A. Stricter cholesterol requirements for sugar lovers
Auntie Zhang is more than 50 years old, many years ago found to have diabetes and primary hypertension, family members, in addition to her sister and she suffers from primary hypertension, her father died many years ago because of sudden cardiovascular disease. Auntie Zhang usually monitors her own blood sugar and blood pressure at home, because blood sugar and blood pressure have been well controlled, so Auntie Zhang has not done other tests. Some time ago, Auntie Zhang suddenly fainted and went to the hospital for examination and found a mild cerebral infarction. In addition to high blood pressure and diabetes, the doctor said that Auntie Zhang’s blood lipids were also high and should be treated with lipid-lowering therapy. Auntie Zhang thought it was strange, her cholesterol had always been normal, and so was this checkup, which was still clearly within the normal range, so why would the doctor say she needed to lower her lipids?
The blood cholesterol level requirement for diabetic patients is more stringent than that of ordinary people
Diabetics often have this question: Why do they need to lower their blood lipids when they are clearly normal? Diabetes and cardiovascular disease often go hand in hand. Studies have found that patients with diabetes have as high a chance of having a myocardial infarction during a 7-year follow-up as those who have had a myocardial infarction; in other words, having diabetes is the same as having coronary heart disease. Therefore, the management of dyslipidemia in diabetic patients should refer to the criteria for people with coronary artery disease with dyslipidemia. Dyslipidemia in diabetic patients is not determined with reference to the general value of dyslipidemia; for diabetic patients, their lipid requirements are more stringent than those of the general population.
The level of control of cholesterol levels is mainly classified according to the degree of cardiovascular disease risk. In general, the low-density lipoprotein cholesterol (LDL-c) requirement for normal people is between 120 mg/dL or less, but for diabetic patients who are at risk for coronary heart disease and other conditions, the LDL-c should be controlled at 100 mg/dL or less. In addition to diabetes, if there is also cardiovascular disease or more than one risk factor for cardiovascular disease, such as smoking, hypertension and a family history of early onset coronary heart disease, then the lipid requirements should be more stringent and the LDC-c of these diabetic patients should be controlled below 70mg/dL.
Like the female glucose patient in the case, she has primary hypertension and a family history of cardiovascular disease. For her, with these risk factors, her lipid requirements are even more stringent and she cannot refer to the general lipid levels.
Most sugar patients need to pay attention to lipid and cholesterol control
In fact, most diabetic patients need lipid-lowering therapy, except for some very young ones, who simply have elevated blood glucose but normal lipids (LDL-c<100 mg/dL) and blood pressure, and no other cardiovascular risk factors, and who are under 40 years old, they do not need lipid-lowering therapy, but this part of patients is rare. Therefore, sugar lovers should pay close attention to their blood lipid levels and lower them early.
Second, the “lipid” to take medicine
Grandma Xie is 73 years old, has a history of diabetes for many years, and has been taking oral hypoglycemic drugs. She usually attaches great importance to blood glucose control and bought a blood glucose meter to measure her blood glucose at home.
Some time ago, she went to the hospital for a checkup and found that her lipid level was abnormal, mainly total cholesterol and low-density lipoprotein cholesterol were significantly elevated, and she needed to take lipid-lowering drugs for treatment. Grandma Xie found that her neighbor also found abnormal blood lipids, triglycerides but he ate different drugs and her, do they have to be divided into “each other” to lower blood lipids?
We know that diabetes is often accompanied by hyperlipidemia, both of which are risk factors for various cardiovascular diseases. Therefore, for diabetic patients, controlling blood lipids and lowering them early can effectively prevent the occurrence of cardiovascular diseases.
However, this “lipid” is not the same as the other “lipid”, and the main type of elevated lipid is different, and the corresponding treatment is also different. Therefore, sugar lovers should know clearly what kind of “lipid” is high and prescribe the right medicine for it in order to effectively reduce lipids.
Lipid abnormalities in diabetic patients mainly include elevated low-density lipoprotein cholesterol (LDL-c), elevated triglycerides and reduced high-density lipoprotein cholesterol (HDL-c). Studies have confirmed that elevated LDL-c levels in the blood are an excessive risk factor for atherosclerotic plaque formation, increasing the risk of cardiovascular events.
How to choose drugs for lowering lipids in diabetic patients
Currently, the commonly used lipid-lowering drugs can be divided into three major categories, including statins, fibrates and niacin, each of which has different lipid-lowering characteristics. The main role of statins is to lower cholesterol, such as fluvastatin, atorvastatin, simvastatin, resevastatin, etc. These drugs are currently considered to have the strongest cardiovascular protective effect. While the shellfish and niacin drugs are mainly for lowering triglycerides, such as fenofibrate, benzofibrate, etc., and niacin, such as acipimox, niacin extended-release tablets, etc. The lipid-lowering effect of herbs is usually very weak.
Since LDL-c is the strongest cardiovascular disease risk factor, when diabetic patients are treated with lipid-lowering therapy, if the triglyceride level is particularly high, such as above 500 mg/dL, or above 5.7 mmol/L, the first priority is to lower triglycerides. If this is not the case, statins are generally considered first for lipid-lowering therapy in clinical practice.
Sometimes diabetic patients have both elevated cholesterol and triglycerides at the same time. If the cholesterol has come down after using statins, but the triglycerides are still high, above 150mg/L or 1.7mmol/L, then the combination of statins with other fibrates and niacin should be considered. The risk of side effects increases with the combination of drugs. When you start to apply, you should monitor the changes of liver function and pay attention to the presence of muscle pain, etc.
Third, blood lipids can not be “eaten”
Auntie Zhang was found to have diabetes and high blood pressure many years ago, and since then she started to pay attention to her diet and no longer eats oily and fried food as before. But soon after a checkup at the hospital, the doctor told her that her HDL was lower and her LDL was significantly higher, and in general, she needed to pay attention to lowering her lipids. But Auntie Zhang was puzzled. She obviously had purposely controlled her diet, but why was this lipid still high?
Can sugar lovers with dyslipidemia lower their lipids through diet?
Most sugar lovers believe that diabetes and high blood lipids are both caused by eating, so many sugar lovers will first consider adjusting their diet to achieve the purpose of lowering sugar and lipids when they are checked for abnormal blood lipids. This is actually a good point, because for people with elevated cholesterol, diet has a certain influence on their dyslipidemia. By controlling diet and adopting a low-cholesterol diet, such as reducing or not eating foods like egg yolk and animal offal, a certain effect of cholesterol reduction can be achieved.
Elevated cholesterol, abnormal metabolism is the main cause
However, in fact, many diabetic patients have elevated cholesterol caused by metabolic factors, and it is difficult to achieve the purpose of lowering blood lipids by simply adjusting the diet structure or controlling the diet when dyslipidemia has already occurred. Therefore, glycemic patients with dyslipidemia should never hope to lower their blood lipids by simply changing their diet structure or controlling their diet. The effectiveness of lifestyle treatment for hyperlipidemia is also related to the type of lipid elevation. If cholesterol, especially LDL cholesterol, is predominantly elevated, it is often difficult to meet the standard and medication should be considered early for lipid-lowering treatment.
Elevated triglycerides and diet control can regulate lipids
What dyslipidemia is more related to diet? It is actually triglycerides, which means that dyslipidemia with mainly elevated triglycerides will be more affected by diet. Therefore, for this part of sugar lovers, it is more effective to lower lipids by adjusting the diet structure and controlling the diet. The important thing to control the diet is the calorie control, to reduce the total calorie intake. Do not think that eating less greasy things will do. Eating excessive carbohydrate-based grains can also increase blood triglyceride levels.
Overall, whether it is mainly elevated triglycerides or elevated cholesterol-based elevated blood lipids, diet has a certain relationship with it, but the main reason is the metabolic aspects.
Fourth, diet and exercise, effective triglyceride lowering
Many sugar lovers have good control of their blood sugar, but when they go to the hospital for a checkup, the doctor will still recommend them to check their blood lipids at the same time. With a lipid test sheet, in a bunch of professional terms, some careful sugar lovers look at them one by one and find that among these lipid check indicators, only triglycerides are significantly higher.
For the high triglycerides, sugar lovers can start from controlling diet and strengthening exercise to lower triglycerides. The first step is to stop eating too much fat (triglycerides) from the diet, then control it from the exercise side, and finally, you can treat it with medication appropriately to finally lower triglycerides.
Triglycerides can be properly regulated by controlling the diet
The elevation of triglycerides actually has a lot to do with diet, so for sugar lovers with elevated triglycerides alone, in order to eliminate the elevated triglycerides from the source based on controlling the total calorie intake, the first thing to consider is to start by controlling the diet. For example, pay attention to eating less high-fat and high-protein foods, eating more coarse grains and foods rich in dietary fiber, not eating fried foods, eating more light foods, and eating more fresh vegetables and fruits.
Exercise to lose weight and effectively lower triglycerides
In addition to elevated triglycerides and diet, there is also an important causative factor is to exercise less. This part of the sugar users are generally more obese, and exercise has a positive impact on the body’s lipid metabolism, can accelerate the operation, decomposition and metabolism of lipids, is a healthy and effective way to reduce lipids. Therefore, for this part of sugar lovers, they can do some exercises appropriately with diet control to lower their body weight and achieve the goal of lowering blood lipids.
In general, the combination of diet control and exercise can play a role in adjusting blood lipids, especially in lowering triglycerides. However, if triglycerides are already severely high, or if diet and exercise cannot lower triglycerides, it is necessary to take lipid-lowering drugs such as statins under the guidance of a doctor.
Small link: What is triglyceride
Triglycerides are the most abundant lipids in the human body. Body tissues, especially muscle tissues, can use triglyceride breakdown products to supply energy, while liver, fat and other tissues can also synthesize triglycerides and store them in adipose tissue.
If we take pork as an example, triglycerides are those white fatty parts, and subcutaneous fat is triglyceride accumulation. In the fasting state, the body’s blood sugar level is low triglycerides can be used for the body’s needs to break down. But there are too many triglycerides, for the body is a burden, may be deposited outside the adipose tissue, triggering hypertension, coronary heart disease, diabetes, cerebrovascular disease and other diseases, for health is a serious threat.
Five, eat less oil also to reduce fat?
Grandma Xie is 73 years old, she was checked out a few years ago and has been taking oral hypoglycemic drugs. Usually she attaches great importance to blood sugar control, but also bought a blood glucose meter at home to test their own blood sugar, but also pay attention to diet, generally to light.
Some time ago, she went to the hospital for a checkup and found that her blood lipid level was abnormal, mainly total cholesterol and LDL cholesterol were significantly elevated, and she needed to take lipid-lowering medication. Grandma Xie didn’t understand why she needed to take medication to lower her blood lipids when her diet was usually light and she rarely ate fatty things.
Many thin people with low weight and a light diet think that they will never have high lipids or abnormal cholesterol, let alone heart attacks. In fact, if there are abnormalities in lipid metabolism, all may have dyslipidemia and even coronary heart disease. There is a medical condition called familial hypercholesterolemia, which is hypercholesterolemia caused by a congenital defect in the process of cholesterol metabolism. This disease may be responsible for the development of myocardial infarction at the age of about 20 years. In middle-aged and elderly people, hypercholesterolemia is also associated with metabolic abnormalities. Therefore, although there is a strong relationship between blood lipids and diet and exercise, avoidance of food and more exercise alone may not be the complete solution.
Metabolic abnormalities are the main cause of elevated cholesterol
In fact, many diabetic patients have elevated cholesterol caused by metabolic factors, and diet has some relationship with it, but not too much. Even if you have controlled your diet or have a lighter diet, if there is a metabolic problem, i.e., the synthesis of cholesterol in the body is abnormal, the body’s lipid metabolism is impaired, too much cholesterol is synthesized or the breakdown of metabolism is abnormally difficult and cannot be metabolized, then cholesterol will accumulate in the body.
This abnormal metabolism can explain the phenomenon that many sugar lovers say they rarely eat or do not eat high cholesterol foods but still have high cholesterol in their blood. Both fat and cholesterol can be synthesized in the body. That is, the food you eat can be converted into fat. If you don’t eat meat, eat eggs, eat fish, eat rice, flour, sugar, starchy things can be converted into fat after eating.
To prevent dyslipidemia, first of all, the diet should be controlled, to control the amount of staple foods, to control the diet containing high cholesterol, such as animal offal, shellfish and eggs, egg food should be eaten less. Exercise is an important way to lose weight. Exercise can not only lower blood sugar, clinical trials have proved that exercise can also lower blood lipids and blood pressure.
Sixth, statins: when to take the most appropriate
Some patients go to the hospital to check out high blood lipids, the doctor prescribed lipid-lowering drugs, instructions to eat at night. Why should lipid-lowering drugs be taken at night? Is this true for all lipid-lowering drugs? At present, the most widely used and most effective lipid-lowering drugs are statins, which can lower cholesterol in addition to regulating lipids and are therefore suitable for people with high blood lipids and high cholesterol.
Statins with a short duration of action are suitable to be taken at night before bedtime.
Generally speaking, doctors recommend that patients take statins at bedtime because most statins have a relatively short duration of action, and since the body is most active in synthesizing cholesterol at night and statins work mainly by limiting cholesterol synthesis, these statins should be taken at night to get the best lipid-lowering effect.
When comparing the efficacy of drugs taken at different times of the day, it was observed that for some statins with a shorter duration of action, the same dose produced a greater reduction in cholesterol when taken at night than during the day.
The newer statins have a longer duration of action and are suitable for daytime dosing. However, with the increase in the number of newer statins, there are some statins that do not necessarily emphasize taking them at bedtime. Some statins have a duration of action of up to 20 hours and can adequately inhibit cholesterol synthesis at night even when taken during the day, so among the common statins, such as atorvastatin and rasulvastatin, there is no emphasis on necessarily taking them at night.
Therefore, when taking statin lipid-lowering drugs, whether to take them at night before bed or during the day depends on the specific time of action of different statins. Also, most patients with dyslipidemia are often combined with other diseases, such as hypertension, and can get up in the morning and take them together with their hypertension medication for convenience. If 2 lipid-lowering drugs such as fibrates and statins are used at the same time, it is usually recommended to take the fibrates in the morning and the statins in the evening.