Diabetes and Your Heart
If you have type 2 diabetes, you know that keeping an eye on your blood glucose (sugar) is an important part of managing the disease. But did you know that having diabetes also makes you more prone to having heart disease or a stroke?
It's true. In fact, cardiovascular disease is the No. 1 cause of death among people with type 2 diabetes. Compared with those who don't have diabetes, women with the condition have about 4 times greater risk for heart disease, while men with the condition have about twice the risk.
So, in addition to watching and controlling your blood glucose, take steps to protect your heart health:
- Ask questions
- Know your risk of heart disease or stroke
- Learn what you can do to stay healthy
If you or a loved one is living with diabetes, use this resource to learn more about the condition and how to manage your heart disease risk.
Questions to Ask Your Doctor
Managing diabetes is a team effort. You will likely be seen by a number of health professionals, and making sure everyone if on the same page is important.
Be sure to ask your health care team about how to best manage your risk of cardiovascular disease. Here are some questions you might consider asking during your next visit.
- How does Type 2 Diabetes change my risk for other diseases, including cardiovascular disease?
- What changes can I make to prevent heart problems or stroke?
- In addition to my blood pressure and cholesterol levels, what should I watch for?
- Do I need to try to lose weight? How much?
- Could medications help protect my heart?
- How often should my heart health be checked? What tests would you recommend?
- Could I benefit from seeing a nutritionist?
- Should I keep taking my vitamins and supplements?
- In addition to my A1C, are there other blood sugar tests that I'll need?
- I heard statins may cause diabetes. Is this true?
- What support groups and resources are available to me?
Living With Diabetes
There's plenty you can do to help keep diabetes in check while also slowing or preventing other health problems. Get some practical tips about controlling your weight, eating healthy, and staying active.
Diabetes (Type 2 Diabetes)
Having diabetes means you have too much sugar—called glucose—in your blood. If untreated, diabetes can harm the body, particularly the heart and vascular system. In fact, people with diabetes are 2-4 times more likely to have heart disease or suffer a stroke than those who don't have the disease. Experts say this risk is even greater for women with diabetes.
Diabetes can lead to heart attacks, strokes, kidney disease, blindness, dental disease, amputations, and other serious health problems. And the longer you have high levels of blood glucose traveling around your body, the more likely you are to have problems.
If you have diabetes, the best thing you can do is learn about how to manage your condition and prevent problems.
Overview
Diabetes develops when the body either:
- Does not make enough insulin or
- Is unable to use insulin properly (called insulin resistance, generally the result of being overweight, not exercising and eating a poor diet, which can lead to metabolic syndrome) or
- Both
Insulin is a hormone that is usually made in the pancreas. It helps your body use the sugars that are in the foods we eat. Glucose gives your body energy, and insulin helps carry glucose to your cells.
If the body doesn't make or use insulin well, glucose builds up in the blood instead of being absorbed by cells in the body. The body's cells are then starved of energy, despite high blood glucose levels.
How Many People Have Diabetes?
Diabetes affects a lot of people. More than 30 million adults in the United States are living with diabetes, yet about 1 in 4 don't know they have it. A recent study estimates nearly half of U.S. adults have diabetes or prediabetes, a condition when blood sugar is elevated but is not yet high enough to be classified as diabetes.
There are three types of diabetes:
- Type 1 diabetes, occurs when the body loses the ability to make insulin. Traditionally, this was thought to occur in children, but it can happen throughout life.
- Type 2 diabetes is the most common form of diabetes—accounting for up to 95% of all cases. People with type 2 diabetes suffer from insulin resistance, which means their bodies don't respond to insulin properly. But they can make insulin early in the disease. Eventually, patients with type 2 diabetes stop making insulin. It most often occurs in adults, but more children are being diagnosed. This may be because more youth are overweight or less physically active than before.
- Gestational diabetes occurs during pregnancy. After pregnancy, levels of blood sugar improve. But if you had diabetes during pregnancy, you are at risk for developing type 2 diabetes.
There is also growing concern over prediabetes. People with prediabetes are more likely to develop type 2 diabetes, as well as heart disease and stroke. The good news is that you can take steps to prevent or delay the onset of full-blown diabetes.
Some studies find that losing weight—just 5% to 10% of your starting weight—can delay or even reverse prediabetes. For example, if you are 5-foot-11 inches and weigh 200 pounds, try losing 10 pounds as a first step.
Diabetes is a lifelong condition that needs to be managed to stay healthy. Over time, too much glucose in the blood can cause serious problems including:
- Heart disease
- Stroke
- Damage to the blood vessels in your eyes, kidneys and nerves
- Damage to the arteries of the legs that, in some cases, can lead to loss of a limb
- Ulcers on the feet or legs that don't heal well
- Gum disease
Signs and Symptoms
According to the Centers for Disease Control and Prevention, about 7 million people in the U.S. have undiagnosed diabetes. While symptoms are often present, some people have no signs of the disease.
Common signs and symptoms include:
- Extreme thirst
- Urinating more than usual
- Unexplained weight loss or losing weight without trying
- Blurry vision
- Wounds or blisters that don't heal well
- Tingling or numbness in your hands or feet, or both
- Feeling very tired
- Dry, itchy skin
- Red, swollen, tender gums
- Frequent infections
What Increases Your Risk?
Several things can make someone more likely to develop type 2 diabetes. For example:
- Being overweight or obese—the more weight you carry, especially around your midsection, typically the more resistant your body is to insulin
- Having high blood pressure generally or during pregnancy (called preeclampsia)
- Eating an unhealthy diet that is high in fat, calories, cholesterol and processed food
- Not exercising regularly
- Being older than 45, although it can occur in younger people
- Having a parent, brother or sister who has diabetes
- If you are a woman, a few more factors can increase your risk:
- Being diagnosed with gestational diabetes
- Up to 3 out of 5 women who had this during pregnancy will go on to develop diabetes within 15 years
- Giving birth to a baby that weighed more than 9 pounds
- Having polycystic ovarian syndrome (PCOS)
- Being diagnosed with gestational diabetes
Type 2 diabetes is also more common among certain ethnic or racial groups including African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders.
It's important to talk with your health care professional about all your personal risk factors.
Exams and Tests
Diabetes is diagnosed by taking a detailed medical history, including a report of symptoms, and blood tests that measure the amount of glucose in the blood or how your body handles it.
There are several types of blood tests to check your sugar level:
- Hemoglobin A1c (HbA1c or A1c), or simple A1c gives an overall picture of your blood sugar level over the past two to three months
- Fasting glucose test measures the amount of glucose in your blood after you haven't had anything to eat or drink for eight hours
- Random blood glucose test measures the amount of glucose in your blood at any point during the day. Eating does not affect this test
- Oral glucose tolerance test checks your blood glucose levels before and two hours after you drink a special sweet drink to show how well your body processes glucose.
Treatment
There are a few things you can do to help manage your diabetes and live a healthier life. It's very important to take steps that will help prevent high blood sugar levels. This is most often achieved through a combination of:
- Healthy eating
- Exercise
- Insulin therapy and/or diabetes medication, and
- Routine blood sugar monitoring
Treatment Goals
Diabetes treatments aim to:
- Lower high blood glucose levels
- Manage blood pressure, cholesterol and other health issues
- Reduce the risk of cardiovascular disease and related deaths
- Prevent problems such as nerve damage, high blood pressure, issues digesting food, or gum disease and others
The American Diabetes Association has set the following blood glucose targets for people with diabetes. Your health care team will work with you to set your personal blood glucose goals and map out a course of treatment that's best for you.
| Target Blood Glucose Levels for Most People with Diabetes | |
| Before Meals | 70 mg/dL to 130 mg/dL |
| 1 to 2 Hours After Start of Meal | Less than 180 mg/dL |
HbA1c/A1c is also used to give an average blood glucose level over the past three months. Target A1c for most people with diabetes should be less than 7%. Talk with your health care professional about your specific goal.
| American Diabetes Association Guidelines | |
| Result | A1c |
| Normal | Less than 5.7% |
| Prediabetes | 5.7% to 6.4% |
| Diabetes | 6.5% or higher |
Your treatment plan will likely include:
❱❱ Making healthier choices overall
- Get regular exercise
- Maintain a healthy weight
- Eat a healthy diet that is lower in salt, fat and refined carbohydrates; it's also helpful to meal plan, read labels and to learn how to substitute saturated and trans fats for healthier fats
- Avoid cigarettes and alcohol
❱❱ Taking medications
Several medications are used to help control your blood sugar levels. The type of medicine you take—insulin therapy and/or diabetes medications—will depend on your type of diabetes, as well as other health conditions.
Some medications are given by mouth; others may be given by injection or by using an insulin pen or pump. Many people with diabetes take multiple medications. Some of the newer diabetes medications also have been shown to lower the risk of heart disease, stroke and related deaths.
❱❱ Ongoing care and monitoring
Taking care of yourself, going to necessary medical appointments, getting lab tests, including a yearly urine test, and knowing your blood glucose number are all important to managing diabetes.
As mentioned, maintaining a healthy weight, staying physically active and eating a healthy diet are also key to controlling blood sugar levels and lowering your risk of heart disease and stroke.
Talk with your doctor about:
❱❱ Checking your blood sugar level
Ask your care team how often you need to check and record your blood glucose, and if you should use a glucose meter at home. Knowing your glucose levels can help you and your doctor make decisions about your medicines, meals and exercise regimen.
If your glucose level is not where it should be, changes can be made to your treatment plan. Random blood sugar testing may also be done or recommended when you have symptoms.
❱❱ Controlling your blood pressure and cholesterol levels, if needed
❱❱ Knowing what to look for
Ask your doctor about possible complications from diabetes and what to watch for. For example:
- Nerve damage (called diabetic neuropathy), which most often shows as a numbness, tingling or burning in your hands or feet
- Eye problems such as blurry vision
- Kidney issues
- Cuts, blisters or sores on your feet
- Heart disease and stroke
Call 911 if you have chest pain, fainting or shortness of breath.
❱❱ Getting immunizations
Ask your doctor about getting vaccinated to help prevent illnesses such as the flu, pneumococcal disease and shingles.
Understand the Connection
If you're like most people, you may not know that diabetes and heart disease often go hand-in-hand.
Diabetes is a major risk factor for cardiovascular disease, including:
- Coronary heart disease
- Heart attack
- Stroke
- Weakening of the heart muscle (cardiomyopathy)
- Heart failure
The ways in which diabetes affects cardiovascular health are complex. But we do know that high levels of sugar in the blood can, over time, damage the blood vessels and nerves. These changes can make your blood vessels stiff and narrowed. As a result, blood may not flow as easily to your heart, brain or body.
Unfortunately, by the time someone learns they have diabetes, changes or injuries to the large (macro) or small (micro) blood vessels in the body have often already started. Talking with your care team about these changes is important.
- Microvascular complications include diabetes-related kidney disease, vision and nerve problems
- Macrovascular complications include heart attack, stroke and peripheral artery disease
People with diabetes are also more apt to have other heart disease risk factors. For example:
- High blood pressure
- Elevated levels of low density lipoprotein (LDL) cholesterol
- Chronic kidney disease that can lead to dialysis
- Being overweight or obese
By the Numbers
- 1 out of 10: Americans living with diabetes
- 2X-4X: How much more likely people with diabetes are to develop heart disease or stroke compared with people who don't have diabetes
- 2 out of 3: Proportion of deaths due to heart disease among people older than 65 with diabetes.
Diabetes Affects Heart Health
Because diabetes and heart disease are linked, treatment plans for diabetes shouldn't focus only on controlling blood sugar levels. Treatment must address other cardiovascular risk factors, too. This approach might include:
- Ongoing assessment of cardiovascular health (for example, watching cholesterol panels, blood pressure or protein in the urine)
- Steps to help protect your heart health with lifestyle changes (for example regular exercise, heart-healthy diet, good sleep habits) and possibly medications to help control high blood pressure or cholesterol
- Referrals to other providers to support a coordinated, team-based approach to your care
- Routine vaccination against the flu and pneumonia to prevent illnesses that can stress the heart
Do You Have Heart Disease?
If you have heart disease but haven't been screened for type 2 diabetes, ask to be tested. Many people with heart disease also have diabetes, but they often remain undiagnosed.
The sooner you know, the sooner you can take steps to lower your risk. Many people have prediabetes, an early warning sign for diabetes. At this stage, they can make changes to help prevent the onset of the disease.
ABCs of Diabetes
The "ABCs of diabetes" is widely used as a reminder of the importance of tracking your blood sugar numbers, along with your blood pressure and cholesterol. High blood pressure and high cholesterol are well-known risk factors for heart disease and stroke.
In addition to knowing your numbers, lifestyle changes are recommended to manage diabetes, and sometimes medications are as well. So if you're living with diabetes, try to remember these ABCDEs:
A is for A1C, or HbA1c, which is a test that measures blood glucose control over the past two to three months. The A1C target for most people is under 7%.
B is for blood pressure. Nearly 2 out of 3 people with diabetes have high blood pressure. For most people with high blood pressure and diabetes, blood pressure levels should be <130/80 mm Hg.
C is for cholesterol. Total cholesterol, LDL and triglycerides should be monitored.
D is for a healthy diet and, if appropriate, drug therapy.
E is for exercise.
S is for stop smoking. Smoking doubles the risk of heart disease in people with diabetes.
Even when blood sugar levels are reasonably controlled, some inflammation in the blood vessels is likely. So ask about your risk of heart disease and stroke—even if your blood sugar levels are in check.
In addition, a healthy diet, regular exercise and certain medications that might be prescribed can protect your heart. Experts suggest:
- Adopt a heart-healthy diet, or eating plan.
Eating fewer carbohydrates (especially simple carbohydrates such as table sugar and sweetened beverages that lack nutritional value) can help lower your body's need for insulin and help regulate your blood sugar level. - Ask about diabetes medications.
These can help lower blood sugar levels, but it seems some of these medications can benefit the heart, too, especially in people with existing cardiovascular disease.
Drug Therapy
In addition to making healthier lifestyle choices every day, medications also can help manage diabetes. Your health care provider may recommend one or a combination of medications that are used to help lower:
- Blood sugar levels and keep them within a target range
- Cholesterol
- Blood pressure
- The risk of blood clots, heart attack or stroke
- Other cardiovascular risk factors
New Medications
Three diabetes medications that lower blood sugar levels—empagliflozin, liraglutide and and canagliflozin—were recently approved by the U.S. Food and Drug Administration to help reduce cardiovascular disease in people with diabetes and heart disease or at high risk for CV disease. In some cases, these medicines also have helped lower related deaths in these patients. But mounting data suggest these medicines may be protective even among those without heart disease.
Talk with your health care provider to find out whether you might benefit from these therapies.
Lower Your Heart Risk
You can change the course of your disease and lower your chances of developing heart-related problems in addition to diabetes. Be sure to talk with your health professional.
Here are some suggestions that may help:
❱❱ Quit smoking
- Ask for help.
- Call 1-800-784-8669 (1-800-QUIT-NOW).
❱❱ Commit to regular exercise
- Sitting for long periods of time, not exercising—or both—are harmful.
- Aim for 150 minutes of activity per week (just over 20 minutes a day).
- Housework, brisk walking, dancing, gardening, swimming and riding a bike are all good ways to stay active. Doing 10-minute bursts of activity at a time counts—and they add up!
❱❱ Choose a heart-healthy diet
- Talk with your health care team about a heart-healthy eating plan that also keeps your diabetes better controlled. For example, try to choose:
- Non-starchy vegetables and fresh fruits
- Whole-grain foods
- Lean proteins
- Low-fat milk and dairy products
- Healthy fats (nuts, seeds, avocado and vegetable oils)
- Foods low in sugar and simple carbohydrates
- Make good choices when eating on the go.
- Hold the salt.
❱❱ Maintain a healthy weight
- If you're overweight, losing just 5% to 7% of your total body weight can improve your health.
❱❱ Know your numbers
- Keep track of your A1C, blood pressure and LDL-cholesterol and triglycerides, and work to keep them under control.
- Ask about cardiovascular risk calculators.
❱❱ Lower stress and get enough sleep
- Aim for seven or more uninterrupted hours of shut-eye a night.
- If you suspect you might have sleep apnea, talk with your doctor as this also can affect your heart health.
❱❱ Educate others
- Most people with diabetes don't know about the relationship between type 2 diabetes and cardiovascular disease.
- Spread the word to empower others to take action for a healthy heart.
Living With Diabetes
People with type 2 diabetes are more likely to develop heart disease or have a stroke compared with those who don’t have diabetes—and at a younger age.
Diabetes is among the strongest risk factors for heart and vascular disease. It’s right up there with smoking and having high blood pressure or high cholesterol.
Having diabetes means you have too much sugar (also called glucose) in your blood. It can affect the way your heart works, and harm blood vessels. For example, the lining of the blood vessels may become thicker, which can impair blood flow. Many people have poor blood flow in their legs and feet, which can lead to numbness and weakness. Diabetes can damage other organs as well, including the kidneys.
Diabetes and heart disease share many of the same risk factors, such as having high cholesterol, being overweight, not exercising and smoking.
If you have diabetes, it doesn’t mean heart disease is bound to happen. In many cases, there are steps you can take to keep your diabetes in check and stay ahead of heart disease. But it’s not always easy. If you have or develop heart disease, then you will have to manage several conditions, which can seem daunting.
Tips to Live Better With Diabetes
Things you can change to be healthier—your weight, food choices and level of physical activity—are called “modifiable risk factors.” Understanding these factors and working to improve them can help you feel more in control of your health.
Here are some tips for managing diabetes while staying heart healthy.
1. Set clear goals for controlling your diabetes and keeping tabs on your health.
Work with your health care team to decide 1) what lifestyle changes you can reasonably make, 2) if medicine or insulin is needed, 3) what your ideal level of blood sugar (also called blood glucose) should be, and 4) how to keep your cholesterol and blood pressure within a healthy range.
Ask questions if you don’t understand your health care provider’s suggestions for managing your diabetes or other heart risk factors. Your provider might want you to keep track of certain health measures at home; for example, by using home glucose or blood pressure monitoring, taking your pulse, or stepping on a scale to record your weight.
2. Be sure all of your health care providers are on the same page.
If you have diabetes, you probably see a number of specialists, including an endocrinologist, eye and foot doctors, in addition to your primary care provider. Most people living with diabetes have other health problems that need to be managed as well. Each provider may order blood work and other tests. Ask that copies of test results and notes from health visits be available to all of your providers so that everyone is on the same page. They should be aware of your conditions, treatments, up-to-date list of medicine and your goals for care.
3. Check your blood sugar level regularly, based on your provider’s advice.
The higher your blood sugar level, the higher your risk of heart disease. You and your health care provider should decide on your target A1C level; it may depend on your health conditions and age. A1C gives an estimate of your blood sugar over the past two to three months. Also, make sure you know what to do if your blood sugar is too high or too low.
4. Lose weight if needed.
Shedding 10 to 20 pounds can make a big difference when it comes to lowering your blood sugar, cholesterol and/or blood pressure. Plus, as you lose weight, you likely will feel better and more able to stay active and make healthy food choices. Take the time to talk with your health care provider about what weight loss plan might help you safely lose weight and keep it off.
—Edward Hulten, MD, MPH, FACC, Walter Reed National Military Medical Center, Bethesda, Md.
5. Get moving.
Our bodies are meant to move. Regular exercise can prevent diabetes and help control it. When you exercise, your blood glucose level goes down because your muscles use glucose.
The trick is to find things to do you enjoy and make them a habit. Sometimes, adding a social element can help keep it fun. Try signing up for a dance or swim class, or joining a running club or an online group that helps you check in and be accountable.
Getting 30 minutes of exercise at least five days a week often is advised. Talk with your health care provider about how to safely exercise more, especially before starting a new routine. Start slowly and commit to a certain number of days a week. If you can’t find 30-minute blocks of time, try to exercise for 10 minutes a few times a day. Remember, activities like cleaning the house and gardening also count. Exercise can lower blood sugar, and in some people, it can drop a lot, so keep your monitor and a snack available while exercising.
6. Make healthy food choices.
A healthy diet, such as a plant-based or Mediterranean-style diet, can help control diabetes. It can also improve other heart disease risk factors such as obesity, cholesterol and blood pressure. Focus on eating nutritious foods that are low in fat and high in fiber, and aim to fill your plate with a colorful assortment of fruits and vegetables.
Foods high in carbohydrates can increase your blood sugar. Moderation is important when eating grains—and be sure to choose whole grains.
If you need advice, a nutritionist or dietitian can help.
7. Kick the habit.
If you smoke, quit. Diabetes and smoking can cause your blood vessels to tighten. If you need help, ask about local smoking cessation programs and other support services. While you’re at it, try to limit alcohol, too. Alcohol is a hidden source of sugar, and drinking too much can make other conditions worse or more likely.
8. Take all your medicine as prescribed.
Use reminders or a pillbox if needed. Tell your health care team if you have trouble taking your medicine (for example, remembering to take doses, side effects, concerns about cost). Make sure you understand why you are taking each medicine, how it works and what to do if you miss a dose. Ask your health care provider if you need to take an aspirin.
9. Be your own champion.
It can be hard to learn that you have diabetes, but it’s important to advocate for yourself and commit to lifestyle changes. You also need to take charge of your health. Uncontrolled diabetes can lead to eye and kidney issues. It also affects blood flow and sensations in your feet and legs, making you more prone to having sores that don’t heal and could become infected. If you have leg pain or numbness, tell your health care provider. You will need annual eye and foot exams, as well as routine blood work and other tests. Add reminders to your calendar so you don’t miss these health visits.
Many people with diabetes and heart disease also struggle with depression. Anxiety or depression can hinder your treatment and also may promote not-so-healthy choices. You might lose your steam to exercise or turn to fat-laden comfort foods or alcohol. Watch how you are feeling and seek help if needed. Stay involved in activities that make you happy, boost your mood and help you de-stress.
10. Find your team.
Whether it’s finding a walking buddy or someone to go to your health visits with you or just provide a listening ear, make sure to surround yourself with people who will support you and help you reach your goals.
How to Eat Well When You Have Diabetes
People living with diabetes often have a lot of questions about food. What foods are OK? Which ones should I avoid? Does having diabetes mean I can't ever have treats or eat at a restaurant?
Fortunately, eating well when you have diabetes is a lot like eating well when you don't have diabetes. In fact, health care professionals no longer recommend the strict "diabetic diet" that you may have heard about years ago.
Research shows that there are lots of ways to maintain a healthy diet while enjoying each and every meal. By learning what your body needs and how to keep your blood sugar levels under control, you can help prevent the complications of diabetes without feeling deprived at the dinner table
More Information
In addition to the resources offered through CardioSmart, other organizations include:
American Diabetes Association
www.diabetes.org
Centers for Disease Control and Prevention
www.cdc.gov/diabetes/prevention/index.htm
National Institute of Diabetes and Digestive and Kidney Diseases
❱❱ Diabetes, Heart Disease, and Stroke
www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke
❱❱ Diabetes (Information Clearinghouse)
www.diabetes.niddk.nih.gov
Source: https://www.cardiosmart.org/topics/diabetes-and-your-heart
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