Diabetes dilemma: The connection between diabetes and heart disease


Results from an A1C exam.

I like knowing why things are the way they are. Understanding the underlying causes of heart problems and treating them is one of the reasons I love working in cardiology.

Sometimes the causes are obvious. Sometimes they’re not. For many people, the connection between diabetes and heart disease falls into the latter category.

In fact, my wife and I talked about that just the other day over breakfast. She pointed out that people might take better care of themselves if they understood how the two conditions are connected. And I agree!

The heart risks of diabetes

If you have Type 1 or Type 2 diabetes, you’re more likely to develop heart disease than someone who doesn’t have diabetes. The Centers for Disease Control and Prevention (CDC) says adults with diabetes are two to four times more likely to die of heart disease or have a stroke than adults who don’t have diabetes.

There are a few reasons for this higher risk in diabetes patients:

  • Fluctuating levels of blood sugar, or glucose, which can damage the interior surfaces of blood vessels
  • Potentially higher levels of lipids, or fats, in the blood, including high cholesterol levels (a condition known as diabetic dyslipidemia, which is associated with heart disease)
  • A wide range of reactions specific to their type of diabetes, including elevated hormones and cytokines (proteins that cells use to communicate and carry out vital functions)

These factors often result in accelerated atherosclerosis, or thickening of the walls of the arteries. But these aren’t the only ways patients with diabetes may be at greater risk for heart disease.

Obesity, which often is a problem for patients with Type 2 diabetes, only makes these issues worse. Obese patients are more likely to have high blood pressure on top of their elevated risk from diabetes, and high blood pressure is another critical risk factor for heart disease. As of 2014, more than 30 percent of Texas adults were obese, and 11 percent had diabetes.

Smoking is another huge risk factor for heart disease, and the risk is magnified if you have diabetes. In fact, diabetes patients who smoke double their risk for heart disease.

Be heart smart with your diabetes care

You need to minimize your risk for heart disease as part of your regular diabetes care. One important step is to control your diabetes with the medications your doctor prescribes.

If you have Type 2 diabetes, especially if you’re obese, losing excess weight can work miracles for both your diabetes and your risk for heart disease. In some cases, Type 2 diabetes can go away completely in patients who reach and maintain a healthy weight!

If you have Type 1 diabetes, focus on vigilance. Use your insulin injections or pump as your doctor prescribes. You must be very careful and mindful about taking care of yourself.

Lifestyle modifications, such as maintaining a healthy diet, healthy weight, and regular exercise regimen, are important steps you can take to control your diabetes. The National Diabetes Education Program recommends making an action plan with your doctor to help you control your diabetes and reduce your risk for heart disease.

Your action plan should include:

  • A diet low in saturated fat, trans fat, cholesterol, salt, and added sugar
  • A diet high in fiber, including whole grains, fruits, vegetables, and beans
  • A plan to stop smoking, if necessary
  • Regular exercise – at least 30 to 60 minutes each day

Test your blood sugar regularly

The above steps and others your doctor recommends are important changes you can make to better control your diabetes. But often, they’re not enough on their own.

As mentioned, fluctuating blood sugar levels can contribute to atherosclerosis. At-home testing can help you keep your blood sugar levels stable. You may be able to physically feel when your blood sugar is too high or too low, but not always:

  • Too high – you may be thirsty, feel nauseated, faint, or have blurry vision
  • Too low – you may feel disoriented, unhappy, tired, or irritable

In addition to routine at-home blood tests, your doctor can use a test for glycated hemoglobin, usually referred to as A1C, to get a more detailed view of how well you’re managing your diabetes. The A1C test gives your doctor information about your average blood sugar levels over the past two to three months. The American Diabetes Association recommends that your doctor test your A1C levels at least twice a year. If you’re trying to control your diabetes with prescribed medication, diet, etc., but you’re still having trouble, your doctor can work with you to make adjustments as necessary.

Commit to caring for your diabetes – and your heart

Taking care of yourself when you have diabetes is tough. It can be painful and annoying to have to test your blood sugar levels and a hassle to make sure what you eat won’t send your levels too high and cause problems.

Some patients don’t stick with their testing and treatment plans because doing so is hard. But the difficulty is worth it. Getting off-schedule is the worst thing patients can do — for their diabetes and their heart.

In most cases, diabetes is a lifelong condition. But if you follow your doctor’s instructions and take good care of yourself, you can live a healthier life and reduce your risk for heart disease in the process.