EP037: Lipids and Diabetes
Lipids and Diabetes: How “Fat Boats” Shape Your Health
“Insulin resistance rewires lipid metabolism and raises heart risk.”
Welcome to The Diabetes Podcast blog. Today we’re unpacking lipids: what they are, how they travel, and why they matter for diabetes and heart health. If you’ve ever wondered why triglycerides creep up, why belly fat feels stubborn, why your LDL looks “okay” but risk is still high, or how fatty liver happens without alcohol—this is for you.
Big idea: lipids are not the enemy. Lipid overload and mismanagement are. The keyword to remember is “lipids function diabetes.”
What Are Lipids?
Lipids are fats and oils your body uses for:
Energy
Cell structure
Hormones and cell signals
Lipids don’t mix with water, so they need help to move in your blood.
Lipids are essential. They become harmful when they spill into places they don’t belong. That spillover drives insulin resistance.
The Main Types of Lipids
Triglycerides: storage form of fat
Free fatty acids: fuel form of fat
Cholesterol: structure and signaling (think hormones)
Supporting actors:
Ceramides (a type of sphingolipid): “danger signals” linked to insulin resistance
Phytosterols (from plants): can help lower LDL
How Do Lipids Travel? Meet the “Boats”
Your blood is water-based, so lipids ride in “boats” called lipoproteins:
Chylomicrons: carry fat from food after meals
VLDL (very low-density lipoproteins): made by the liver to ship triglycerides
IDL (intermediate-density lipoproteins): “leftover” boats on their way to become LDL
LDL: delivers cholesterol to tissues
HDL: “recycling” boats that bring cholesterol back to the liver
Why This Matters in Diabetes
Insulin resistance reshapes these boats. Common patterns in insulin resistance and type 2 diabetes:
Higher VLDL and more remnant particles (IDL)
Smaller, denser LDL
Lower HDL
Higher triglycerides
Lower adiponectin
Higher ceramides
These changes raise heart risk—even when LDL cholesterol (LDL-C) looks “normal.”
LDL-C vs LDL Particles vs ApoB
Old view: “High LDL causes heart disease.” That’s partly true.
Better view: The number of LDL-like particles matters more than how much cholesterol they carry.
ApoB is a protein on each atherogenic particle (VLDL, IDL, LDL, and Lp(a)). One particle = one ApoB.
Higher ApoB = more plaque-forming particles = higher risk.
You can have normal LDL-C but high ApoB. Risk can still be high, especially with insulin resistance.
What About Lp(a)?
Lp(a) is a sticky, inherited LDL-like particle.
It raises clotting and inflammation risk.
You usually test it once in a lifetime.
Even if it’s high, you can lower overall risk with the steps below.
Atherosclerosis in Simple Terms
Over time, too many ApoB particles slip into artery walls.
They form plaques. Plaques can rupture and cause clots.
Clots block blood flow to the heart or brain, causing heart attacks or strokes.
Diabetes increases the number of these risky particles—often 3–4.5x the risk compared to people with the same LDL-C but normal insulin sensitivity.
A Simple Everyday Marker: Triglyceride-to-HDL Ratio
You can calculate this from standard labs.
Lower is better for insulin sensitivity and heart risk.
Rough guide:
Greater than 3: likely insulin resistance
Greater than 4: high cardiometabolic risk
This ratio tracks with liver fat, VLDL, remnant cholesterol, and heart risk.
Fat Tissue Is an Endocrine Organ
Not all fat is the same:
Healthy fat tissue:
Stores fat safely
Keeps fat out of liver and muscle
Makes adiponectin (helps insulin work)
“Overstuffed” fat tissue:
Leaks fatty acids into liver and muscle
Raises inflammation
Increases ceramides
Boosts VLDL output
Lowers HDL
Makes LDL smaller and denser
Raises triglycerides and ApoB
This is the engine of diabetes dyslipidemia.
Ceramides: The “Danger Signals”
Ceramides rise when fat cells are stressed.
When ceramides go up:
Insulin signaling breaks down
Inflammation rises
Liver fat increases
LDL particles get more atherogenic
Good news: Ceramides can go down with weight loss, exercise, more fiber, less saturated fat, and higher adiponectin.
Core Message
Type 2 diabetes and insulin resistance reprogram lipid metabolism in a way that raises heart risk—even if:
Your weight is “normal”
Your LDL-C looks “okay”
Your A1C looks “fine”
This is about lipid overload and traffic jams, not moral failure or “no carbs ever.”
Practical Steps to Improve Lipids Function in Diabetes
You don’t need to do everything at once. Start small. Build wins.
Modest weight loss (if you have weight to lose)
Aim for 5–10% body weight.
Benefits:
More adiponectin
Lower ceramides
Less liver fat
Reduce liver fat
Cut simple sugars (sugary drinks, sweets, refined snacks).
Watch overall calories.
Result:
Lower VLDL and remnant cholesterol
Lower ApoB
Move your body most days
Walking after meals is powerful.
Lower-intensity activity burns more free fatty acids.
Aim for at least 150 minutes/week total activity.
For HDL: add cardio sessions (at least 30 minutes, 3–5x/week). Work up to at least 15 minutes in your cardio heart-rate zone per session.
Eat more fiber
Beans, lentils, nuts, seeds, whole grains, veggies, fruit.
Fiber binds bile acids and helps lower LDL and remnants.
Helps with weight loss and glucose control.
Choose healthier fats
Reduce saturated fat to improve LDL particle number.
Favor olive oil, nuts, seeds, fish, and avocado.
Try a Mediterranean-style pattern
Well-studied for heart health.
Rich in fiber and healthy fats.
Includes plants that provide phytosterols (plant sterols). Food alone rarely gives the full 2 grams/day used in studies; talk to your clinician about supplements if needed.
Don’t smoke
Quitting smoking is one of the best ways to raise HDL and lower risk.
Sleep better
Good sleep improves insulin sensitivity.
This helps your triglyceride-to-HDL ratio and LDL particle size.
Ask your clinician about advanced labs
ApoB (particle count)
Lp(a) (genetic, test once)
Remnant cholesterol or NMR lipoprotein profile
These give a clearer picture than LDL-C alone.
What to Track Over Time
Triglyceride-to-HDL ratio (lower is better)
ApoB (lower is better)
Fasting triglycerides (lower is better)
HDL (higher is better)
Liver enzymes and imaging if fatty liver is suspected
Weight, waist size, sleep, steps, and how you feel
Remember
You can improve your lipid profile in weeks to months.
Small, steady changes work best.
We’re aiming for metabolic flexibility: your body can switch between burning sugar and fat smoothly.
Key Takeaways
Lipids are essential, but lipid overload is harmful.
In diabetes, the “boats” (lipoproteins) matter, especially ApoB particle number.
Triglyceride-to-HDL ratio is a simple home base metric.
Ceramides link insulin resistance, fatty liver, and heart risk—and they can go down with lifestyle change.
Focus on fiber, movement, sleep, and healthy fats. Reduce saturated fat and simple sugars.
Progress beats perfection.
If you want support or have questions, email [email protected]. Take courage! You can do this, and we can help.
Disclaimer
The information in this blog post and podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.
Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.
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