Cholesterol total 251, HDL 48, LDL 188. Thoughts?

High lipid panel. Looks like your cholesterol and LDL is high. Normal cholesterol should be under 200, LDL under 100. If you are a diabetic it should be even lower. Your HDL is good- it should be above 40 for males. You may want to focus on a low cholesterol diet and discuss other treatment options with you doctor.
Cholesterol. Current guidelines state that if the LDL is > 180 you should be treated with a statin to reduce the risk for heart attack and stroke. Ask your doctor about this.
Not too good. HDL is acceptable, but LDL is much too high and does pit you at vascular risk. It needs to be lowered - diet, exercise, weight reduction, medications.
Hyperlipidemia. The cholesterol is high, based on other risk factors it needs to be treated. It is recommended to have the LDL less than 100.