Howstuffworks "Diabetes and Cholesterol Medications"

When the pipes in the bathroom sink are clogged, you pour in some liquid drain cleaner. Too bad you can't do the same thing for your arteries, but medications can do the next best thing: Keep cholesterol and other gunk from accumulating in the first place. If your doctor hasn't prescribed a pill for improving your blood fats yet, there's a good chance he or she will sooner or later. According to the Centers for Disease Control and Prevention (CDC), 70 to 97 percent of people with diabetes have unhealthy levels of cholesterol or triglycerides.

High cholesterol or triglyceride levels can be treated with medication.

High cholesterol or triglyceride levels, common in diabetics,
can be treated with medication.

The medications discussed in this article may help keep your pipes clear, but there are some additional considerations if you have diabetes. Continue to the next page to learn about the first one -- statins.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Diabetes and Statins

Once upon a time, you could watch television for an evening or read an entire magazine without seeing a commercial or ad for a statin drug. But the ubiquity of these heavily promoted cholesterol-lowering medications has had a major payoff: Doctors say the widespread use of statins has contributed heavily to an overall drop in total cholesterol and LDL cholesterol among adults in the United States since the drugs were introduced in the 1990s. Studies show that statins slash the risk of heart attack by about 30 percent.

Officially known as HMG CoA reductase inhibitors, statins knock out an enzyme the liver needs to make cholesterol. They also encourage the liver to reabsorb more LDL cholesterol, which we all know is the "bad" kind. Studies show that these drugs can decrease LDL cholesterol up to 36 percent in diabetes patients. Sharp-eyed readers may be thinking: Why should I care, since people with diabetes don't necessarily have super-high LDL in the first place?

Maybe not, but people with diabetes do have high concentrations of small, dense LDL cholesterol particles, which are more likely to plug up arteries. Statins wipe out all LDL particles, including the dangerous kind.

And that's not all. Statins also lower triglycerides, though not as effectively as they decrease LDL cholesterol. The drugs also cause a slight uptick in HDL cholesterol, and that's good news, too. In fact, scientists from other disciplines are studying whether statins fight other diseases, including various forms of cancer.

Doctors who treat heart disease are so grateful for the lives saved by statins that they sometimes suggest adding the drugs to our nation's drinking water. And they're only half kidding. Unfortunately, while these cholesterol crushers are considered quite safe, they carry a few risks. Some are mild and short term, such as gastrointestinal problems, headaches, and a rash. However, statins may also irritate the liver, so your doctor will keep tabs on it with occasional blood tests.

More controversially, statins have been linked to several conditions, particularly myositis (swelling of the muscles) and rhabdomyolysis ( a breakdown of muscle fibers, which are then released into the circulation). Although they are rarely fatal, these conditions can cause muscle pain, cramps, and weakness. However, studies suggest that these problems are not very common. A 2003 survey in the Journal of the American Medical Association estimated that one to five percent of patients who take statins develop some form of muscle pain or weakness. What's more, the problem may be triggered by taking some other medication (such as fibrates and niacin; see below) with a statin drug. Regardless, the symptoms fade once you stop taking a statin.

Another type of cholesterol-lowering drug -- fibrates -- is discussed next.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

Diabetes and Fibrates

Unlike statins, these drugs (sometimes called fibric acid derivatives) aren't known for their LDL-lowering prowess. However, fibrates stimulate an enzyme that breaks down fats, so they lower triglycerides very effectively -- by as much as 50 percent in some trials. Fibrates also produce a respectable increase in HDL cholesterol, more on the order of 10 or 15 percent.

Although they are considered safe, fibrates can cause gastrointestinal distress and may increase the risk of developing gallstones. If you're taking a statin, adding a fibrate may increase the risk of muscle pain or weakness.

Learn how resins work to lower cholesterol -- and learn their side effects -- in the next section.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

Diabetes and Resins

Your multitalented liver not only makes cholesterol, but it can convert the waxy fat into bile acid, which you need to digest food. Resins (sometimes called bile acid sequestrants) lower cholesterol by forcing the liver into borrowing resources to get its work done. These drugs enter the gut and kidnap bile acids by binding to them, then carrying them through your GI tract to be excreted. The liver figures out that the intestines are low on bile, so to produce a fresh batch it pulls cholesterol out of the blood to use as raw material. Resins lower cholesterol levels by 10 to 20 percent.

Resins have a relatively clean safety record, too, though any time you start messing with business in your intestines you risk tummy trouble. As that goes, resins may cause nausea, gas, constipation, and other gastrointestinal unpleasantness. Convenience is a small matter, too, since resins come in the form of powders that must be mixed with water or juice and taken with a meal.

Sometimes small doses of a vitamin are recommended for lowering cholesterol. We'll talk about this option in the next section.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

Diabetes and Niacin

Here's a drug that may make you red in the face in more ways than one. Niacin is a form of vitamin B that you will no doubt find in your multivitamin. However, it is also packed into pills at ultra-high doses (sometimes called nicotinic acid) for treating cholesterol problems. The good news is that niacin works wonders on all your blood fats, lowering LDL cholesterol and triglycerides while raising HDL cholesterol.

But there's a potential catch or two, especially if you have diabetes. High doses of niacin have a common, and infamous, side effect: flushed skin and hot flashes. Some users say their skin tingles. The pills can cause gastrointestinal problems, too.

Taking niacin with meals and starting with slow doses may alleviate the tomato-face issue. However, when taken at drug-level doses, niacin has another side effect that would frustrate any diabetes patient: It may raise blood sugar. Since the object of treating diabetes is doing just the opposite, you may wonder why niacin is even worth mentioning. While many doctors won't prescribe niacin to diabetes patients, recent studies show that, when taken in small doses (no more than one or two grams), it doesn't seem to increase glucose levels.

Best bet: Ask your doctor whether small doses of niacin could improve your cholesterol and triglycerides. Worst idea: Self-treating with niacin supplements that are available over the counter. Too much niacin can cause liver problems, which your doctor may not notice or test for if unaware that you're taking high doses of the vitamin. What's more, if you're already taking a statin drug, adding niacin to the mix increases the risk for muscle problems.

Ezetimibe is a relatively new drug that can lower cholesterol. For more on this new medication, read on.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

Diabetes and Ezetimibe

Hands up if you always thought the cholesterol in meats and milk is the same stuff that clogs arteries. While that's partly true, the reality is more complicated. Your liver can make its own cholesterol, thank you. In fact, that hard-working organ produces about 75 percent of the cholesterol in your body.

However, that means the liver relies on cholesterol in the diet to produce the other 25 percent. Ezetimibe is a relatively new drug that prevents the liver from taking up cholesterol in the intestines. While reasonably effective on its own, ezetimibe has been paired in a single pill with a statin drug (simvastatin) to create a double-threat medication called Vytorin. Studies show that the duo can lower LDL cholesterol more than 50 percent. Side effects linked to ezetimibe include stomach pain and fatigue.

Read the next page to learn how plain old aspirin can help diabetics.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

Diabetes and Aspirin

The little white tablets in your medicine chest don't lower cholesterol or triglycerides, but they are a potent weapon against heart disease. By some estimates, taking an aspirin a day lowers the risk of heart attack by about one-third.

Aspirin makes blood less "sticky," meaning cells that cause coagulation (called platelets) are less likely to clump together. Furthermore, aspirin fights inflammation, which some scientists believe triggers plaques to erupt, causing heart attacks. Talk to your doctor before adding an aspirin to your daily regimen. Physicians who recommend preventive aspirin very often suggest taking a half tablet or child-size aspirin (75 milligrams, typically) to minimize possible side effects, which can include upset stomach. However, since your cardiovascular risk is heightened by diabetes, your doc may want you to pop a whole pill (162 milligrams).

A majority of diabetics suffer from high cholesterol. The good news is that there are a variety of medications that can help "clean the pipes." Talk with your doctor to see which medication or medications might be right for you.

For more information on diabetes, and its effect on cholesterol and the heart, try the following links:

Diabetes and Heart Disease explains the relationship between these two conditions.
Diabetes Symptoms covers the diverse signs of the disease, from increased thirst and hunger to sudden weight loss.
To learn more about diabetes in general, including diagnosis, causes, symptoms, and treatment, visit our main Diabetes page.
For more information on cholesterol and its effect on your health, read How Cholesterol Works.

ABOUT THE AUTHORS:

Timothy Gower is a freelance writer and the author of several books. His work has appeared in many magazines and newspapers, including Prevention, Health, Reader's Digest, Better Homes and Gardens, Men's Health, Esquire, Fortune, The New York Times, and The Los Angeles Times.

ABOUT THE CONSULTANTS:

Dana Armstrong, R.D., C.D.E., received her degree in nutrition and dietetics from the University of California, Davis, and completed her dietetic internship at the University of Nebraska Medical Center in Omaha. She has developed educational programs that have benefited more than 5,000 patients with diabetes. She specializes in and speaks nationally on approaches to disease treatment, specifically diabetes.

Allen Bennett King, M.D., F.A.C.P., F.A.C.E., C.D.E. is the author of more than 50 papers in medical science and speaks nationally on new advances in diabetes. He is an associate clinical professor at the University of California Natividad Medical Center and cofounder and medical director of the Diabetes Care Center in Salinas, California.