Hello...
I was dxed Type 1 (LADA) in late October 2011 with an a1c of 5.7. I went to a very low carb high fat diet on November 1st. I lost about 35 pounds in 4 months and have not gained or lost weight since March...I do not take any diabetic medicines and rarely have a bg over 115.
So anyway, I convinced my doctor to do a blood test for cholesterol as I am concerned that the high fat diet will result in high cholesterol. I got the results yesterday...HDL 128...Triglycerides 57...LDL 55.
My doctor called in a script for some sort of statin to reduce my LDL stating because I am diabetic the HDL should be under 100. I am very leery about taking statins and don't know if HDL of 128 is all that high...
Any thoughts?
Hey there,
I'm not a doctor, and I sure don't know all of your particulars that your doctor hopefully does-- but based alone on what you said here, I think I would recommend getting a second opinion right away. If you A1C was 5.7 at initial diagnosis, I'm not sure why you were diagnosed. A1C of 6.5 or greater is considered diagnostic criteria for diabetes of any type (by the labs I go to at least). If you rarely have a BG over 115 without any meds, I am not sure what the problem is... Also if they told you are a type one diabetic with or without the "LADA" term, but didn't put you on some sort of insulin regimen immediately-- hopefully they gave you a pretty thorough explanation why not.
Also I don't understand what you listed as your cholesterol numbers, did you accidentally misplace the numbers?-- do you mean that your LDL is 128? and HDL is 55? And your doctor wanted your LDL below 100? If so, that is very similar to what my lipids were at the time of diagnosis-- which was a big surprise to me, because they were totally normal a year before when I had routine blood work done. They did put me on a small (10mg) dose of atoravastatin (lipitor) due to my elevated LDL and triglycerides at my initial diagnosis. I'm hoping I won't have to be on it for very long, as I think my numbers were just messed up because I was pretty sick-- with A1c over 11 at the time.
Keep us posted,
Sam
Hey there again, I just read the rest of your profile. I saw that you were diagnosed as type 1, or LADA with a natural serum insulin level of 11? That sets off some alarm bells in my mind also--- 11 is well within the normal range-- actually perfectly between what would be considered the high normal and low normal levels based on my own lab reports. Did they do a C-peptide test? That is an essential test for determining a diagnosis of type 1 or LADA. Again I'm far from an expert, and this is all new to me too, but it really sounds to me like you might benefit from a second opinion...
Well I was in a hurry to get to a dinner and mixed up HDL and LDL. So to get it straight, bad cholesterol 128. Dx was confirmed with a GAD antibody factor greater than 250 I pegged the meter, and a fasting bg of 130. Anyway my low carb diet has kept my numbers low. I have experimented by eating a known number of cabs and found I go up 1 point for every gram of carb and will come back below 100 within 3 hours
Unfortunately, many doctors believe diabetes is actually caused by high cholesterol and that the primary treatment should be a statin. This is crazy.
There is no compelling evidence that cholesterol lowering or statin use is of any benefit as a secondary treatment (i.e. if you don't have CVD). The guidelines for diabetics were made more aggresive "just because" they have more CVD. But, duh, the CVD is driven by high blood sugars?
If you read around, most people find that with a high HDL and low Tris, any LDL is often the big "fluffy" kind which is actually good. Treatment with statins to correct a non-problem is a bad thing. Unfortunately, since there are guidelines telling doctors to medicate all diabetics, doctors are not liable for problems caused by prescribing statins and they just overdo it. I personally refuse to take statins no matter what my labs say. I tell my doctors to not bother testing because I am going to refuse to do anything and it is just wasting money. But they demand to do it anyway and waste money.
As you are not currently at risk of diabetic heart disease (no high blood sugar) and as statins have many nasty side effects, and as your cholesterol is in a good range for a nondiabetic, and as furthermore your current cholesterol levels may still be being influenced by earlier high blood sugars, I advise you to not take statins.
Thanks for all the replies. I called the doctor today to get some more numbers. Mu total cholesterol is 194 and my triglycerides were 137 last September and now the tri's are 57..I don't thinkI will have the prescription filled...
Peter Attia has been doing a great series on his blog about cholesterol. It's very technical, but I've found it fascinating and worth reading. He's at waroninsulin.com. He's on the 5th installment of the series right now, but you can go back to older entries and read from the beginning. I'd sure do that before I took a drug, doctors seem to overprescribe statins. Some think it should be put in our water supply so everyone gets it. (Eeek!)
Good call man. You post inspired me to review my own labs. At my initial time of diagnosis my lipids were similar to yours, except my triglycerides were much higher (over 200). Like I said this was really a surprise-- as I had just gotten full blood work done for a life insurance policy about a year ago and everything was perfectly fine then. I do think all my lipids were out of whack just due to the super high glucose I had been living with for some time when diagnosed. I plan to ask my doctor for some new tests to determine if the statins are actually a good idea anymore now that my glucose levels have stabilized. I really do think the labs you've cited invite some questions about your diagnosis, and I hope that your doctor explained them all adequately to you.
If you A1C was 5.7 at initial diagnosis, I'm not sure why you were diagnosed. A1C of 6.5 or greater is considered diagnostic criteria for diabetes of any type (by the labs I go to at least)
I know the type of lab paperwork you are talking about. Every time I get an A1C in the high 5's, the lab paperwork comes back with the explanation column saying that this means I am at "moderate risk for diabetes". I kinda chuckle at that!
That's one of many possible diagnostic criteria. An A1C of 5.7 is definitely abnormally high for a young healthy adult that doesn't have diabetes. I wasn't diagnosed with an A1C, I was diagnosed by showing up as a kid in the ER in DKA and turning the Tes-Tape jet black when they dipped it in my urine.
About 1991 when I was looking for a new Endo, I went to one that had been highly highly recommended by the docs at my school's clinic. He ran an A1C on me and told me that I didn't have diabetes at all. (Despite the fact that I had been insulin dependent for nearly 10 years and had pretty dang good control.) Needless to say, my opinion of that endo wasn't as high as everyone elses.
Today a LADA who is diagnosed early on and maintains tight control, might never ever have an A1C over 6.5. Ever.
As you are not currently at risk of diabetic heart disease (no high blood sugar)
I don't think it's that simple.
Just me looking at the DCCT results... an A1C in the high 5's does not eliminate the risks of microvascular complications, the ones that are highly correlated with high average bg's. It just puts you at a lower risk than an A1C in the 6's, or an A1C in the 7's, or an A1C in the 8's. I don't see any magic average bg below which the risk completely disappears.
And looking at the follow-on DCCT results for heart disease as they've come available (now over 25 year timespan in the study and follow-ons), they find that (compared to the nondiabetic population) even the DCCT participants with A1C's in the 5's (a tiny bin but still there in the statistics) have a risk for heart disease that's greatly elevated compared to the non-diabetic population. Yes, good bg control helps, because the risk for a diabetic with an A1C in the 5's is less than with an A1C in the 9's or 10's. But it's still greatly elevated compared to the non-diabetic population.
I found an interesting conclusion in a early 90's paper that looked at cholestorol/lipid levels in T1's. They credit the move away from the traditional diabetic low-carb/high-protein-high-fat diet, and towards a more balanced diet, with helping normalize lipid levels in T1's. Lipid and Lipoprotein Levels in Patients With IDDM: Diabetes Contro...
The differences between the DCCT data and older studies that demonstrated more profound abnormalities in lipid levels in IDDM populations may reflect patient selection and/or changes in dietary patterns (higher-carbohydrate and lower-fat content) and in glucose control that has occurred in recent years.
Just saw a segment on TV about the herbal supplement Red Yest Rice being used to lower cholesterol and triglyceride levels. I'm not generally a huge believer in herbal stuff but apparently there some pretty legit science behind this one and many doctors are recommending it for people who don't want to take statins. I'm going to mention it to mine.
I think there's a huge difference between an A1c in the 5s that a person like me could get- one that would reflect major highs and lows- vs an A1c in the 5s attained with "rarely a bg over 115".
A1c is not an adequate measure of blood sugar control. The average diabetic with an A1c in the 5s doesn't have blood sugar control like Lab Mouse.
Yeah, that's one of the reasons I think that we cannot assume "my bg control is good enough there's nothing else I have to do." There simply is no bg below which we are safe from the risk of complications, no matter how much various websites promote their magic numbers.
For the microvascular complications, even just moderately elevated blood pressure is a risk factor that becomes more and more important as bg control is improved.
Same for everything we can do to reduce any and all risks from heart disease.
It will never be enough to eliminate the risk, like people want it to. But we still have to bust our butts doing everything we can. It's not just aboug bg's, because there is no magic number below which the risk disappears.
The data I have seen suggests that those of us with diabetes have twice the risk of heart disease with an A1c of 6% compared to a non-diabetic (independent of cholesterol levels). And as Tim notes, reducing your A1c all the way down to "normal" probably won't eliminate all your risk. There is just some stuff about diabetes that messes with us. But there isn't anything that suggests that cholesterol is the "causal" source of these problems. There have not been any high quality studies (random controlled trials) which suggest that cholesterol lowering or statination helps us, let alone when our blood sugars are reasonably controlled.
When I looked through the numbers, having an A1c in the 9s or 10s resulted in a risk of heart disease far, far worse than any risk related to cholesterol. I suspect that if you are a diabetic with an A1c of 7% or higher, dropping your A1c by 1% would likely reduce your heart disease risk far more than any treatment for cholesterol has ever been demonstrated. So I choose to minimize my heart disease risk by keeping tight control on my blood sugars. I'll always be at higher risk of heart disease compared to my non-diabetic cohorts, but that is life.
But this is what I don't get BSC. You state: But there isn't anything that suggests that cholesterol is the "causal" source of these problems. There have not been any high quality studies (random controlled trials) which suggest that cholesterol lowering or statination helps us, let alone when our blood sugars are reasonably controlled.
But on the previous page you said it doesn't matter what the numbers are that you would not take a statin. So my question is: most people go by the numbers and are always looking for proof. There is proof that if your cholesterol is high you are at greater risk for heart disease and taking a statin to reduce your cholesterol lowers the risk. Why would you NEVER take them and even further not even want to know what the numbers are?
Believe me I am NOT all for statins but I think sometimes people attach a certain boogeyman attitude toward them that may be unjustified.
I also think people tend to gravitate toward research that SUPPORTS their view and find reasons not to believe those that don't. Not saying this is you but I find this to be highly prevelant.
Red Yeast Rice is actually very similar to I belive lovastatin and that is where all the latest and greatest Crestors and Lipitors stem from. In effect if you take Red Yeast Rice you are taking a statin. Me personally I would rather just take the statin- at least I can be sure of purity and that I am getting the right dose.
I agree with your contention that legit prescribed drugs are probably far better than herbal remedies-- but there are also other considerations in play for some of us though-- such as employment medical requirements that put us further under the microscope for each prescription we are taking...
I think you got things mixed up, either that or your doctor has.
your numbers look great.
My doctors want me on statins too, but my cholesterol and HDL/ LDL are perfect as they are.
you want your HDL to be HIGH. at 128 that is fantastic. You want your LDL to be low. 55 for LDL is also fantastic unless those numbers are switched, even if they were they would not be that bad.
Triglycerides are all about the carbs you eat, so You should expect them to be low with a low card diet unless you have something wrong with your liver. Trig of 57 is fantastic !!
There is a formula that you can use to decide if your lipid numbers are good it is called many different things, corinary risk factor or corinary heart factor.
divide your total cholesterol by the HDL to get the number. for women a 4.4 or less is considered good and for men it is 5.0 or less. The lower the better. You did not post your total Cholesterol or I would have calculated it for you.