The fibrates are mainly used to treat two hyperlipi-demias, familial hypertriglyceridemia (type IV) and dysbetalipoproteinemia (type III). They are also useful in the treatment of hypertriglyceridemia associated with type II diabetes (secondary hyperlipidemia). The fibrates are the drugs of choice in treating hypertriglyc-eridemias, particularly those associated with low levels of HDL cholesterol. The fibrates additionally appear to shift LDL particles to larger, hence less atherogenic, species.
Type III or dysbetalipoproteinemia is a rare condition in which cholesterol-enriched VLDL remnants, called p-VLDL, accumulate in the plasma. They are atherogenic particles. Dysbetalipoproteinemia is a genetic condition associated with expression of an unusual form of apolipoprotein E (apo E2 versus the normal E3) that leads to reduced plasma clearance of these lipoproteins by the liver. Through stimulation of LPL and perhaps other lipases, the fibrates accelerate clearance of these p-lipoproteins. Both plasma cholesterol and triglyceride levels are elevated in dysbetalipopro-teinemia and in combined hyperlipidemia, type IIb. However, the drug treatments are different for the two conditions. Type lib hyperlipoproteinemia requires use of agents that lower both LDL and VLDL particles; for example, a statin plus niacin, niacin alone, or niacin in combination with a fibrate. Care should be taken in distinguishing between types IIb and III as the cause of the elevated cholesterol plus triglyceride. This can be achieved by examining the profile of the elevated plasma lipoproteins separated by electrophoresis. A broad p-band is seen in type III but distinct p- and prep-bands are seen in type IIb.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.