Diabetes and Cholesterol
Whilst cholesterol levels may rise for a number of reasons, high cholesterol levels over a period of years is often associated with a greater risk of health problems.
Lifestyle modifications and statins are commonly used to reduce high cholesterol levels.
What is cholesterol?
Cholesterol is a form of blood fats (blood lipids). Cholesterol is carried in the blood by proteins called lipoproteins and it is these that are measured when you have a cholesterol test.
- High Density Lipoprotein (HDL)
- Low Density Lipoprotein (LDL)
HDL is usually referred to as ‘good cholesterol’, and actually serves to protect the heart from developing problems.
LDL is referred to as ‘bad cholesterol’, because it is this form of cholesterol that can build up in blood vessels.
Cholesterol is a complicated topic. Whilst regarding HDl as good and LDL as bad is a useful guide, there’s more to cholesterol than these simplified descriptions.
Total cholesterol is a figure gleaned by testing the levels of both HDL and LDL cholesterol within a diabetic patient’s body.
Triglycerides are another form of blood lipid (blood fat) and are also measured when a cholesterol test is taken.
Cholesterol is needed within the body as it forms the membrane of each cell of the body.
However, too high levels of total cholesterol could indicate a higher risk of health problems and particularly heart disease.
Cholesterol targets for people with diabetes
NICE does not specify target cholesterol levels for people with diabetes. Diabetes UK provides the following guideline cholesterol levels to aim for:
- Total cholesterol: under 4.0 mmol/l
- LDL levels: below 2.0 mmol/l
- HDL levels: at least 1.0 mmol/l (men) or 1.2 mmol/l (women)
- Triglyceride levels: less than (or equal to) 1.7 mmol/l
Symptoms of high cholesterol
High cholesterol does not usually present any symptoms in itself, however, people that have high cholesterol levels over a number of years are more likely to develop problems Conditions such as heart disease, stroke and peripheral arterial disease (PAD).
What causes high cholesterol?
High cholesterol levels may be brought on by:
- High calorie diet
- Low physical activity
- High alcohol intake
High cholesterol levels may also result from the following:
- Hypothyroidism - an underactive thyroid
- Kidney disease
- Liver disease
- Familial hypercholesterolaemia - a genetic condition that affects around 1 in 500 people
Cholesterol is a type of fat that is transported in the blood. Cholesterol is used to make the membranes of our body’s cells.
Cholesterol has been found to be important because high levels of cholesterol in the blood has been linked with higher risks of heart disease in particular. Cholesterol levels can be measure via a blood sample, usually taken from your arm.
The cholesterol targets are:
- Total cholesterol to be under 4 mmol per litre
- LDL levels to be under 2 mmols per litre
- HDL, often known as good cholesterol, to be above 1 mmol per litre
Triglyceride levels should be under 1.7 mmol per litre.
People with high levels of cholesterol will be asked to make changes to their lifestyle, such as their diet. Doctors will usually suggest reducing intake of saturated fat. In addition to lifestyle changes, a medication called statins may be prescribed.
Statins are effective in reducing levels of cholesterol and have been found to reduce risk of heart disease. As with any medication, be aware of the side effects that can exist.
Diagnosing high cholesterol
A cholesterol test, which measures total cholesterol, HDL cholesterol, non-HDL cholesterol and triglyceride levels, should be performed at least once every year for people with diabetes.
It is more difficult to measure LDL cholesterol, and so non-HDL cholesterol is used instead of getting a direct LDL measurement.
Treating high cholesterol
If your cholesterol levels are found to be too high, you will be advised to modify your diet.
Try to cut down on any convenience foods you may be having and have home cooked or home prepared food where possible.
Consider using the plate method which is a good way to ensure you’re having appropriate portion sizes and getting enough vegetables.
If you need help with modifying your diet, arrange an appointment with a dietitian.
Regular exercise is also recommended. You should aim to dedicate 30 minutes or more to physical activity at least 5 times a week.
If you smoke, it is highly beneficial to quit smoking to lower your risk of heart attack or stroke. Statins will often be offered to adults with diabetes and high cholesterol.
Do I need tablets (statins) for high cholesterol?
NICE generally recommends that people, with a 10% or greater risk of developing heart disease within the next 10 years, take statins.
For people with diabetes NICE recommends :
- Consider statin treatment for all adults with type 1 diabetes
- Offer statins to anyone with type 2 diabetes with a 10% or greater risk of developing heart disease in the next 10 years
The starting dose of statins should be atorvastatin 20 mg, unless this is not tolerated by the patient.
Statins have been shown to prevent a major heart event in around 1 in 100 people that take the tablets for 3 years. Statins may cause side effects, such as aching muscles, headaches or memory trouble, in some people.
If sides effects occur speak to your doctor. If you have side effects from statins, they should disappear once you stop taking them.
Whether you take statins should be an agreement between you and your doctor and you have the right to accept or turn down the offer to take statins.
Preventing high cholesterol
Following a healthy diet, that is not over-reliant on processed food, and taking regular exercise will reduce your risk of having too high cholesterol levels and benefit your health in general.