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Lipids

With diabetes we need to consider all of the blood fats (what doctors call lipids). These include:

LDL Cholesterol

This is the so-called "bad" cholesterol whose levels are closely associated with the risk of heart disease. The level of cholesterol in diabetics is probably only slightly higher than in the general population, but the cholesterol particle (specifically the LDL particle) itself is made somewhat differently — it’s smaller and denser. Even with equal amounts of LDL cholesterol in the blood, the diabetic person will experience more hardening of the arteries than the non-diabetic with their larger, less dense cholesterol particles.

Since high blood glucose and other factors further increase the risk of hardening of the arteries, we aim for much lower levels of LDL cholesterol in diabetics than in individuals who do not have the disease. Plaque and hardening of the arteries do not occur as readily if the LDL cholesterol is low. An LDL level of less than 2.6 mmol/L is therefore recommended for all individuals with diabetes.

A person’s level of LDL cholesterol is mostly controlled by genetics, but may also be strongly influenced by obesity and a high-fat diet. Methods to lower LDL cholesterol are therefore dietary, including smaller portions, promoting weight loss, and eating less fat. If LDL cholesterol is not satisfactory with these measures, medications work quite well.

Triglycerides

By now everybody has heard of cholesterol, which is a credit to the news media. But almost no one has heard of a blood fat called "Triglycerides", and in the Type 2 diabetic this may be just as important as cholesterol. Some studies in diabetics have shown a greater connection between heart disease and triglycerides than cholesterol. This is extremely important because many people with Type 2 diabetes — 30 to 50% or more — have high triglycerides. So they must be watched and treated aggressively. If you are tracking your own triglycerides, aim for levels below 2.0 mmol/L, and, even better, less than 1.7 mmol/L.

Triglycerides can be lowered by losing weight, eating fewer carbohydrates, exercising and cutting down on alcohol. If these measures don’t work, medication can be very effective.

HDL

HDL is the so called "good" cholesterol, because a lot of it will protect you from heart and blood vessel disease. The opposite is also true — less HDL means less protection, and much higher risk of disease. This is because an important function of HDL is to transport LDL cholesterol away from the artery to the liver, where it can be metabolized (broken down). If LDL is not in the artery, it can’t contribute to the formation of the plaque that makes the artery "hard".

Diabetics usually have low levels of HDL cholesterol, resulting in much higher rates of heart disease. Ideally, the level of HDL cholesterol in the blood should be greater than 0.9 mmol/L, the higher the better.

Methods to raise HDL cholesterol include weight loss, exercise, and if you are a smoker, quitting. Limited amounts of alcohol can also raise HDL. If necessary, medication is also capable of raising HDL cholesterol, although not usually to a great extent.

Total Cholesterol

In someone with diabetes, the measurement of total cholesterol by itself is almost totally useless. It must be taken in conjuction with the fractions of cholesterol and triglycerides. There are therefore no normal limits for the isolate total cholesterol. Taken in relation to the HDL cholesterol, the ratio of total cholesterol to HDL should be less than 4.0.

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