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Understanding and Managing Hypercholesterolaemia
Introduction
Diabetes increases risk of cardiovascular disease later in life, so monitoring and managing cholesterol effectively is essential.
As part of the Diabetes Health Check and Annual Review bloods each year, cholesterol levels are monitored for cardiovascular risk.
Blood also contains another fat called triglycerides, which can also contribute to cardiovascular disease and is also sometimes measured. This information leaflet will focus solely on cholesterol.
What is cholesterol?
Cholesterol is a fatty substance which has some essential functional roles in the body such as forming cell membranes, various hormones, bile, and Vitamin D. Cholesterol is made in the body by the liver and is also found in some foods we eat. Normal Reference Value ≤5mmol/l.
Cholesterol and other blood fats are carried in the blood by proteins. When these proteins and fats combine, they are then called lipoproteins.
There are 2 main types of lipoproteins:
- LDL (Low-density Lipoprotein) takes cholesterol to the cells – if there is too much it can build up in the walls of the arteries, causing them to narrow. Over time these ‘plaques’ (atherosclerosis) restrict blood flow and increase risk of cardiovascular disease. So are referred to as ‘Bad Cholesterol’. Normal Reference value ≤3mmol/l.
- HDL (High-density Lipoprotein) carries excess cholesterol away from the cells back to the liver, where it can be broken down and removed from the body. For this reason, it is referred to as ‘Good Cholesterol’. Reference Range 1.2-5mmol/l
Why are children and young people with Type 1 Diabetes more at risk of hypercholesterolaemia?
In children and young people (CYP) with Type 1 Diabetes (T1D), high cholesterol can result from a combination of genetic factors, lifestyle habits, and effects of diabetes itself:
- Diabetes affects how the body processes fats, increasing the likelihood of abnormal cholesterol levels.
- Poorly managed blood glucose levels – high blood glucose levels can damage blood vessels, making cholesterol issues more harmful.
- Dietary habits – a diet high in saturated fats, processed foods, and excessive sugar can raise cholesterol levels.
- Lack of physical activity – regular exercise helps maintain healthy cholesterol levels.
- Family history – if high cholesterol runs in the family, then CYP are more likely to develop it. This hereditary condition is known as familial hypercholesterolaemia.
- Hypothyroidism (an auto immune condition which can be associated with T1D) - an underactive thyroid gland can also raise cholesterol, but if treated the cholesterol should return to normal levels.
Managing cholesterol
While medication may be necessary in some cases, the primary approach to managing high cholesterol in CYP with T1D, is lifestyle based – focusing on heart healthy diet and exercise.
What is a Heart Healthy Diet?
A diet that supports healthy cholesterol levels is rich in fibre, healthy fats, and lean protein, whilst avoiding excessive saturated fats, refined sugars, and ultra-processed foods.
Foods to eat more of:
Fibre rich foods
Eating fibre rich foods can help lower your cholesterol – fibre (particularly soluble fibre) helps reduce the amount of cholesterol that is absorbed into the blood stream from the digestive system
- Whole grains (brown rice, whole wheat pasta, wholegrain bread)
- Oats/barley
- Fruits and vegetables (aim to have a minimum of 5 different types each day)
- Beans, peas, lentils and pulses
Healthy fats
- Nuts (e.g. walnuts) and seeds (e.g. Linseeds/flaxseeds/Chia seeds)
- Oily fish (salmon/mackerel/sardines/herrings)
- Avocado
- Olive oil
Lean proteins
- Skinless chicken, turkey, fish (particularly oily fish as it provides Omega-3 fats)
- Soya beans, edamame beans, and soya products e.g. tofu
- Low fat dairy (Greek yoghurt, semi or skimmed milk)
- Eggs (appropriate portions)
Healthy Heart snacks
- Unsalted nuts/seeds
- Hummus with vegetable sticks/wholegrain oat crackers
- Plain popcorn
- Fruit/vegetables
Foods to limit or avoid:
Saturated and Trans fats
- Fried and processed foods
- Full fat dairy
- Fatty cuts of meat and processed meat products
- Pastries, cakes, and biscuits
Excess sugar and refined carbs
- Sugary cereals
- Sugary drinks
- White bread, white rice
- Processed snacks
- Crisps, sweets, chocolate
Dietary Cholesterol:
Some foods naturally contain cholesterol such as eggs and shellfish. This is called dietary cholesterol.
For most people dietary cholesterol does not have much of an effect on blood cholesterol levels so can be eaten in normal portions as part of a balanced diet.
It is more important to reduce the amount of saturated fats in your diet.
Also consider:
- Use Olive oil for cooking and dressings
- Make homemade sauces rather than ready made
- Try steaming/grilling/baking rather than frying foods and add no or minimal oil.
- Check food labelling and choose lower fat and lower saturated fat options.
Healthy Lifestyle Tips
- Encourage regular exercise – aim for a minimum of 60 minutes activity per day – walking/cycling/swimming/running/dancing, etc. Being physically active benefits every part of the body, including your mental health.
- Maintain a healthy body weight.
- Maintain good blood glucose management – aim for minimum 70% Time in Range.
- Minimal blood glucose variability and in range blood glucose levels help regulate cholesterol and prevent complications.
- Routine check-ups with the Diabetes Team – attend for annual blood screening and ask your consultant to discuss the results. Attend a minimum of 4 diabetes clinic appointments per year.
- For the older teens avoid smoking, vaping, and alcohol.
- Find ways to help with stress – here are some ideas:
- yoga/meditation
- stress management apps
- listening to music/podcasts
- time with family/friends/pets
- breathing exercises
- arts/crafts/hobbies
Summary
- Cholesterol is important for some functions within the body, too much can cause long term heart and vascular issues, so it is important to get annual blood tests done.
- A balanced, fibre-rich diet, regular exercise, and good diabetes management are the foundations of long-term health and will help maintain healthy cholesterol levels.
- There are many ways to help lower your cholesterol. Remember that small changes can make a big difference.
- Managing Type 1 diabetes can feel overwhelming, but it is possible with education and support to keep on track.
Contact
Please contact the Diabetes Team if you need support to improve blood glucose management
Email: fhft.
Additional information:
Diabetes UK - https://
Heart UK - https://
British Heart Foundation - https://
Contact us
If you have any queries relating to this information, please contact the Dietetics service.
About this information
Service:
Dietetics
Reference:
DT/104
Approval date:
1 June 2026
Review date:
1 June 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.