How To Manage High Triglycerides With Diabetes

If you have diabetes, you may already know that there’s a lot to keep track of – counting carbs, checking blood sugar, timing insulin, and thinking about how things like sleep, stress, and exercise affect it all. But there’s another number worth keeping an eye on: Your triglycerides. 

These fat molecules that circulate in your bloodstream often get overlooked, but they can quietly increase your risk for heart problems, pancreatitis, and other serious complications.

High triglycerides are one of the most common lipid conditions seen in people with diabetes. According to the American Diabetes Association (ADA)’s 2025 Standards of Care, people with diabetes who have a triglyceride level of 150 mg/dL or higher should work on improving their blood sugar management and making healthy lifestyle changes. Triglycerides usually stay below 500 mg/dL, but can less commonly rise above 880 mg/dL.

“I consider a fasting triglyceride of greater than 880 mg/dL as a concern for an increased risk of acute pancreatitis. At this triglyceride level, chylomicrons are found in the bloodstream,” explained Dr. Robert Rosenson, cardiologist and director of the Cardiometabolics Unit at Mount Sinai.  

Chylomicrons are a type of fat particle that can build up in the blood, which can trigger painful and even life-threatening inflammation in the pancreas (pancreatitis).

High triglycerides often fly under the radar until complications arise, especially in people with diabetes. The good news is that triglyceride levels can often be lowered with a few key changes. 

Lifestyle changes

While dangerously high triglycerides may sometimes require urgent medical intervention, most people can lower their levels and reduce their long-term risk by building consistent lifestyle habits with ongoing monitoring from their healthcare provider.

Limiting sugar and refined carbohydrates

One of the most effective ways to lower triglycerides is to cut back on added sugars and refined carbohydrates. That includes things like sugary drinks, white bread, pastries, and processed snacks. These foods can cause blood sugar to spike quickly, which triggers the body to make more insulin. Over time, high insulin levels can lead to more fat being stored in the liver, which eventually turns into triglycerides.

Instead of cutting out all carbs, the goal is to choose more nutritious ones, like whole grains, beans, vegetables, and fruits in moderation. These foods break down more slowly in the body without causing dangerous spikes in blood sugar, helping to keep blood glucose and triglyceride levels steadier.

If you're drinking sweetened beverages like soda, sweet tea, or juice regularly, replacing them with water or unsweetened drinks can make a big difference. Even small changes, like switching from white rice to brown rice or from white bread to whole grain, can add up over time. These simple shifts in eating habits are one of the most impactful places to start.

Limiting alcohol intake 

It’s not just sugar and refined carbs that can push triglyceride levels higher. Alcohol is another major contributor, especially when consumed regularly or in large amounts.

Even though alcohol doesn’t contain fat, drinking it can significantly raise triglyceride levels. That’s because alcohol is processed by the liver, where it can be converted into triglycerides. For people with diabetes, cocktail culture can make it even harder to manage glucose levels safely.

Alcohol’s effect on triglycerides is dose-dependent, meaning the more you drink, the more your levels may rise. Even moderate drinking, such as one drink per day, can be enough to cause problems for some people with elevated triglycerides.

In people with very high levels (especially above 880 mg/dL), completely avoiding alcohol is often recommended. Cutting out alcohol can be a critical step in lowering triglycerides and reducing the risk of developing pancreatitis.

If you choose to drink, talk to your healthcare provider about what’s safe for you. Many people with high triglycerides find that limiting or eliminating alcohol (alongside other healthy changes) can lead to noticeable improvements in their triglyceride levels.

Include healthy fats in your diet 

When trying to lower triglycerides, many people assume they need to cut out all fat – but it’s not that simple. The key is knowing the difference between unhealthy fats and healthy fats.

Saturated fats, which are found in foods like red meat, butter, full-fat dairy, and many fried or processed items, can raise triglyceride levels and increase the risk of heart disease. In contrast, unsaturated fats are considered heart-healthy and can actually help improve blood fat levels when used in place of saturated fats.

Healthy fats are found in foods like:

• Olive oil
• Avocados
• Nuts and seeds
• Fatty fish like salmon, sardines, and mackerel (rich in omega-3s)

For people with extremely elevated triglycerides, Rosenson recommended a strict low-fat diet (10-15 grams of fat per day) to help prevent serious complications like acute pancreatitis. In these cases, even healthy fats may need to be limited under medical supervision.

For others with mild to moderate hypertriglyceridemia, the Mediterranean diet has shown the most consistent benefits. This eating pattern emphasizes plant-based foods, whole grains, fish, and plenty of unsaturated fats like olive oil, while limiting red meat, added sugars, and processed foods. Studies have found that the Mediterranean diet can help reduce triglycerides and improve overall cardiovascular health.

Swapping saturated fats for unsaturated ones and following a balanced eating pattern like the Mediterranean or DASH diet can support healthy triglyceride levels, especially when combined with other lifestyle changes.

Exercise regularly

Physical activity is one of the most powerful tools for lowering triglycerides, especially if you also have diabetes. Exercise helps the body use insulin more effectively, lowers blood sugar, and encourages your muscles to burn fat for energy, which can lead to lower triglyceride levels over time.

The American Heart Association recommends getting an average of 40 minutes of moderate-to intense aerobic activity three to four times per week. This level of activity has been shown to lower triglycerides, improve cholesterol, and reduce the risk of heart disease.

And you don’t have to do it all at once. Short sessions, like walking for 10-15 minutes after meals, can be effective too. The key is to find something you enjoy and do it regularly.

If you're just starting out or have physical limitations, talk to your healthcare provider about a safe way to begin. Even small increases in daily movement can lead to big improvements in triglyceride levels and overall health.

It might sound like a broken record – eat right and exercise – but there’s a reason you hear it so often: It works. These lifestyle changes aren’t just generic health advice; they’re backed by strong scientific evidence. Studies consistently show that improving your diet and staying physically active are among the most effective ways to lower triglycerides, improve blood sugar, and reduce the risk of complications before medications are even needed.

Blood sugar management

People with diabetes often experience changes in blood lipids, such as cholesterol and triglycerides. This condition, known as diabetic dyslipidemia, typically includes higher triglycerides, lower HDL (the "good" cholesterol), and higher LDL (the "bad" cholesterol) – all of which can increase the risk of heart disease and stroke.

When blood sugar levels remain elevated over time, the body may convert some of that extra glucose into triglycerides, contributing to higher levels in the blood. In addition, insulin resistance can make it harder for the body to break down and clear triglycerides efficiently.

Improving blood sugar management through nutrition, physical activity, medications, stress reduction, and other lifestyle strategies can have a direct impact on triglyceride levels. More stable glucose levels help reduce the production of triglycerides in the liver and support the body's natural processes for maintaining a healthier lipid balance.

Tools like continuous glucose monitoring (CGM) can provide a more complete picture of how blood sugar levels fluctuate throughout the day. Instead of relying solely on A1C, CGM allows individuals to track their time in range (70-180 mg/dL). More time in range has been associated with higher healthy cholesterol and lower triglycerides. 

Triglyceride-lowering medications 

While lifestyle changes and improved blood sugar management are key first steps, some people may also need medication to help lower triglyceride levels and further reduce the risk of heart disease.

Statins are a common treatment used to lower LDL (“bad”) cholesterol and decrease the risk for heart disease in people with diabetes, but they can also modestly reduce triglycerides. 

For people who already take a statin and have their LDL cholesterol under control but still have high triglycerides (between 150-499 mg/dL), the ADA recommends adding icosapent ethyl (brand name Vascepa) to help lower the risk of heart problems. Icosapent ethyl is a derivative of an omega-3 fatty acid. One study found that adding icosapent ethyl to statin therapy not only lowered triglycerides by about 20-30%, but also reduced heart attacks and strokes in high-risk individuals, including those with diabetes. 

In addition, some diabetes medications (like GLP-1s) have also shown potential in lowering triglycerides while improving blood sugar and reducing the risk of heart problems.

For people whose triglycerides remain high – especially above 200 mg/dL – a doctor may prescribe a class of drugs called fibrates. However, their effectiveness may vary depending on the person. In a study with people who had type 2 diabetes, taking pemafibrate reduced triglycerides and cholesterol levels, but did not lower the risk of heart problems.

Niacin (vitamin B3) used to be a popular treatment to lower triglycerides, but is used less today because it can cause side effects like flushing and may raise blood sugar, which isn’t ideal for people with diabetes.

In rare cases where triglycerides are dangerously high (above 880 mg/dL), emerging medications have great potential to lower them. The FDA recently approved olezarsen (brand name Tryngolza) for a rare genetic condition known as familial chylomicronemia syndrome (FCS). Clinical trials for FCS have shown that it could lower triglycerides by over 50% and help prevent pancreatitis. 

Dr. Savitha Subramanian, an endocrinologist at the University of Washington and medical director of the UW Lipid Clinic, explained how this novel treatment targeting apolipoprotein C3 (apoC-III) works.

“Think of apoC-III as a villain – it prevents triglycerides from being broken down and causes them to build up in the bloodstream. ApoC-III inhibitors, like olezarsen, allow the body to break down triglycerides and clear them from our system,” she said.

Another drug, plozasiran, is under FDA review. In clinical trials, it reduced triglycerides by up to 80% in people with severe high triglyceride levels and showed promise in cutting pancreatitis risk even further. 

Although these newer treatments are being approved for people with rare genetic conditions that cause extremely high levels of triglycerides, their effectiveness shows how much progress is being made in managing triglycerides, especially for people with diabetes, who often need multiple treatments to protect their heart and health.

The bottom line

If you have diabetes, keeping an eye on your triglyceride levels is just as important as managing your blood sugar. Managing blood sugar and weight, eating a low-fat diet, and staying active are all changes that can make a big difference.

For people with very high triglyceride levels or genetic conditions, emerging medications are offering new hope for lowering levels and protecting long-term health.

Learn more about managing triglycerides and blood sugar here:

• Current Targets for Lipids, Cholesterol, Blood Pressure, Time in Range, and A1C
• Five Best Diets for Diabetes
• Expert Tips for Kidney and Heart Health