To understand the relationship between diabetes and cholesterol, you must first know that there are two types of cholesterol in our blood, each with a distinct function and the one that is often seen to coexist with diabetes.
80% of the cholesterol is produced by the liver and the rest is obtained from the foods that we eat like egg yolk, butter, red meat, organ meat, etc.
- Low-density lipoprotein (LDL) is the lipoprotein that is bad and referred to as the “bad cholesterol,” which carries it through the bloodstream to the various parts of the body for its cells. It helps in the production of certain hormones and in building cell membranes and other body tissues.
- High-density lipoprotein (HDL) is the “good cholesterol,” which carries the cholesterol from the blood to the liver to be metabolized and passed into the intestine through the bile for removal from the body.
It can be seen that LDL is responsible for the circulation of cholesterol through the blood and HDL is responsible for the excretion of cholesterol from the body.
This post explains the link between circulating LDL cholesterol and diabetes. According to heart.org, diabetes lowers HDL levels and raises triglyceride and LDL levels, which increases the risk of heart disease and stroke. This condition is called diabetic dyslipidemia.
Add to it the high blood sugar of diabetes and you have a double-whammy working against you.
Diabetes and cholesterol relationship
Insulin plays a pivotal role in the conversion of glucose and fats into energy. When the production of insulin falls (as in Type 1 diabetes ) or the utilization of insulin is not proper (as in Type 2 diabetes), then the conversion of glucose and fats into energy is hampered.
This results in increased levels of glucose and cholesterol (fats) in the blood. It can, therefore, be seen, why diabetes and high cholesterol are often seen together.
Cholesterol has a wax-like consistency and when the levels of LDL are increased in the blood, it tends to get deposited onto the inner walls of the blood vessels. These deposits are called plaques.
As the process of the LDL cholesterol deposits on the blood vessel wall progresses, the walls of the blood vessels get thickened, resulting in clogging of the artery.
Blood glucose attaches to the LDL cholesterol and this stays longer in the blood to cause more damage.
This results in reduced blood supply to the part being supplied blood by that particular blood vessel. It can thus be, the heart or the kidney or the eye or the legs, and the problems relevant to that part occur. This is the crux of the reason for the various complications arising in diabetes.
Ideal cholesterol blood levels in diabetes
- LDL should be less than 100 mg/dL
- HDL more than 40 mg/dL men and more than 50 mg/dL women
- Triglycerides should be less than 150 mg/dL
Management guidelines for diabetes and cholesterol
- Exercise daily. More of aerobic and less of strength training exercises. Here is the list of exercises recommended for diabetics, which works well for people with both these disorders.
- Stick to the healthy diet explained above. You should also refer to the dietary foods advised for diabetes and the foods that lower your cholesterol. This post explains the foods that you should avoid with high cholesterol, which increase your risk of heart disease and stroke.
Diet meal plan for diabetes and high cholesterol
- Choose healthy fats, which you find in nuts, seeds, fish, and olive oil. Eat fish, such as salmon, mackerel, lake trout, and sardines, two or three times a week.
- Eat a handful of nuts, especially walnuts and almonds every day.
- Eat fruits every day. Don’t worry about the glucose in fruits. It is the fiber content we are aiming for. Soluble fiber binds with the cholesterol in the food and gets rid of it through the intestine. Fiber also slows down the absorption of carbohydrates and prevents a spike in blood sugar levels. Fiber also makes you feel full for a longer time, thereby helping in weight loss. High fiber fruits include apples and pears with skins, blueberries, blackberries, strawberries, oranges, and grapefruit. Fruits are also rich in antioxidants and vitamins.
- Eat vegetables. They are a rich source of nutrients and fiber. The American Diabetes Association especially recommends sweet potatoes, spinach, kale, and collards.
- Eat whole grains, whole cereals, brown bread, brown rice for the same reason.
- Eat more beans. Black beans, kidney beans, lima beans, and other legumes do not contain cholesterol and are very low in saturated fats.
- Have low-fat dairy products such as skim or 1% milk, fat-free yogurt, reduced-fat cheese, frozen yogurt instead of ice cream.
Drugs for diabetes and cholesterol
Diabetes can be controlled by eating the right foods and having a routine physical exercise plan. If followed religiously, you could well reverse your diabetes especially if it is of mild to moderate nature. However, medication to control diabetes becomes necessary when your blood sugar remains stubbornly high in spite of a disciplined lifestyle.
There are various drugs to control your blood sugar. They are explained in detail in these linked posts.
Will you need tablets for your raised cholesterol? It will depend on four things:
- If you or your family have a history of angina, heart attack or stroke
- You have any blood circulatory problems such as atherosclerosis
- If you have a family history of high blood cholesterol (hypercholesterolemia)
- Your diet, exercise, and lifestyle are unable to bring down your high levels within the normal range
As far as the cholesterol drugs are concerned, your doctor is the best person to determine and choose the right drug and define the course of action. In brief, here is a list of drugs used.
Bile acid sequestrants or Resins
Bile acid sequestrants or Resins lower LDL by binding themselves with bile acids, which contain cholesterol.
Cholesterol absorption inhibitors
Cholesterol absorption inhibitors act directly by reducing its absorption from the intestines, thereby lowering its blood levels.
Fibrates act by stimulating the extra production of an enzyme, which breaks down the fats in the blood.
Niacin or Nicotinic acid
Niacin or Nicotinic acid lowers LDL cholesterol and triglycerides and effectively raises HDL.