Pathophysiology
In type 2 DM, the body does not use insulin well, so sugar stays in the blood. Insulin helps control fat, but with resistance, fat breaks down too much and sends extra fatty acids into the blood. The liver takes these fatty acids and makes more triglycerides, which are carried in VLDL, leading to high triglyceride levels. At the same time, the "good" cholesterol (HDL) goes down, and the "bad" cholesterol (LDL) become small & dense. The small LDL particles can easily stick to blood vessels and cause blockages. This pattern of high triglycerides, low HDL, and high LDL is dyslipidemia. Over time, it leads to hardening of the arteries, poor circulation, and higher risk for heart disease, stroke, and foot infections that heal slowly.