Cholesterol Check
High Cholesterol in Diabetic Patients
Abnormal cholesterol levels are commonly seen in patients
with diabetes.
Cholesterol disorder, diabetes, hypertension and obesity
are usually seen in an individual or in his/her family members.
Collectively, these disorders represent basically one underlying
disease, called Insulin Resistance Syndrome, which probably
is one of the most common diseases affecting mankind at the
present time.
Cholesterol disorder in Type 2 diabetes typically consists
of the following abnormalities:
Low HDL cholesterol (the good cholesterol)
High triglycerides.
Preponderance of small dense LDL cholesterol ( the bad cholesterol),
which is more atherogenic than the large buoyant LDL particles.
LDL cholesterol may also be high, as a result of the genetic
disorder.
All of these three abnormalities are independently associated
with hardening of the arteries, also known as atherosclerosis,
which can cause heart attack, stroke, dementia, poor circulation
in legs and impotence. In order to prevent these serious complications
in diabetic patients, cholesterol must be treated aggressively.
Hypothyroidism (underactive thyroid), renal disease and thiazide
diuretics may further increase LDL cholesterol.
Very high triglyceride levels (> 1000 mg/dl) are sometimes
seen in uncontrolled Type 2 diabetic patients with an underlying
genetic disorder of familial hypertriglyceridemia. These patients
are at a high risk for acute pancreatitis.
Alcohol consumption, estrogen and beta blockers may further
worsen hypertriglyceridemia
Target Cholesterol Values LDL Cholesterol
< 100 mg/dl
HDL Cholesterol
> 45 mg/dl in men, > 55 mg/dl in women
Triglycerides
< 200 mg/dl
Treatment Strategy
Blood Glucose Control :
Good control of blood glucose markedly decreases serum triglycerides
level and modestly increases the HDL cholesterol (the good
cholesterol).
Target Blood Glucose Values
Pre-meal blood glucose
80-120 mg/dl
Bedtime blood glucose
100-140 mg/dl
Hb A1c
< 7% ( with upper limit of normal 6.0%)
However, not every person is a candidate for such tight glycemic
control.
Relative contra-indications to tight glycemic control:
Recurrent hypoglycemia ( low blood sugar)
A frail, elderly person who has already developed the complications
of diabetes such as blindness, stroke, heart disease, or kidney
failure.
Diet
Low cholesterol diet is an important aspect of management
of cholesterol disorder, but often is not effective in reaching
target cholesterol values.
Life-style changes
Behavioral changes such as weight reduction, increased physical
activity and decrease in alcohol consumption are important
aspects of treating cholesterol disorder.
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