Diabetes and Cholesterol
Understanding the Connection and How to Protect Your Heart.
Learn how diabetes affects cholesterol levels, why the combination increases heart disease risk, and how to manage both effectively for better long-term health.
When most people think about diabetes, they focus on blood sugar. But for millions of adults, diabetes also brings another dangerous companion: high cholesterol. Together, diabetes and unhealthy cholesterol levels form a powerful combination that dramatically increases the risk of heart disease, stroke, and circulation problems.
Understanding the connection between diabetes and cholesterol — and how to manage both — is essential for protecting long-term health.
The Link Between Diabetes and Cholesterol
People with type 1 or type 2 diabetes are much more likely to develop unhealthy cholesterol levels. This is because high blood sugar affects how the body handles fats, damages blood vessels, and disrupts hormone and liver function.
Here’s what typically happens:
1. Insulin Resistance Disrupts Fat Metabolism
In type 2 diabetes, the body becomes resistant to insulin. This doesn’t just affect glucose — it also interferes with how the body processes lipids (fats). The result is a pattern known as diabetic dyslipidaemia, which includes:
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High triglycerides
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Low HDL (“good”) cholesterol
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Small, dense LDL (“bad”) cholesterol particles that are more harmful
2. High Blood Sugar Damages Arteries
Glucose damages the inner lining of blood vessels, making it easier for cholesterol to stick and form plaque — the starting point of heart disease.
3. The Liver Overproduces VLDL
When insulin isn’t working properly, the liver releases more very low-density lipoproteins (VLDL), which later become LDL cholesterol, raising heart risks.
This combination makes cholesterol more dangerous for diabetics than for the general population.
Why Diabetes + High Cholesterol Is So Dangerous
People with diabetes already have a higher baseline risk of cardiovascular disease. When cholesterol levels are also high, the risk becomes significantly worse.
1. Accelerated Atherosclerosis
Atherosclerosis (hardening and narrowing of the arteries) happens faster in diabetics. Plaque builds up more easily and becomes more unstable, increasing the risk of:
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Heart attack
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Stroke
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Peripheral artery disease (PAD)
2. Silent Symptoms
Both high cholesterol and early heart disease often have no symptoms. This means many diabetics don’t know there’s a problem until a major event occurs.
3. Higher Mortality Risk
The combination of diabetes + high cholesterol increases the likelihood of life-threatening cardiovascular events more than either condition alone.
In fact, heart disease is the leading cause of death in adults with diabetes.
What Cholesterol Numbers Should Diabetics Aim For?
Health authorities (including Diabetes Australia, ADA, and the Heart Foundation) recommend stricter cholesterol targets for people with diabetes:
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LDL (bad cholesterol): under 2.0 mmol/L (or even 1.8 mmol/L for high-risk individuals)
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HDL (good cholesterol): above 1.0 mmol/L
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Triglycerides: under 2.0 mmol/L
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Total cholesterol: under 4.0 mmol/L
Since diabetes accelerates vascular disease, these tighter targets help protect the heart and arteries.
How to Manage Cholesterol When You Have Diabetes
The good news is that cholesterol can be improved — and cardiovascular risk reduced — through lifestyle changes and, when needed, medication.
1. Improve Your Diet
A heart-healthy, low-GI eating plan helps control both cholesterol and blood sugar:
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Choose lean protein like fish, chicken, tofu, and legumes.
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Increase fibre: vegetables, oats, barley, beans, and whole grains.
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Include healthy fats: olive oil, avocado, nuts, seeds.
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Limit saturated fats: fatty meats, butter, cream, cheese.
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Avoid trans fats and processed foods.
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Reduce sugary foods which trigger insulin spikes and fat storage.
2. Move More
Regular activity improves insulin sensitivity and raises HDL (the “good” cholesterol).
Aim for:
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150 minutes per week of moderate exercise
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Strength training 2–3 times weekly
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Daily movement: walking, stairs, stretching
3. Maintain a Healthy Weight
Weight loss — even 5–10% of body weight — can significantly improve cholesterol, triglycerides, and diabetes control.
4. Quit Smoking
Smoking doubles the risk of heart disease in diabetics and lowers HDL levels.
5. Take Cholesterol-Lowering Medication if Needed
Many people with diabetes take statins, which reduce LDL cholesterol and lower the risk of heart attack and stroke.
Other treatments include:
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Ezetimibe
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PCSK9 inhibitors
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Fibrates (for high triglycerides)
Your doctor will recommend the right strategy based on your risk profile.
How Often Should Diabetics Check Their Cholesterol?
Most guidelines recommend a full cholesterol test at least once a year.
More frequent checks may be required if:
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You have high cardiovascular risk
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You’ve recently started cholesterol medication
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Your levels are fluctuating
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You have uncontrolled diabetes
Regular monitoring ensures problems are caught early — long before symptoms appear.
The Bottom Line
Diabetes and cholesterol are deeply connected — and when both are poorly controlled, cardiovascular risk rises quickly. However, with regular check-ups, healthy lifestyle choices, and the right treatment plan, you can dramatically reduce your risks.
Managing cholesterol is more than a lab number — it’s a key part of staying healthy, protecting your heart, and preventing long-term complications of diabetes.
