When you have diabetes, you're more likely to get heart disease. Because of that, you need to have your cholesterol levels and triglycerides (a type of blood fat) checked at least once a year. A simple blood test is all you need.
It also helps to know as much as you can about cholesterol and the steps you can take to keep your levels where they should be.
The golden rule: Keep your “bad” LDL cholesterol level down and your “good” HDL level up.
What Is Cholesterol?
Your body actually needs some cholesterol. But many people have too much of the “bad” kind and not enough of the “good.” Over time, that can lead to a buildup called plaque in your arteries, leaving less space for blood to flow.
Blocked heart vessels can cause chest pain, a heart attack, or a stroke.
The "good" HDL cholesterol helps your body get rid of the "bad" LDL. The higher your HDL level, the better.
Another type of blood fat, called triglycerides, also makes heart disease more likely, although it’s not the same as cholesterol. You want to keep your triglyceride levels low.
What Affects Your Cholesterol Levels?
- Diet. Saturated fat in the foods you eat raises your “bad” cholesterol level.
- Weight. Extra pounds increase your cholesterol and your chance of getting heart disease.
- Exercise. Get it regularly, since that can lower "bad" cholesterol and bring up the "good."
- Genes. They influence how much cholesterol your body makes. High levels can run in families.
- Other causes. Certain medications and medical conditions can raise your levels. High triglycerides could come from diabetes or thyroid problems. It can help to lose extra weight and avoid foods that are high in calories.
What Should My Total Cholesterol Level Be?
A blood test is all you need to find out what your cholesterol level is.
Your doctor may recommend that you fast for 8 to 12 hours before that test in order to measure your triglycerides, LDL, HDL, and total cholesterol. Or you may start with a test that shows your total cholesterol level without fasting.
Your doctor may start with a non-fasting test and then recommend a lipid profile, based on your results. You may get more tests later on to see how well treatment is working for you.
Lifestyle Changes Can Help
Many of the same things that help your diabetes also help to lower your cholesterol and triglycerides and protect your heart.
Clean up your diet. Avoid saturated fat and trans fats. Instead, use the unsaturated kind, such as those found in canola oil, olive oil, or liquid margarine. Eat more fruits, vegetables, beans, nuts, and seeds. They have nutrients that can lower cholesterol, such as fiber, omega-3 fatty acids, and plant stanols and sterols.
If you smoke, quit. Lighting up lowers "good" HDL cholesterol. When you stop, it goes back up.
Lose excess weight. This helps bring down your “bad” cholesterol and higher triglycerides.
Get exercise. Just 30 minutes of it a day can help boost your “good” cholesterol, lower your triglyceride levels, improve your diabetes, make you more fit, and bring down high blood pressure -- and lower your chances of heart disease.
Do I Need Medication?
Some people who are making healthy lifestyle changes also need to take medicine to lower their cholesterol. Usually, doctors recommend treatment with a type of drug called a statin.
If you have diabetes and you’re between 40 and 75 years old, your doctor may suggest that you take a medium dose of a statin along with the lifestyle changes you make. This will help lower your chances for heart disease or a heart attack.
If you have diabetes plus fat and cholesterol buildup in your arteries (a problem called atherosclerosis), your doctor will want you to take a higher dose of a statin, along with making healthy lifestyle changes. This will help lower the odds that you’ll have another heart attack or similar life-threatening problem.
Other medicines you might take to help with cholesterol include:
- Nicotinic acid
- Bile-acid resins
- High-dose or prescription fish oil supplements (to lower triglycerides)
- PCSK9 inhibitors, biologic drugs that can dramatically reduce cholesterol when combined with a statin
Remember: These meds work best when you also follow a healthy diet and are active.