Many people with diabetes also have dyslipidemia (a problem with one or more cholesterol – or lipid – levels). The common form of dyslipidemia in diabetes is low HDL and high triglycerides. The LDL level in diabetes does not differ significantly from those without diabetes. But with diabetes, there can be changes in the lipid particles themselves. When diabetes is present, LDL particles become smaller and denser. These smaller, denser particles are more damaging to blood vessel walls, and are more easily used for plaque formation – and they can accelerate the process of atherosclerosis.
HDL particles also undergo a change, making them less able to carry LDL back to the liver. This makes HDL particles less protective.
High triglyceride levels contribute to the formation of small, dense LDL particles, and reduced amounts of HDL. High triglycerides often accompany high blood sugar levels, and when blood sugar levels are returned to more normal levels, triglycerides usually improve.
Diabetic dyslipidemia refers to this triad of lipid problems: high triglycerides, low HDL, and smaller, denser LDL particles that may or may not be at a higher level. As with people without diabetes, the first priority for treatment is to reduce LDL if it is elevated. Normalizing blood sugars is also a priority and will help improve lipids, particularly triglycerides.