Triglycerides and Diabetes

Reviewed by Robert Ehrman, MD

When you have type 2 diabetes, it is likely that you also have heart disease. In fact, your heart problems might have started before you developed diabetes. In addition to a high triglyceride level, factors that lead to heart disease in people with diabetes include being overweight, being inactive, smoking, low “good” cholesterol (HDL) levels and high “bad” cholesterol (LDL) levels.

WHAT ARE TRIGLYCERIDES?

Triglyceride is another word for fat. You take in triglycerides from the foods you eat. Your liver can also make triglycerides. Triglycerides, along with HDL, LDL, and total cholesterol, are measured from a blood sample in a lipid (blood fat) profile. People with diabetes should have their triglyceride and cholesterol levels checked at least once each year. You may need to have them checked more often if they are higher or lower than your target range. You and your health care provider will want to check them if you are making changes in your eating habits and/or starting a medication to help lower triglycerides. The American Diabetes Association recommends keeping your triglyceride level under 150.

WHAT CAUSES HIGH TRIGLYCERIDES?

You can get high triglyceride levels if your liver makes too many on its own or if your body is not able to remove triglycerides from your bloodstream quickly enough. Your liver may make too many triglycerides if you eat too many calories, too much fat and/or drink too much alcohol. Being overweight and having insulin resistance (a common problem in type 2 diabetes in which the body’s cells aren’t able to use the insulin you make to keep your blood glucose in control) can slow the removal of triglycerides from the bloodstream.

WHAT’S BAD ABOUT HIGH TRIGLYCERIDES?

It is common for people with diabetes and heart disease to have normal or high LDL levels (the bad cholesterol, which should be under 100 if you have diabetes or heart disease). However, these LDLs, even at near normal levels, can be the small, dense type of LDLs (like a baseball) rather than the larger and less dense type of LDLs (like a beach ball). It is the small dense type that is more likely to cause heart problems. On their own, high triglycerides mildly increase the risk of heart disease. But when you have high triglycerides combined with increased small, dense LDLs, heart disease risk increases dramatically. As triglyceride levels come down, the size of the LDL particles becomes larger and safer for your heart.

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