Can Diabetes Cause High Cholesterol?

Dr Jedha, Host

Hello wonderful people, Dr. Jedha here and welcome to episode 104.

Today we’re diving into a very important topic: the link between diabetes and cholesterol. If you’ve ever wondered “Can diabetes cause high cholesterol?” the answer is yes, and today we’ll unpack why that happens, what the connection really is, and what you can do about it.

This isn’t going to be another discussion on “good” vs “bad” cholesterol. We’ve already broken those myths down in episodes 42 and 44, so feel free to go back and listen if you missed them. Today’s episode builds on that, taking a closer look at how insulin resistance and high blood sugar directly affect your lipid profile, especially if you’re seeing high triglycerides, low HDL, or changes in your LDL.

You’ll learn the deeper mechanisms behind cholesterol changes in diabetes, what tests actually matter, and most importantly, what actions you can take to improve both your cholesterol and your blood sugar, naturally.

If you’re one of our members, you can go to your Healthmaps to find a detailed step-by-step plan for lowering cholesterol naturally that includes targeting specific aspects, like triglycerides, LDL and HDL, and exactly what to do with food, supplements and lifestyle. And if you have questions about your lipid profile or plan, use the monthly member check in to get feedback on the direction to take, because as you may have heard from Mary’s experience in episode 102, by getting help with her lipid profile and the right resources, she found out medication wasn’t necessary at all – something her doctor fully supported once he knew the facts as well.

Now, as always, this podcast is grounded in science, not hype. Everything we talk about comes from peer-reviewed research and clinical observations working with thousands of people just like you. So let’s get into this question: Can diabetes cause high cholesterol?

When we think about high cholesterol, most people jump straight to the idea of eating too much fat. They think, well I better eat egg whites not the yolks and cut down on the cheese. But in reality, especially with prediabetes or type 2 diabetes, the issue is far more complex, and it has a lot more to do with how your metabolism is functioning, not just what you eat.

At the core of both prediabetes and type 2 diabetes is insulin resistance, a condition where your body becomes less responsive to the effects of insulin, we’ve covered this in episode 21 and 70 if you’d like a deep dive into that. As a result of insulin resistance, both blood glucose and insulin levels tend to rise. And here’s the key part: high insulin and insulin resistance disrupt how your body processes fats, including cholesterol.

This disruption leads to a very distinct cholesterol pattern often seen in people with type 2 diabetes or prediabetes:

• Higher triglycerides
• Lower HDL, your “good” cholesterol
• And often, more small, dense LDL particles, even if your total LDL looks “normal” on a standard blood test

Now why does that matter?

Triglycerides are essentially fat molecules made in the liver from excess glucose and insulin. The more sugar and refined carbohydrates in your diet, and the more insulin circulating in your bloodstream, the more likely your liver is to convert that excess energy into fat and pump it out into your bloodstream in the form of VLDL particles. These VLDL particles are the smaller and denser they are, the more likely they are to contribute to plaque buildup in your arteries. The key takeaway here is that it is the metabolic state of elevated glucose, elevated insulin, and impaired nutrient handling that creates the perfect storm for this shift toward triglyceride and small dense LDL production.

At the same time, HDL, the cholesterol that helps clean up excess lipids and carries them back to the liver for processing, tends to go down. So not only are you producing more of the potentially harmful lipids, you also have less of the protective HDL to clean them up.

This cholesterol profile, high triglycerides, low HDL, and small dense LDL, is known as diabetic dyslipidemia, and it’s a hallmark of insulin resistance.

So yes, diabetes and high cholesterol are absolutely linked. And yes, diabetes can cause high cholesterol. But the root cause isn’t cholesterol itself, it’s the metabolic imbalance that comes from chronically high insulin and glucose levels.

Because the issue is metabolic, when you start to improve your blood sugar and insulin levels, your cholesterol numbers usually improve right along with it. So simply focus on getting your blood sugar and A1c levels in a healthy range, and cholesterol usually follows, without too much additional effort. 

When it comes to numbers, the wrong ones are often emphasized, or rather, misunderstood. Most people are told to focus on their total cholesterol or LDL cholesterol number, but those numbers alone often do not tell the full story, especially if you have insulin resistance, prediabetes, or type 2 diabetes.

The standard lipid panel that most doctors order gives you just a basic snapshot. It tells you your total cholesterol, HDL, LDL, and triglycerides. But it does not tell you anything about the quality or functionality of those lipoproteins. And that is where the real risk lies.

For example, two people could have the exact same LDL cholesterol level, which might be a bit high. One of them could have mostly large, fluffy LDL particles, which are generally neutral for cardiovascular risk. The other could have mostly small, dense LDL particles, which are more likely to oxidize, penetrate the arterial wall, and trigger inflammation that contributes to plaque buildup. But on paper in a standard lipid test, the numbers look exactly the same. This is a major reason why so many people are misclassified when it comes to cardiovascular risk.

And unfortunately, it happens all the time, as we spoke about in episode 102, people being put on statin medications because their LDL is high when really they didn’t need the medication at all. High LDL cholesterol doesn’t necessarily mean anything bad, nor does high total cholesterol. 

In insulin resistance, prediabetes and type 2 diabetes, it is far more likely you will have the pattern of low HDL, high triglycerides, and small, dense LDL particles. This is why looking at the triglyceride to HDL ratio can be a much better indicator. Ideally, you want that ratio to be under 2 if you’re using mg/dL, or under 0.87 if you’re using mmol/L, and some experts recommend aiming for even lower ratios. Essentially, the lower the ratio, the better your insulin sensitivity and cardiovascular risk profile tends to be, while a higher ratio suggests more insulin resistance and a greater risk of those small, dense LDL particles.

If your standard lipid panel comes back with a ‘high’ indication, there are more advanced tests that can provide a clearer picture. 

These include:

• LDL particle size and number
• ApoB, which measures the total number of atherogenic particles
• Lipoprotein(a), a genetically influenced marker that can increase cardiovascular risk

Most of these are not part of routine testing, but they can be requested through your doctor. The key takeaway here is that if your cholesterol numbers look off, or if you are trying to get a better understanding of your real cardiovascular risk, these extended panels are worth asking your doctor about. 

It is also important to remember that cholesterol is just one part of the metabolic puzzle. If your blood sugar is high, your insulin is high, and your triglycerides are elevated, then your cholesterol profile has likely been impacted, even if your LDL number appears normal. That is why we need to look at these numbers in context, not in isolation. 

By now, it should be clear that the cholesterol issues seen in type 2 diabetes and prediabetes are not random. They are a direct result of metabolic dysfunction, and while that sounds complicated, it simply means your metabolism has become altered. So, let’s look more closely at some of the key drivers behind that dysfunction and the metabolic alterations, because these are the things we want to target when improving cholesterol naturally.

First, high blood sugar. When your blood sugar is elevated over time, it signals to your body that energy is abundant. In response, the liver starts converting that excess energy into fat, particularly triglycerides and especially when there is too much carbohydrate intake. As we discussed earlier, these triglycerides are packaged into VLDL particles, which then contribute to the pool of LDL cholesterol in your bloodstream.

Second, high insulin levels. Insulin is a storage hormone. Chronically high insulin not only contributes to fat storage, it also activates the enzymes that drive triglyceride production in the liver. Insulin resistance also disrupts the normal recycling and breakdown of cholesterol, which further compounds the issue.

Third, fatty liver. Non-alcoholic fatty liver disease is very common in people with prediabetes and type 2 diabetes, and it plays a big role in altering cholesterol metabolism. A fatty liver is less effective at clearing excess lipoproteins from the blood, and it tends to overproduce VLDL, which leads to more triglycerides and more small, dense LDL particles.

Fourth, inflammation and oxidative stress. Chronic low-grade inflammation can damage the delicate balance of lipids in the blood. Oxidation of LDL particles, particularly the small, dense ones, makes them more likely to cause plaque buildup. High blood sugar and high insulin both contribute to inflammation, so again, it all ties back to metabolism.

So while cholesterol might be the number that gets flagged on your blood test, the root causes often stem from poor blood sugar regulation, high insulin, insulin resistance, and impaired nutrient handling. That is why targeting the underlying metabolic drivers is so important. 

Now that we have explored how diabetes and cholesterol are connected, and the key drivers behind high cholesterol in insulin resistance, let’s talk about what actually works to bring your cholesterol levels into a healthier range.

The first place to start is always your nutrition. Not by cutting out fat, but by focusing on lowering your blood sugar and insulin levels, because those are the root drivers of the metabolic issues that influence your cholesterol.

A lower carbohydrate nutrition plan is one of the most effective ways to do this. By reducing carbohydrates, particularly refined carbs and added sugars, you reduce blood sugar spikes, lower insulin demand, and naturally reduce the liver’s production of triglycerides and VLDL.

When people shift to a lower carb, whole foods-based way of eating, we often see:

• A significant drop in triglycerides
• An increase in HDL cholesterol
• A shift in LDL from small, dense particles to larger, more neutral particles
• And in many cases, improvements in overall metabolic markers like fasting insulin, A1c, and waist circumference

This is not theoretical. These are the real results we see in clinical trials and in the real-world outcomes of our members.

So what does that look like in practice?

Before we explore these tips, a quick reminder for our members, to go to your Healthmaps, to find a detailed step-by-step plan for lowering cholesterol naturally that includes targeting specific aspects and exactly what to do with food and supplements. 

In brief, here are a few important things to do:

Focus on eating nutrient-dense, unprocessed foods. This means plenty of non-starchy vegetables, quality protein sources like meat, poultry, seafood, and eggs, and natural fats found in foods like avocado, olives, nuts, and seeds. Avoid highly processed foods, especially those made with seed oils, added sugars, and refined grains.

Some foods that have specific benefits for improving cholesterol include:

• Fatty fish like salmon, sardines, and mackerel, which are high in omega-3 fatty acids that help lower triglycerides
• Nuts, especially almonds and walnuts, which have been shown to raise HDL and lower LDL
• Olive oil and avocado, which are rich in monounsaturated fats that support healthy cholesterol ratios
• Vegetables high in soluble fiber, such as Brussels sprouts, asparagus, and artichokes, which help bind and eliminate excess cholesterol
• Flaxseeds and psyllium husk, both of which are excellent sources of soluble fiber with well-documented benefits for cholesterol and blood sugar
• Green tea and turmeric, which may help reduce LDL and improve antioxidant status
• Foods naturally containing plant sterols, like seeds, nuts, and certain vegetables, which can help reduce cholesterol absorption in the gut
• Supplements may also play a helpful role, depending on your needs. But food comes first, and supplements are there to support a strong foundation.

Outside of diet, several lifestyle factors can also contribute to improved lipid profiles. Daily movement is essential. You do not need to run marathons. Even a brisk walk after meals can help lower blood sugar and improve lipid metabolism. Sleep also matters. Poor sleep increases insulin resistance and inflammation, which can negatively affect your cholesterol profile.

When you address the drivers of poor cholesterol through your nutrition, your lifestyle, and your daily choices, you are not just improving a number on a blood test, you are supporting the entire metabolic system that keeps your body healthy. 

So let’s bring this all together: can diabetes cause high cholesterol? The answer is yes, but not in the way most people think.

It is not about eating too much fat or cholesterol in your food. It is about what happens when blood sugar and insulin levels are consistently high. That altered metabolic state affects the way your body processes and transports fats, leading to higher triglycerides, lower HDL, and more harmful small, dense LDL particles.

Standard cholesterol tests often miss the full picture, which is why looking at things like your triglyceride to HDL ratio or requesting an extended lipid panel can provide more useful insights. But at the end of the day, the real solution is to address the root cause.

By lowering blood sugar, improving insulin sensitivity, and shifting toward a whole foods, lower carbohydrate nutrition plan, you support better cholesterol function at every level. Add in regular movement, quality sleep, stress management, and the right supplements, and you are giving your body the conditions it needs to thrive. By doing so, cholesterol levels usually balance out on their own, no medications necessary. 

Need help to lower your cholesterol? Well, if you’re one of our members you have all our guidelines to follow, along with the Healthmap of lowering cholesterol, which will take you step-by-step through exactly what to do to improve your levels. 

Not one of our members yet? Please consider joining us. We provide you with science-baked resources that actually work, plus real support to ensure you achieve and maintain the health goals you’re aiming for, so visit our website to check out options. 

For now, remember, your health is an investment, not an expense, so keep prioritizing you. 

See you next week. 

Dr Jedha, over and out.