As if diabetes doesn't give us enough to worry about in the day-to-day, we also have to be constantly aware of what could happen to us, down the line. Here at the 'Mine, we're big believers that knowledge is power, and it's better to be prepared for the worst, which is why we've been bringing you an in-depth look at various diabetes complications in our "411 Series" since the beginning of the year.
September is National Cholesterol Education Month, so even though we covered heart disease in February, we're going to take a deep dive into cholesterol, which most of us probably didn't plan on thinking about until we were old and gray. Well, cholesterol is a big deal for PWDs of all ages, namely because heart disease is the No. 1 complication and killer for us. But thankfully, there are some things we can do about it.
Did you know that cholesterol is actually a necessary component of life? It lives inside a waxy substance found in all of your cells, and has a variety of functions, including helping to build your body's cells. So not having any cholesterol is definitely not what we're aiming for...
There are two kinds of cholesterol: LDL and HDL. LDL is more-or-less the "bad" kind, the kind that you get from one too many trips through the drive-thru. Build-up of LDL in the arteries causes heart attacks. HDL is the good kind. HDL helps to rid the body of the bad kind of LDL cholesterol by shuttling it down to the liver to be disposed of.
And as it happens, people with diabetes naturally have higher LDL and lower HDL. Lucky us, huh? Researchers aren't entirely sure why, but high levels of insulin in the bloodstream appear to breakdown HDL and raise LDL. Another gift with diabetes is that it tends to raise triglycerides, a different kind of fat roaming around the blood stream.
About 20% of Americans actually have this problem (too low HDL / too high LDL). What should your numbers be?
HDL: At least 40 mg/dl, but preferably 60 mg/dl or higher (the more, the better)
LDL: Under 100 mg/dl, but preferably even lower than that, to around 70 mg/dl because people with diabetes are already at such a high risk for cardiovascular disease
Of course, the best way to keep tabs on your cholesterol levels is to get your annual labs done, specifically a blood test called the Lipid Profile. It's actually a single blood draw that's sufficient for the lab to measure your LDL, HDL, and triglycerides (three for the price of one!)
The book that Amy co-wrote with Dr. Jackson of Joslin Diabetes Center, called Know Your Numbers, Outlive Your Diabetes, has lots of information about this test (and what you can do about it if your numbers are out of range - see below).
Quoting from that guidebook: "If you have concerns about your triglycerides, the test should be done following overnight fasting. LDL and HDL cholesterol are not much affected by food, however, so you don't need to be fasting if you're taking the test especially to monitor these lipids. Nevertheless, it is always bad form to show up for your blood test gripping a fast food takeout sack, even if it was a two-for-one special. Don't laugh, as we've seen this happen!
And the smell of French Fries can be disconcerting in the lab."
So, have you made your annual labs appointment yet?
In their book, Rich and Amy recommend the following steps to improve your cholesterol numbers:
* Eat foods with low cholesterol and avoid saturated fats. The American Heart Association recommends less than 300 milligrams, but if you already have heart disease, limit your intake of saturated fats to 200 milligrams. Luckily, cholesterol is listed close to carbohydrates on the nutrition label of packaged foods, so it won't be too hard to find.
* Quit smoking. Smoking lowers HDL ("good") cholesterol levels. Plus it does a whole host of yucky things to you. So knock it off. Please.
* Exercise. Being overweight leads to an increase in triglycerides and an decrease in HDL cholesterol. Meanwhile, exercise is a "marvel of health improvement" that helps lower your lipids, A1C and blood pressure! Aerobic exercise is king here, i.e. physical activity that elevates your heart rate for a sustained amount of time.
* And then there are meds. The most commonly used and discussed meds for lowering cholesterol are a family called "statins," including lovastatins (Advicor, Mevacor, and Altocor), atorvastatins (Lipitor), and pravastatins (Pravachol and Pravigard). But statins are pretty controversial, as you may have heard...
The Statin Conundrum
You've probably heard about the risk/benefits debate over statins (it's always in the news). And maybe you're thinking, Do I really need another drug? Well, that's debatable...
Last year at the European Association for the Study of Diabetes (EASD) conference, Professor John Betteridge, of University College London Medical School, stated his conviction that all people over the age of 40 with either type of diabetes should be taking statins. Dr. Robert Eckel, an endocrinologist and past president of the American Heart Association, also recommended this advice to us in February because PWDs have such an increased risk of cardiovascular disease.
On the negative side, there's all the evidence of unsettling side effects, ranging from muscle pain, to liver damage, to mental confusion described as "cognitive dysfunction." So you might be wondering if you should be jumping on this statin bandwagon.
In July, the Boston Globe reported about a study that's suggesting a more measured approach, as in the answer may lie in your A1C number. The more elevated it is — and the older you are — the more likely you are to have a heart attack or stroke. In those cases, a statin would prove invaluable. But for those with a "normal" A1C number (7.0 or less) and in folks who are younger, a statin is probably not necessary.
The Boston Globe story quoted Dr. Om Ganda, head of the Lipid Clinic at Joslin Diabetes Center, saying, "I don't think we should lump all diabetics into the same high-risk category. Clinicians really need to use their judgement and consider other factors like age, family history of heart disease, blood pressure and cholesterol levels, and smoking habits."
Right, and the same goes for us patients as far as using our judgement. If you think you might need a statin, discuss it with your doctor. But don't let him/her talk you into anything you're not comfortable with. Be an active participant in your health and do your homework. And make sure you get your cholesterol screened every year, otherwise you don't know what you're up against!