lab results will be evaluated after 4-6 weeks. Although there are several groups to treat abnormal lipid levels, each group appears to be more effective in treating certain types of lipids. Thus, a combination therapy might be needed for certain compliant patients according to their response after multiple trials of a single medication. The following table summarizes all the medication groups:

Medication  Cholesterol  LDL  HDL  TG
Niacin 
Fibrates
Statins