Management Lipid abnormalities in diabetics
Lipids include 'bad' and 'good' cholesterol / lipids.
Bad lipids include:
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Triglycerides. |
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Very low density lipoprotein (VLDL) cholesterol. |
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Low density lipoprotein (LDL) cholesterol. |
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Total cholesterol. |
Good lipid include:
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High density lipoprotein (HDL) cholesterol. |
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A high level of bad and /or low level of good lipid lead to Atherosclerosis (hardening of arteries due to lipid deposits). |
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Dyslipidemia is a term used to describe abnormal lipid levels with altered lipid ratios .(LDL / HDL; Cholesterol / HDL) |
Management of lipid disorder (dyslipidemia) includes:
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To achieve 'Target levels' of lipids for optimum control. |
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Good 'Glycemic control' (sugar control). This helps to decrease the level of dyslipidemia, especially the raised serum Triglycerides levels; HDL-C (good cholesterol) may increase; extent of oxidant stress and degree of glycation and oxidation of proteins decreases. |
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Life style modification. |
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Weight reduction, if overweight. |
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Regular exercise schedule; can help to increase HDL-C levels. |
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Smoking and alcohol intake to be actively discouraged. |
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Diet control. |
Diet control
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Diet therapy is central to optimizing lipid levels. |
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Total fat intake < 20% of total calorie intake. |
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Ensure correct essential fatty acid (EFA) intake, with near optimal omega6 / omega3 (w6/w3) ratio (5:1). |
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'Invisible' fat in the food must be taken into account. |
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Cooking oils should be a judicious mix of PUFAs, MUFAs and saturated fats; no one oil is beneficial; cooking oils should contribute < 6% total energy intake. |
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Foods rich in saturated fats and high in n6 fatty acids should be reduced. |
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Foods rich in n3 fatty acids may be beneficial. |
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Diet and life style modifications should be given an adequate trial for at least 3-6 months before commencing specific lipid lowering drug therapy. |
Target levels of lipids for optimum control.
OPTIMUM MANAGEMENT
TEST PARAMETER |
GOOD |
FAIR |
POOR |
Total Cholesterol mg/100ml |
<200 |
200-240 |
>240 |
HDL-Cholesterol mg/100ml |
>45 |
35-45 |
<35 |
LDL-Cholesterol mg/100ml |
<100 |
100-129 |
>130 |
Triglycerides mg/100ml |
<150 |
150-200 |
>200 |
Drug therapy.
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Different classes of drugs are available having effect on various lipids to varying degree. The therapy is individualized depending upon the lipid pattern. |
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Anti-oxidants such as Vitamin-E, Vitamin-C etc. may play a significant role by decreasing LDL oxidation. |
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Fish oils rich in n3 fatty acids have been shown to help in correcting dyslipidemia. |