Lipid Profiles And Diabetes

Most people have had a lipid profile completed at some point in time, especially during a yearly physical examination. Lipid profiles are designed to measure the specific types of fats in the blood including “good” cholesterol or HDL (high-density lipoproteins) as well as “bad” cholesterol or LDL and triglycerides. These three components will vary in the body based on several factors. People of different genders, ages, activity levels, overall health, smoking status and glucose levels in the body will have different lipid profiles that can indicate the presence of various conditions including diabetes.

The Importance of Cholesterol

Although cholesterol is often seen as all bad, it does pay an important role in the body. All cholesterol is produced in the intestines and the liver and it is essential in the production of hormones in the body as well as the cell membranes that surround each cell in the body. It is also used in the production of Vitamin D in the body, which is interesting as a low level of Vitamin D may be linked to the development of type 1 diabetes.

Cholesterol is produced within the body but is also found in some foods. Egg yolks, cheese, red meats, fish, shrimp and poultry as well as some plant products such as flax seed and peanuts also contain phytosterols, which are like cholesterol but actually help to lower overall cholesterol levels in the blood.  Saturate and trans fats are the major sources of cholesterol in foods.

The most important component of cholesterol for the requirements of the body is healthy cholesterol or HDL. HDL is a large molecule that is seen as essential in ridding bad cholesterol from the blood and cells.  LDL or low density lipoproteins are small molecules that can form layers on the inside of the walls of blood vessels, leading to atherosclerosis and cardiovascular disease.

High LDL levels, diabetes and hypertension are often seen together. Studies have shown that self-management techniques, including counseling on diet, exercise and lifestyle changes, can be effective in reducing the harmful cholesterol and in one study, there was a significant reduction in A1C compared to patients that did not receive the support. 1

Triglycerides In The Body

Triglycerides are actually formed from glycerol, which itself can be converted into glucose in the liver. Triglycerides and phospholipids can also be formed in the fatty tissues of the body and forms the basis for storage of energy until needed. Triglycerides are used in the formation of the very low density lipoproteins (VLDL) that are used as energy sources in all cells of the body but also, in high amounts, can be very dangerous. Triglycerides require the presence of glucagon to start the breakdown process.

Triglyceride levels that are high have been linked to stroke and heart attack as well as atherosclerosis. Since cardiovascular disease is often present in diabetic patients this is an important test for overall health. Triglyceride levels are always tested after fasting, similar to the fasting blood glucose tests.

Diabetes and Lipids Tests

Lipid tests or profiles can be helpful in assessing how effectively people are managing their blood glucose levels. Individuals that have type 2 diabetes have a distinctive lipid profile that can be used in diagnosis. Typically the HDL, the good cholesterol, tends to be lower in people with type 2 diabetes. In addition triglycerides tend to be higher. The LDL or bad cholesterol tends to be more problematic for people with type 2 diabetes and has the strongest link to heart disease and stroke of various types of cholesterol.

The test for lipids in the body starts with an 8 hour fast. The test is a simple blood test that is sent to a lab for complete analysis. The test will report the total cholesterol, HDL, LDL and triglyceride levels and some tests may also report the VLDL and the non-HDL cholesterol.

Testing frequency will usually be determined by your medical history as well as any diagnosis of hypertension, cardiovascular disease or diabetes. Most diabetics will have a lipid profile completed annually or every two years, again depending on history and current health status.

Individuals that are at risk for diabetes may wish to request screenings at annual medical check-ups. In one study, individuals that had lower BMI, were younger and were not of a minority group typically had lower rates of screening than those that were considered to be in the very high risk groups.  However, these individuals still had factors that met the criteria under the American Diabetes Association recommendations for screening. 2

Lowering Cholesterol In Diabetics

Bringing your lipid profile into the normal range can be accomplished without the need for medications in many individuals. The key element is to keep blood glucose levels regulated and to avoid skipping insulin treatments or allowing your blood glucose to spike. Regular exercise is seen as a critical element to both reduce your LDL and triglyceride levels and to raise your HDL levels, all of which work to minimize the risk of cardiovascular disease.

Choosing healthy foods and eating low cholesterol food choices is considered an effective and simple strategy as well. Switching saturated fats such as butter for monounsaturated fats such as olive oil is a simple change the can really be effective in reducing the intake of cholesterol. Increasing the amount of fiber in the diet by adding whole grains, fresh fruits and vegetables and fiber supplements, if necessary, is seen as a major contributing factor to lowering the LDL and VLDL levels while increasing the HDL cholesterol levels in the body.

In some individuals with diabetes or high cholesterol, medications such as statins may be an effective therapy in lowering cholesterol. This is true for individual with any type of diabetes and regardless if a prior history of vascular disease is present. In a study of individuals with various health conditions and diabetes with high cholesterol, it was found that statins provided a 9% reduction in all-cause mortalities for every 1 mmol/L reduction in LDL. In the same study of 18,686 individuals it was also found that there was a reduction in major vascular events including myocardial infarctions, coronary death, coronary revascularization and stroke. 3

References

1 Powers, B. J., Olsen, M. K., Oddone, E. A., & Bosworth, H. B. (2009). The Effect of a Hypertension Self-Management Intervention on Diabetes and Cholesterol Control. The American Journal of Medicine , 639-646.

2 Rifas-Shiman, S. L., Forman, J. P., Lane, K., et al. (2008). Diabetes and lipid screening among patients in primary care: A cohort study. BMC Health Servicies Research .

3 Kearney, P., Blackwell, L., Collins, R., et al. (2008). Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. The Lancet , 117-125.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.