Abnormal levels of fats (lipids) in the blood are twice as common in people with type 2 diabetes as in people who do not have the disease. Obesity, insulin resistance, and high levels of insulin cause several lipid abnormalities.

• Total cholesterol and low-density lipoprotein (LDL) blood levels can be normal to high.
• Triglyceride blood levels are usually elevated.
• High-density lipoprotein (HDL) blood level is usually low.
• Blood levels of lipoprotein a (Lp a), a molecule similar to LDL, are also increased in people with diabetes. Lp a has been shown to be a risk factor for heart disease in people who do not have diabetes, but its relationship to heart disease in people with diabetes is unknown.

The combination of low HDL and high LDL puts people with diabetes at higher risk for macrovascular disease. These cholesterol abnormalities can improve with good control of blood sugar levels. Increased exercise and weight loss can help increase your HDL level and modestly lower LDL. Taking medications called statins can further reduce the level of LDL and triglycerides.¹ Estrogen treatment can increase HDL levels but is associated with a slightly increased risk of stroke and breast cancer.