hyperlipidemia

People with type 2 diabetes or type 1 diabetes with insulin resistance commonly experience a special type of hyperlipidemia known as “diabetic dyslipidemia” characterized by high triglycerides (>300mg/dL), low HDL (<30mg dl),="" and="" a="" qualitative="" chang="" [ }to the LDL particles. This qualitative change allows the LDL to carry more free cholesterol, increases their susceptibility to oxidation, and consequentially promotes the formation of plaques in the arteries, or atherosclerosis.

Because of this structural change in the LDL, dyslipidemia in diabetes significantly increases the risk for both coronary heart disease and peripheral arterial disease. In fact, cardiovascular risk often exists years prior to an actual type 2 diagnosis due to the metabolic syndrome (HTN, insulin resistance, hyperlipidemia, abdominal obesity) that often precedes diagnosis.

Lipid control is therefore paramount to decrease morbidity and mortality in diabetes. Diet and exercise are the first-line treatment, but statin therapy is also effective and often necessary. The ADA recommends high intensity statin therapy in all PWD diagnosed with cardiovascular disease as well as PWD between 40-75 years with diabetes and additional risk factors. Moderate intensity statins are recommended for all PWD above age 40, even if no additional risk factors are present.

Statins have been known to have some significant side effects; most commonly, muscle cramping, fatigue, headaches, and digestive discomfort. Please weigh these risk/benefits with your clinician. 

I find it SO interesting that insulin resistance can actually change the structure of LDL. There are certain diets that can help mange insulin resistance. The most popular is a whole food, low fat diet which aims to reduce insulin resistance by cutting out animal fats. This diet has helped me decrease my TDD by 1/3! 

Ultimately, risk reduction is complicated, multi-factorial, and should be discussed with your clinician.