Lipid Management and Diabetes

By Chris K. Guerin, MD, FACE

Did you know that one of the major concerns about diabetes is that it increases your risk for heart disease and stroke?

There is good and bad news. Unfortunately, the chances of dying from heart disease or stroke are two to four times higher in people with diabetes than in people without diabetes. The good news is that you can largely reduce these risks by managing your risk factors for heart disease. In one study, researchers tried to achieve optimal blood glucose (sugar), blood pressure, and lipid control in people with diabetes. They were able to reduce the study patients’ development of heart and blood vessel disease by nearly 50%--a significant amount! If you have diabetes, it is also very important give up smoking, pay attention to what you eat, and be physically active. These three things are called TLC’s (therapeutic lifestyle changes).

Let’s examine lipid (blood fats) levels in more detail. We are all aware of cholesterol [ko-LESS-ter-ahl], but sometimes when people talk about lipids, they only know their total cholesterol. LDL cholesterol, also known as the “bad” cholesterol, is the blood fat most associated with heart disease and stroke. HDL cholesterol, the so-called “good” cholesterol, is protective against heart disease. But even with high HDL cholesterol, we still pay attention to LDL cholesterol. You may be surprised to know that the average LDL cholesterol level in people with diabetes is about the same as in people without diabetes. You may ask, “Why do patients with diabetes then have a higher risk of strokes and heart attacks?” The answer is that their cholesterol is of a different quality--something we call “dense” rather than “light and fluffy.” The small and dense cholesterol is associated with hardening of the blood vessels, which leads to heart attack and stroke.

Therefore, it is highly recommended that people with diabetes take cholesterol-lowering drugs such as statins. Sometimes combination medication approaches are used to decrease LDL cholesterol and triglycerides [try-GLIH-ser-rides] (sugar fats), and raise HDL cholesterol. Doctors can prescribe niacin -to raise HDL-cholesterol levels. Fibrates and/or fish oils are used to treat high triglyceride levels. Doctors are always looking for a better way to predict who is at risk for blood vessel problems. You may see on your blood tests the term “non-HDL cholesterol” or “apolipoprotein [ah-poh-lih-poh-PRO-teen] B.” These tests might be better for predicting risk factors in people with diabetes. Later this year, there may be new guidelines that might incorporate some of these additional lab tests.

As mentioned earlier, TLCs refer to therapeutic lifestyle changes. Many attempts have been made to define an “ideal diet” for a person with diabetes. A commonsense approach to food choices can be a very good start. Let’s start with your weight. Weight issues are a problem for many people with or without diabetes. Health benefits of weight loss can begin with only a 5%-10% loss from your current weight. In The Diabetes Prevention Program study, people at high risk for getting diabetes could reduce their risk for diabetes by almost 60%. They only had to lose about 7% of their weight and exercise about 150 minutes per week (about 20 minutes per day).

Is there a “magic diet” that would be the best? Many books tell you that they contain THE answer. But what do we really know? Eating simple sugars, or simple carbs, are what raise blood sugar in your body. There are many simple carbs that most people are aware of, such as juices, milk, soda, donuts, candy, cake, and crackers, that raise one’s blood sugar levels. However, there are other foods that you might not be aware of that have a similar effect. These carbs include white rice, most pasta, flour tortillas or white bread, potatoes (fried or mashed) and instant cereals. Better choices are brown rice, whole wheat pasta, whole grain tortillas or bread, small baked potatoes, and old-fashioned oatmeal. You still need carbs for energy, but it’s better to get these in the form of carbs with higher levels of fiber, such as whole fruits and vegetables. Also, limit your intake of processed foods. Use fats and oils sparingly, especially animal products which contain saturated fat. Meat and dairy should be limited, too.

To increase your physical activity, you do not have to run a 10K tonight! Fitness has been shown to be a predictor of heart health. Even people who are overweight or obese have lower heart and blood vessel problems than those who are thin but not fit. Aim for 30-45 minutes most days of the week, although as mentioned earlier, even 20 minutes daily has benefit. It is helpful to cross train so as to avoid injury. Cross training means using different exercises. For example, you may walk on most days, but swim or use some light weights three times a week. It is always better to go for more repetitions with lighter weights if you want to build up muscle, rather than very heavy weights which may lead to more injuries. Muscle is very important in terms of burning calories, even when you are not active.

Unfortunately all heart problems may not be preventable in every person with diabetes. Family history can put you at risk, as can increasing age, whether or not you have diabetes. But other risk factors can be acted on: be choosey about what you eat, and move, move, move! Quit smoking if you are smoking. Get your cholesterol levels checked and discuss with your doctor if you need medication to improve those levels. Get your blood pressure checked and know your numbers, and work with your medical team to get them to GOAL!

Dr. Guerin is an Endocrinologist practicing in North San Diego County. He trained at the Mayo Clinic in Rochester, Minnesota. Following his Residency and Fellowship at the Mayo Clinic, he was a Post-Doctoral Scholar of the NIH (National Institute of Health). Currently, he is an Assistant Clinical Professor of Medicine at University of California in San Diego. He is also the Director of Diabetes Services at Tri-City Medical Center in Oceanside, California. He has been active as a Clinical Research Investigator in the areas of Diabetes and Lipid metabolism and is Board Certified in Clinical Lipidology. He has a personal interest regarding prevention of Cardiovascular Disease in patients with Diabetes.