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A Guide to Living with Diabetes and High Cholesterol

Medically reviewed by Deborah Weatherspoon, PhD, MSN, RN, CRNA on April 17, 2017Written by Colleen Story

If you’ve been diagnosed with diabetes, you know that controlling your blood sugar levels is important. The more you can keep these levels down, the lower your risk of developing cardiovascular disease and other health problems.

Having diabetes puts you at a higher risk for developing high cholesterol. As you watch your blood sugar numbers, watch your cholesterol numbers too.

Here, we explain why these two conditions often show up together, and how you can manage both with practical lifestyle approaches.

Diabetes and high cholesterol often occur together

If you have both diabetes and high cholesterol, you’re not alone. The American Heart Association (AHA) states that diabetes often lowers HDL (“good”) cholesterol levels and raises triglycerides and LDL (“bad”) cholesterol levels. Both of these increase the risk for heart disease and stroke.

The National Diabetes Statistics Report of 2014 shared similar findings. Between 2009 and 2012, about 65 percent of adults with diabetes had LDL cholesterol levels higher than ideal, or used cholesterol-lowering medications.

As a reminder:

  • An LDL cholesterol level under 100 milligrams/deciliter (mg/dL) is considered ideal.
  • 100–129 mg/dL is close to ideal.
  • 130–159 mg/dL is borderline elevated.

High cholesterol levels can be dangerous. Cholesterol is a type of fat that can build up inside the arteries. Over time, it can harden to form a stiff plaque. That damages arteries, making them stiff and narrow and inhibiting blood flow. The heart has to work harder to pump blood, and risk for heart attack and stroke go up.

Why diabetes increases risk of high cholesterol

Scientists aren’t sure yet exactly how diabetes affects cholesterol, but they’re working on it. Some research has pointed to a connection between insulin and cholesterol. In 2001, researchers reported in Nature Genetics that a gene called TCF1 regulates insulin and cholesterol production. When this gene doesn’t operate correctly, people are more at risk for both diabetes and high cholesterol.

Research on statin medications gave us more evidence of a link between insulin and cholesterol. Statins are very effective at keeping cholesterol levels under control and in reducing risk of heart disease. But in 2012, the U.S. Food and Drug Administration warned that statins could increase risk of diabetes. Why would this be?

Scientists found that it was because of this connection between cholesterol and insulin. In the journal Adipocyte, they reported that statins activate an immune response that can stop insulin from doing its job. That in turn slightly increased risk of diabetes.

In 2002, researchers found a connection between diabetes and cholesterol, but weren’t sure why the connection was there. In their study published in Diabetes Care, they reported that diabetes seemed to either increase the production of cholesterol in the body, or reduce its absorption so that more of it stayed in the blood.

Researchers don’t have all the answers yet, and continue to grapple with the question. In one study published in The Journal of Lipid Research, they found that blood sugar, insulin, and cholesterol all interact with each other in the body, and are affected by each other. They just weren’t sure exactly how.

Meanwhile, what’s important is that you’re aware of the combination between the two. Even if you keep your blood sugar levels under control, your LDL cholesterol levels may still go up. However, you can control both of these conditions with medications and good lifestyle habits.

7 lifestyle habits

Managing one medical condition can be challenging enough. If you have to manage diabetes and high cholesterol, that can get confusing. Does a diabetes diet work for high cholesterol, too? What about exercise? Do you have to do more if you have both conditions?

The main goal is to reduce your risk of heart disease and stroke. If you follow these seven tips, you’ll be giving your body what it needs to stay healthy and active.

1. Watch your numbers

You already know that it’s important to watch your blood sugar levels. It’s time to watch your cholesterol numbers, as well. As mentioned previously, an LDL cholesterol level of 100 or less is ideal. Follow your doctor’s instructions on keeping your blood sugar levels under control.

Be sure to check on your other numbers during your annual doctor visits. These include your triglycerides and blood pressure levels. A healthy blood pressure is 120/80 mmHg. The AHA suggests that those with diabetes shoot for a blood pressure of less than 130/80 mmHg. Total triglycerides should be less than 200 mg/dL.

2. Follow standard health advice

There are some well-known lifestyle choices that clearly reduce the risk of cardiovascular disease. You probably know all of these, but just be sure that you’re doing everything you can to follow them:

  • Don’t smoke or quit smoking.
  • Take all your medications as directed.
  • Maintain a healthy weight, or lose weight if you need to.

3. After a meal, take a walk

As someone with diabetes, you already know that exercise is key for keeping your blood sugar levels under control. Exercise is also key for managing high cholesterol. It can help increase levels of HDL cholesterol, which are protective against heart disease. In some cases, it can also reduce levels of LDL cholesterol.

Probably the most effective exercise you can do to help control blood sugar levels is to take a walk after eating a meal. A small New Zealand study published in Diabetologia reported that the improvement in blood sugar levels was “particularly striking” when participants walked after the evening meal. These participants experienced greater blood sugar reduction than those who just walked whenever they liked.

Walking is good for high cholesterol, too. In a 2013 study published in Arteriosclerosis, Thrombosis, and Vascular Biology, researchers reported that walking reduced high cholesterol by 7 percent, whereas running reduced it by 4.3 percent.

4. Breathe a little harder five times a week

In addition to walking after meals, it’s also important to do some aerobic exercise for about 30 minutes daily five times a week.

In a 2014 study review published in Sports Medicine, researchers found that moderate-intensity aerobic activity can be just as effective as high-intensity types when it comes to optimizing cholesterol levels. Try to incorporate some vigorous walking, biking, swimming, or tennis into your routine. Take the stairs, ride your bike to work, or get together with a buddy to play a sport.

Aerobic exercise is also beneficial for people with diabetes. A 2007 study published in PLoS One reported that it helped reduce HbA1c levels in participants with type 2 diabetes. Another study published in Diabetes Care found that exercise training helped reduce waist circumference and HbA1c levels.

5. Lift a few heavy things

As we age, we naturally lose muscle tone. That’s not good for our overall health, or for our cardiovascular health. You can resist that change by adding some weight training to your weekly schedule.

Researchers in the Diabetes Care study mentioned previously reported that resistance training, or weight training, was an effective way to control cholesterol. In a 2013 study published in the Journal of Applied Physiology, researchers found that people who had a regular weight-lifting program had more efficient HDL than those who didn’t.

Weight training is beneficial for those with diabetes, too. In a 2013 study published in Biomed Research International, researchers found that resistance training helped participants build muscle. It also improved overall metabolic health and reduced metabolic risk factors for those with diabetes.

For overall health, it’s best to combine resistance training with your aerobic exercise. Researchers reported in JAMA that people who combined both types of exercise improved their blood sugar levels. Those who did only one or the other did not.

6. Plan healthy meals

You’ve probably already made changes in your diet to help keep your blood sugar levels low. You’re controlling the amount of carbs you eat at each meal, choosing foods low on the glycemic index, and you’re eating small meals more regularly.

If you have high cholesterol too, this diet will still work for you, with just a few small modifications. Continue to limit unhealthy fats such as those in red meat and full-fat dairy, and choose more heart-friendly fats like those found in lean meats, nuts, fish, olive oil, avocadoes, and flaxseeds.

Then, simply add more fiber to your diet. Soluble fiber is most important. According to the Mayo Clinic, it helps to lower LDL cholesterol.

Examples of foods that contain soluble fiber include oats, bran, fruits, beans, lentils, and veggies.

7. Watch out for the rest of your health

Even if you’re careful about controlling both your blood sugar and your blood cholesterol, diabetes can affect other parts of the body over time. That means it’s important to stay on top of all facets of your health as you go.

Your eyes: Both high cholesterol and diabetes can affect your eye health, so be sure to see your eye doctor every year for a checkup.

Your feet: Diabetes can affect the nerves in your feet, making them less sensitive. Check your feet regularly for any blisters, sores, or swelling and make sure that any wounds heal as they’re supposed to. If they don’t, check with your doctor.

Your teeth: There is some evidence that diabetes can increase risk of gum infections. See your dentist regularly and practice careful oral care.

Your immune system: As we age, our immune system gradually weakens. Other conditions like diabetes can weaken it even more, so it’s important to get your vaccinations as you need them. Get your flu shot each year, ask about the shingles vaccine after you turn 60, and ask about the pneumonia shot after you turn 65. The Centers for Disease Control and Prevention also recommends that you get your hepatitis B vaccination soon after you’re diagnosed with diabetes, as people with diabetes have higher rates of hepatitis B.

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