Diabetes complications

How to Manage Diabetes and High Cholesterol

High cholesterol can cause atherosclerosis which can make dealing with diabetes harder. Learn how to manage diabetes and high cholesterol together.

Managing what you eat is a constant tedious task for people with Diabetes, but it can be made easier through the use of tools and systems, such as diabetes plate, -a portion formulation and control tool, or dietary tracking applications such as DiabTrend.  These are highly effective at keeping those damaging extremes of blood glucose levels to a minimum.  However, in some cases, there are complications, such as high cholesterol (below) or high blood pressure, which people with diabetes also tend to suffer from at some point or another. Additional considerations and changes to the diabetic diet may need to be made to manage these complications. This article will address this question of how to manage diabetes and high cholesterol.

Wait a minute, isn't high Cholesterol and Diabetes the same thing?

While diabetes and high cholesterol do often occur together, it does not always so, therefore, no, high cholesterol and diabetes are not the same, but there is an increased risk of getting it. This risk can be minimized by adjusting your diet to take into account high cholesterol.

What is High Cholesterol?

As the phrase implies, high cholesterol is cholesterol levels that are well above normal, however, it's not as simple as just that, because there are different kinds of cholesterol, there are both “good” and “bad” types. To go any further we need to look at these types of cholesterol and consider other factors that affect blood cholesterol levels in order to understand why they are considered good or bad, which in turn will help you understand how and why to change your diet. 

High-density Lipoprotein (HDL) vs Low-density Lipoprotein (LDL)

Since cholesterol (and other lipids) are not water-soluble, they need some carriers in the bloodstream to facilitate entry into cells after absorption. These carriers are proteins, hence the name:  lipoproteins. There are various types of lipids bound to these proteins, such as triglycerides, cholesterol, and phospholipids. 

The ratio of protein to fat changes the density of these lipoproteins. The more protein they have in them, the higher their density is. High-density lipoprotein (HDL) is considered “good,” and Low-density lipoprotein is “bad.” This reputation has been earned because they have different effects on the body when absorbed into the bloodstream, ultimately changing their destination.  

….and so HDL is good because it helps to remove cholesterol from the arterial wall and takes cholesterol to the liver efficiently for excretion or repackaging.

Whereas LDL is bad because it gets taken to the circulatory system just like HDL, rather than efficient delivery to the liver, LDL gets deposited in arteries and veins if those walls are injured, causing atherosclerosis over time, as the deposits grow over many years. 

Dyslipidemia (an imbalance in blood lipids such as mentioned above) increases the risk of atherosclerosis. 

What Is Atherosclerosis?

Atherosclerosis is a narrowing and hardening of the arteries; they become less flexible because of the build-up of plaque which ultimately makes them less responsive to changing needs of the body.  Blood vessels carry oxygen and nutrients around the body.

If fats and cholesterol collect in your blood vessels, it forms plaque. Plaque build-up makes it difficult for blood to flow through your blood vessels. It can result in a shortage of blood and oxygen in various tissues of your body, causing dangerous blood clots. Without treatment, atherosclerosis can lead to heart attack, stroke, or heart failure, among other conditions.

Consequences of Atherosclerosis

Atherosclerosis is a common condition in the elderly as they suffer from clogged arteries, a gradual accumulation of fatty deposits, and narrowing arteries over many years.

The heart has to work harder to deliver the same amount of oxygen because the arteries become narrower, resulting in reduced flow, which puts strain on the heart, increasing the likelihood of heart failure.  The risk of having a stroke is also increased due to insufficient oxygen reaching the brain.

Diabetes and High Cholesterol

Diabetes tends to increase the risk of lipid abnormalities, meaning that diabetic people have a higher chance to have high levels of LDL cholesterol and triglyceride levels, and lower levels of HDL cholesterol, which all increase the chance of getting early-onset Atherosclerosis, and the problems related to it which are mentioned above.

How to Manage Diabetes and High Cholesterol

Following the guidelines of a “diabetes diet” published in the Diabetes Care Journal is an excellent starting point for having a heart-healthy diet as well. It recommends fiber-rich meals, is low in added sugars, and supports changing ultra-processed foods to whole foods. But if you are at risk for cardiovascular diseases, there is more to pay attention to! 

It’s not just about how much cholesterol you consume, but also how much saturated/unsaturated fats and trans-fat you eat, as those can also have an effect on blood cholesterol levels. Let’s look at the different types of fats to see where changes need to be made. 

Primary Fat Sources that increase LDL Cholesterol

  • Saturated fats
  • Red meat and fatty cuts of meat 
  • Processed meats like sausages and bacon
  • Animal fats like lard
  • Full fat dairy
  • Tropical oils like coconut and palm oil 
  • Partially hydrogenated (trans) fats 
  • Fats in ultra-processed foods such as fast foods, commercially baked goods, etc.
  • Dietary cholesterol 
  • Animal products like egg yolks, marrow, liver, etc.

Main Lifestyle Causes of High Cholesterol

Overeating the above-listed foods greatly contributes to your risk of getting high cholesterol; your diet is key. This is why another diet-related disorder is found at the top of our list below:

  1. Obesity
  2. Smoking
  3. Lack of Exercise
  4. Consuming Alcohol

Steps to take to Reduce High Cholesterol

  • Reduce/cut out Primary fat sources that increase LDL cholesterol
  • Be active; even walking 30 minutes each day helps
  • Minimize alcohol consumption
  • Maintain a healthy body weight
  • Follow a fiber-rich diet like the Mediterranean diet

Food swaps to reduce High Cholesterol.

  • Pay attention to what fat sources you use! Try to lower your saturated fat/trans-fat intake, or even better, swap them for unsaturated fats, like MUFA and PUFA (e.g. omega-3). 
  • Fatty cuts → Lean meat. 
  • Deep-fried foods → Grilled or pan-fried foods.
  • Tropical oils, animal fats →  Liquid plant oils
  • Coconut oil, lard →  Olive oil
  • Full-fat dairy → Skimmed / light dairy products
  • Red meat (e.g. beef) → Oily fish (eg. salmon)
  • Fast food meals, instant foods → Home-made meals 
  • Add more fiber to your diet. 
  • Refined grains → Whole grains 
  • Eat at least one portion of veggies/fruits for every meal you have 
  • Juices → Fresh fruits
  • Red meat, fatty cuts → Plant-based protein sources 
  • Instead of candies, sweets → Snack on nuts (in moderation!) 

Mediterranean Diet 

A Mediterranean-style eating pattern rich in whole grains, legumes, fruits, vegetables, nuts and seeds, oily fish, and olive oil is shown to positively affect both type 2 diabetes and cardiovascular diseases like atherosclerosis. To know more about how much your current eating pattern fits the Mediterranean diet, fill out this quiz to learn more: 

Mediterranean Diet Score


Richard Johnson
Reading time: 
April 25, 2022

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