Thursday, March 8, 2012

Diabetics and Statin Drugs

I recently read this blog post by Michael Aviad about his experience with doctors and the perspective that statins are crucial to reducing cardiac risk in diabetic patients. I commented on it as concisely as I could, but I think I'll expand on it here.

My doctor recommended that I take statins last summer because my Total Cholesterol was above the acceptable range for a diabetic. It was fine for a non-diabetic.
Why do diabetics have a lower ideal number than non-diabetics? Risk factors... Because, generally, diabetics tend to have higher triglycerides and higher A1Cs than normal people, which also carry a greater cardiac risk profile. Abnormal A1Cs typically correlate with high LDL counts.

I did some research about statins and found a couple of facts about the relationship of all these things to each other and came to some conclusions.
  • Statins are anti-inflammatory, which can reduce risk for inflammatory health problems, like heart disease. Some experts even say that the benefits of statins might be more from the anti-inflammatory characteristics than the cholesterol lowering effects. 
  • High blood sugar is inflammatory, which is a risk factor for inflammatory health problems. 
  • Insulin also inflammatory. Insulin resistance is a sign of hormonal imbalance and inflammation.
  • Eating low-carb reduces the need for insulin and increases insulin sensitivity. Needing smaller amounts overall helps achieve tighter glucose control (Dr. Bernstein's "rule of small numbers".
You could say that they kind of cancel each other out. But... if you can manage to keep your blood sugar normal... then you have activated an anti-inflammatory change and improved your risk. I chose to aim for that, and skip statins. Plus, research has shown that if you lower your A1C score, your LDL count will often descend with it. I'd rather work with something I've had 26 years practice with. Sounds like good glucose control is the winner all around. I'm not saying it's easy, but, it's possible.

Also, about LDL cholesterol. There is a correlation between LDL cholesterol and triglycerides. If you have high triglycerides (from eating a lot of carbs and sugar) then your LDL particles are likely to be dense and be plaque forming. If your triglycerides are low, then your LDL particles are more likely to be large fluffy particles that resist forming arterial plaques. Your LDL isn't considered dangerous if you also have low triglyceride numbers.

As a low carb eater my triglycerides are very low. My A1C is getting closer and closer to normal, non-diabetic numbers. With these two arguments, I told my doctor that I wasn't going to take the statins and risk their side-effects. He agreed with my choice. Another doctor, on the floor at the hospital in December, tried to put me on statins without even meeting me, and I also refused that offer.

I'm much more interested in discipline and knowledge than in a preventative drug.  I think we have the information to make wise individual decisions for ourselves in this matter. Look at all the facts, and check out all the opinions. I don't consider myself to be the average diabetic or statistic. So the collective opinion of doctors created for the average statistic, isn't necessarily a good fit for me.


  1. I had a crazy doctor at Kaiser once who wanted to put me on cholesterol meds even though my numbers were well within the norms for "regular" people, and the limits for diabetics were super low (this was 8 years ago, so not sure if anything has changed.) I also opted out, and was a little scandalized at the thought. My triglycerides are also super low, and although my total cholesterol is on the high side, a closer look at all of the ratios would show that I am doing well. It makes me crazy when doctors try to apply certain standards to all patients, without looking at the total picture (or even half!) Good for you for not going for it. Statin drugs can be really harmful, and the statistics on the number of people in the US that are taking them are pretty shocking!

    1. Yes, Ariana. When I have looked at the ratios and lipid profiles that are targeted for non-diabetics, I'm doing well. I'd rather have a blood sugar goal that I'm working toward, than a cholesterol goal, which is suspect.

  2. Do you know what your ISF averaged in the year before you went low carb and what it was the following year?

    I have not read that going low carb improves insulin sensitivity.

    I think if you have high cholesterol because of high blood sugars that you have some hope of improving (because you haven't been trying your hardest) it is reasonable to try to lower blood sugar. But what happens when you've been trying your darndest and you still have high cholesterol?
    I'm still not convinced statins are the answer- I think there are too many problems with polypharmacy, side effects, quality of life, etc, and not enough evidence that they help. My own cholesterol and triglycerides are low accross the board, so I haven't been in a place to decide yet.

  3. Jonah,
    Good eye. I used to use a ISF of 40 and now I believe I'm using about 35. However, I think I may have just not known that my ISF was insufficient until I dialed things in. For sure, my carb to insulin ratio changed with low-carb. I used to use 1:15 grams, and now it's 1:8 grams. I'm more sensitive to carbs, maybe less sensitive to insulin? My correction factor seems to have changed less than my carb factor. One thing that I think has to be mentioned, though is that fat and protein do impact blood glucose, so you have to use insulin for them. It looks like I'm bolusing more insulin for carbs than before, but I'm probably actually just acknowledging that it's not just carbs that require insulin. Fat creates some level of insulin resistance and protein gets converted to glucose. Regardless, I'm bolusing about 1/2 what I did for meals compared to what I was before low-carbing. My average meal bolus today is 2.5 units and before it was more 5 units, and I was probably under-bolusing because my overall control was pretty poor.
    I guess there are enough competing factors that it's hard to say whether ISF really changed.
    I think exercise has been a greater factor in insulin sensitivity for me. Thanks for questioning that statement.

  4. Right on! I totally agree with you. My ex doctor wanted to put me on statins even though none of my lipid profile was out of healthy range. When I asked why he said, "Just as a preventative measure...I assume you'll eventually need it." I didn't go back to him after that. My triglycerides are low, too. Like, 28 or 30, something like that. And like you, I've read that as long as those are low, LDL cholesterol doesn't pose the same threat. Like you said, it's not easy to aim for normalized blood sugars, but it seems like common sense. When we can avoid drugs and their subsequent side effects and work on the root of inflammation (high blood sugars for us mostly) then we are giving ourselves the best possible outcome-for sure :D

    1. Sysy,
      Maybe if more doctors start to realize that the last time they saw a patient was when they tried to prescribe an unnecessary drug... maybe they will begin to think differently.
      I'm interested in seeing if my cholesterol profile has changed recently because I've improved my glucose control. Seems like it might...