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Lipid disorders in diabetes

Type 1 diabetes and type 2 diabetes both affect lipid metabolism. Monitoring and treating the blood lipid levels are an important part of the prevention and treatment of arterial diseases.

In the picture on the right, there is a healthy blood vessel; on the left, excess cholesterol has started to attach to the vessel wall, and at the top of the image, the vessel is completely blocked.
In the picture on the right, there is a healthy blood vessel; on the left, excess cholesterol has started to attach to the vessel wall, and at the top of the image, the vessel is completely blocked.

A lipid disorder refers to a condition where the level of “harmful” LDL cholesterol in blood is over 3 mmol/l or the blood fat (triglyceride) level is over 1,7 mmol/l or the level of “good” HDL cholesterol is low: below 1,0 mmol/l in men and below 1,2 mmol/l in women.

The distribution of lipid bodies in blood changes as a combined result of genetics, lifestyle, age and illnesses. In the case of a person with diabetes, lipid disorders may be related to diabetes itself, or it may be caused by the same factors as in other people: lipid disorders can be the result of an unhealthy diet, a high intake of saturated fats, a metabolic syndrome and the reduced effect of insulin, heavy alcohol consumption, lack of exercise, some pharmaceutical products as well as hereditary lipid disorders. An underactive thyroid gland can also increase cholesterol, so the functioning of the thyroid gland should be checked with a blood test.

Especially a high concentration of apolipoprotein B (apoB) atherogenic lipoprotein particles, including low-density lipoproteins (LDL) and triglyceride-rich lipoproteins, has a direct correlation with the build-up of cholesterol on the intima of arteries, which can lead to coronary artery diseases as a result of an inflammatory reaction.

In blood, cholesterol and triglyceride are coupled with proteins called apolipoproteins. The apolipoproteins, cholesterol and triglyceride form lipid bodies in blood.

An important task of lipid bodies is to transfer energy and the structural materials of cells in blood in a soluble form. Cholesterol is a normal and necessary structural material of the body used, e.g. in cell membranes and hormone production. Triglycerides act as an energy storage in the fatty tissue.

Lipid = a fatty compound, such as cholesterol

Dyslipidemia = a lipid disorder

Lipoprotein = a particle made of lipids, i.e. fats, and proteins, the mode of transporting lipids in blood

Cholesterol = a lipid obtained from food or produced by the liver

LDL-cholesterol = Low Density Lipoprotein, in excess harmful, ”bad cholesterol”

HDL-cholesterol = High Density Liporotein, beneficial, ”good cholesterol”

VLDL = Very Low Density Lipoprotein

Triglycerides = fatty acids in blood that act as an energy storage of the fatty tissue

In type 1 diabetes, lipid disorders are caused by same factors as in other people. Type 1 diabetes has no significant effect on “bad” LDL cholesterol. Nonetheless, its target level is lower, if you have been diagnosed with a coronary artery disease, other complications related to diabetes or if they've had diabetes over 10 to 20 years.

The HDL cholesterol level is often high in insulin therapy but, based on studies, it cannot be considered a factor that protects from coronary artery disease.

The metabolic syndrome and type 2 diabetes are characterised by the reduced effect of insulin, i.e. insulin resistance. It includes a higher blood triglyceride level and the small, dense structure of LDL cholesterol particles. Other features include a low HDL cholesterol level, higher apoB level and postprandial triglyceride increasing for a prolonged period of time. This combination is called a diabetic dyslipidemia.

The metabolic syndrome includes a combination of other metabolic anomalies, such as hypertension, insulin resistance, fatty liver as well as a build-up of fat around the midriff and internal organs. Together with a lipid disorder, they highly increase the risk of coronary artery disease, even if the LDL cholesterol level were only slightly high or even within the target range of the general population.

Updated 30.9.2023