One of the most important benefits of controlling blood glucose levels is the reduced risk of heart disease. People with diabetes are at an increased risk of developing heart disease because of abnormal levels of fats in the blood known as lipids. It is important to keep your blood lipids in the normal ranges. Interestingly, studies show that if you improve your blood glucose levels, you will likely improve your blood lipids.
WHAT ARE LIPIDS?
Lipids are measured with a blood sample. They are made up of cholesterol and triglycerides. Cholesterol is subdivided into low density lipoproteins (LDL) and high density lipoproteins (HDL). LDL cholesterol is often called the “bad cholesterol” because it tends to stick to your blood vessel walls and can form plaque on those walls. This plaque narrows the walls of the blood vessels and reduces the blood flow through your vessels. Ultimately, the plaque can stop blood flow completely, which would result in a heart attack, stroke or possible amputation. HDL cholesterol is called the “good cholesterol” because it actually helps to remove cholesterol away from the blood vessel walls and into the liver, where it can be removed from the body entirely. Medical studies show that low levels of LDL cholesterol (less than 100 mg/dL) and high levels of HDL cholesterol (greater than 45 mg/dL) can reduce the risk of developing heart disease in people with diabetes. Triglycerides are thought of as fat freely flowing in your blood stream not attached to other proteins. People with type 2 diabetes tend to have high triglyceride levels, as well as low HDL cholesterol levels—a scenario that increases the risk of developing heart disease.
If arteries in the heart are narrowed by plaque, a heart attack may occur. If the blood vessels of the brain are narrowed, a stroke is more likely to occur. If the blood vessels in the limbs are narrowed, the resulting poor circulation could cause an infection and—in extreme cases—amputation of a foot or a leg. It is important to understand lipids and follow the American Diabetes Association’s guidelines for testing. The ADA recommends that adults with diabetes have a fasting (before breakfast) lipid profile measured every year. This includes the measurement of total cholesterol, triglycerides, HDL and LDL cholesterol levels. If these numbers are not normal, discuss with your health care provider what steps to take.
IMPROVING YOUR LIPIDS
The first step in improving your lipids may be to make some changes in the foods you eat. Try to eat more healthier fats such as olive oil and canola oil while eating less unhealthy fats. That means to avoid saturated fat from animal sources—such as butter, whole milk and fatty meats. It is recommended that people with high cholesterol consume 20 to 35 grams of dietary fiber, plus 2 grams of margarine-like spread containing plant sterol/stanols daily. These fats can help to lower LDL levels. You might also benefit from some weight loss. Weight loss has many benefits, including the improvement of blood lipid levels and blood glucose control. In general, the greater the weight loss, the greater the improvement in lipids and glucose control. It is worth noting that even a small amount of weight loss, about 10 pounds to 20 pounds, can bring about better blood glucose and blood lipid levels. The best way to lose weight is to cut back on the amount of calories you take in. One simple technique is to decrease portion sizes.
Another way to lower lipid levels is to increase your physical activity. Increased physical activity can improve blood glucose control and make it easier to take weight off. In addition, being active can help make the insulin that your body produces work better.
WHAT IF I CAN’T LOWER MY LIPIDS?
When blood glucose control, weight loss and/or increased physical activity do not result in improved lipid control, it may be necessary to take medications. Treatment with medicine in people with diabetes may be recommended when LDL cholesterol is above 100 mg/dL or triglyceride levels are above 200 mg/dL. This is aimed to normalize LDL levels first and then treat the elevated triglyceride levels. If triglyceride levels are above 500 mg/dL, they should be treated before an elevated LDL level due to the risk of developing pancreatitis.
This is the same medication regimen health care providers use to manage a person diagnosed with heart disease—because the risk for heart attack, stroke, or heart failure in people with type 2 diabetes is as high as in people without diabetes who have already had a heart attack.
STATINS FOR LOWERING YOUR BLOOD LIPID LEVELS
Today, statins are the most commonly prescribed medicines for treating lipid problems. Statins primarily help lower LDL cholesterol levels by about 18 percent to 55 percent—depending on the dose. Statins work by not allowing the body to make new cholesterol in the liver. The statins are usually given in a single does at the evening meal or at bedtime. It is important that these medications be given in the evening to take advantage of the fact that the body makes more cholesterol at night than during the day. The statins are well tolerated by most people and do not affect blood glucose control.
What’s new on the horizon? Zetia—a new medicine used to lower levels of total cholesterol and LDL cholesterol in the blood. It can be used by itself or with a statin to treat high cholesterol. Zetia prevents cholesterol from being absorbed by your body.
