Diabetes and Heart Disease A guide to keeping your heart healthy as a diabetes patient

What is diabetes?

Diabetes is a chronic disease that is caused by excessive levels of sugar in your blood. This condition occurs when the body is unable to produce insulin, unable to use insulin or makes too much of it.

Our bodies get sugar from the food we eat, which is then converted into energy to keep the body going. The pancreas produces a hormone called insulin, which transports the sugar to the cells and ensures the body has enough energy. This system fails to work properly among people with diabetes because their bodies cannot produce enough insulin or because they are unable to use the insulin that is produced.

Since this process does not work effectively, the pancreas works overtime to produce more insulin. However, as the condition worsens, the pancreas struggles to produce increasing amounts of insulin and this leads to the accumulation of sugar in the blood.

There are three main types of diabetes. Type 1 diabetes is caused by an auto-immune disorder where the body destroys the cells in the pancreas that produce insulin. Type 2 diabetes is caused by insulin resistance, where the body makes insulin but does not react properly to it. Gestational diabetes is a form of diabetes that occurs in pregnant women due to a change in hormones and other predisposing factors.

What is the cardiovascular system?

The cardiovascular system, also known as the circulatory system, consists of the heart and blood vessels that are responsible for the transportation of blood from the heart to all parts of the body and back. The heart acts as a pumping device each time it beats and it pumps the blood into the blood vessels, which then circulate it to the rest of the body.

The three main types of blood vessels are arteries, veins and capillaries. The cardiovascular system’s primary functions are to transport blood, oxygen and nutrients to all the organs and tissues in the body and to get rid of carbon dioxide. Having a well-functioning cardiovascular system is essential for your health and to avoid heart ailments.

What is the link between diabetes and heart disease?

We know that there is a correlation between heart disease and diabetes. People with untreated diabetes are at a greater risk of getting heart ailments because diabetes can have a severe impact on your blood vessels. Since diabetes leads to a spike in your sugar levels, the excess sugar starts to stick to your red blood cells and accumulates in your blood. This is termed glycated haemoglobin.

Over time, this accumulation can block and damage your blood vessels and restrict the flow of blood to and from your heart, damage the nerves supplying your heart and lead to severe heart ailments. An HbA1c test is used to measure your blood sugar levels over the last three months and it studies the glycated haemoglobin levels in your body.

The other common cause of heart disease among people with diabetes is atherosclerosis. This is a form of cardiovascular disease where plaque (which consists mainly of fat and cholesterol) deposits and may obstruct the blood vessels that supply blood to the heart. The build-up of plaque causes the arteries to harden and narrows them and damages them. This in turn restricts the flow of blood to your heart and could lead to a heart attack. This could occur in the arteries across the body. You could suffer a stroke when the blood flow to the brain gets affected, while poor blood flow to your limbs could lead to peripheral vascular disease.

What are some of the ways to manage heart ailments as a result of diabetes?

Now that we know of the relationship between heart disease and diabetes and the impact diabetes can have on your circulatory system, let us look at some of the common methods to manage heart ailments that are caused by diabetes.

When it comes to exercise, some of the best exercises for a healthy heart include any form of aerobic exercise such as walking, running, cycling, swimming or sports such as tennis and football. These activities cause your heart to pump more blood and will help in strengthening your heart and in preventing high blood pressure. You can also understand the 5 health benefits of yoga for good health and a healthy heart.

Maintaining an active lifestyle has multiple benefits. It can help you lose some extra weight and would also help you keep your diabetes in control as it will make the body more receptive to insulin.

How to prevent diabetes from progressing to heart disease?

Having seen in detail how diabetes affects the heart and the link between heart disease and diabetes, you must take good care of your heart especially when you have diabetes. Staying healthy, maintaining a healthy heart diet plan and keeping fit by pursuing activities such as yoga for a healthy heart will serve as a big boost in the long run. Some of the ways you can prevent diabetes from progressing to heart disease are by:

Monitoring blood pressure and blood sugar

As a rule of thumb, you must regularly monitor your blood pressure and blood sugar levels if you are diabetic. Monitoring blood pressure at home is fairly simple and all you need is a BP monitoring machine, which is commonly available in medical stores. Monitoring blood pressure at home can help in keeping a track of your treatment and help in the early diagnosis of high blood pressure. It will also make you accountable to yourself and aid in motivating you to keep your blood pressure and blood sugar levels under control.

Monitoring cholesterol levels

You must regularly test for cholesterol levels to ensure they are under control. A test for cholesterol levels is a simple blood test that will measure your total cholesterol, the amount of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides in your blood. Keeping your LDL and triglycerides levels under control is very important in preventing high blood pressure and heart ailments.

Paying close attention to a diet

It is just as important to know how to keep your heart healthy and strong as it is to know how to take care of your mental health as well. Apart from managing your blood pressure, cholesterol and blood sugar levels you also need to make sure you also pay attention to your food, sleep and stress management.

Ensure you follow a healthy heart diet plan that is rich in fibrous foods and whole grains. You can also include foods that control high blood pressure such as carrots, broccoli, pumpkin seeds and pistachios, spinach, berries and citrus fruits to name a few.

Regularizing your sleeping patterns

It is vital that you get a good 7 – 8 hours of sleep to help your body recover and function properly. Maintaining a proper sleep cycle and getting enough sleep will boost your mood and also make you feel energetic and will also help you manage stress better. Studies have shown an increased risk of heart diseases in people with poor quality sleep or irregular routine.

Finding ways to improve your mental health

Living with diabetes and heart disease can be very difficult but it is crucial that you stay positive and try to remain optimistic. Indulge in any sort of physical activity. Regular exercise can boost your self-esteem and reduce stress. Even 10 minutes of brisk walking can increase mental alertness and energy. Quitting smoking and drinking can help in improving mood and relieving anxiety and depression. Practice self-care routine, learn relaxation techniques, meditation and yoga for better health. You can try doing things that make you happy such as gardening, painting, starting a stamp collection and the like and see if it makes you feel good. You can also join a support group and find solace among people going through something similar to what you are going through. Another option would be to seek professional advice and help from a therapist.

Why is it silent?

This happens due to the link between heart disease and diabetes as high blood sugar levels damage your blood vessels. Long-term damage to your blood vessels leads to neuropathy (nerve damage). This may present as a tingling sensation in your legs and feet and also causes an altered sensation in other parts of the body, thereby masking any pain or discomfort that you may feel when you have a heart attack. You might not notice that you have a heart attack but it will have an impact on your heart.

Signs of nerve damage

You can keep a close eye on yourself to check the following symptoms which are for diabetic nerve damage so do not ignore these signs:

Watch out for these early signs to prevent a silent heart attack:

1) Electrocardiogram or ECG

ECG or an electrocardiogram is a test that records the electrical activity of your heart. An electrocardiogram is a painless, non-invasive way to help diagnose many common heart problems in people of all ages. Electrocardiograms may be used to detect the following:

• Abnormal heart rhythm (arrhythmias).
• If blocked or narrowed arteries in the heart are causing chest pain or a heart attack.
• Whether there has been a previous heart attack.
• How well certain heart disease treatments, such as a pacemaker, are working.

When should you get an ECG? It is recommended to do an ECG test under the guidance of your doctor if you have any of the following symptoms:

2) 2D Echocardiography Test

2D Echocardiography or 2D Echo of the heart is a test in which ultrasound technique is used to take pictures of the heart. It creates images of the various parts of the heart using ultrasound vibrations and makes it easy to check for damages, blockages and blood flow rate.

This test is suggested by doctors to check any of the following heart conditions:

• Any underlying heart diseases or abnormalities.
• Congenital heart diseases and blood clots or tumours.
• Malfunctioning of the heart valve.
• Abnormality of blood flow within the heart.

3) Stress Test (TMT)

TMT or stress test is conducted when the patient’s heart rate is faster than usual. Usually, when we get an ECG done, the patient is rested and will not always complain of any discomfort. In a stress test, a patient is asked to walk or jog on the treadmill and his heart rate is calculated at this time. The test shows how your heart reacts to different levels of exercise. Taken at an interval, this test can also show the improvement or deterioration of a patient’s heart function.

4) Cardiac Markers

Cardiac markers are substances that are released into the blood and they are measured through tests to determine heart health. Tests for cardiac biomarkers can also be used to help determine a person’s risk of having these conditions or to help monitor and manage someone with the suspected acute coronary syndrome and cardiac ischemia.

Some different biomarkers tests are:

• Troponin (I or T)
• High-sensitivity troponin
• Creatine kinase (CK) and CK-MB
• Myoglobin

How often should I get a complete health check-up?

Even as a healthy person we don’t always know what is happening inside our bodies. So it is always recommended that you have a full-body check-up at once or twice every year. But if you have been diagnosed with diseases like diabetes, high cholesterol, high blood pressure, etc, you need to go for a bi-yearly health check-up. Consult your doctor because they will be the best people to guide you through the entire diagnosis and treatment process.

How is blood pressure measured?

When your blood pressure is measured, the result is shown in a fraction-like format with one number on the top and one number at the bottom (eg: 120/80 millimetres of mercury (mm Hg)). The number on the top is your systolic pressure, which is the pressure in your arteries when your heart squeezes and pumps blood. The number on the bottom is called diastolic pressure, which is your blood pressure when the heart relaxes.

What is the normal blood pressure range?

The normal systolic pressure is below 120 mm Hg, while a reading above 130 is hypertension. Normal diastolic pressure is below 80 mm Hg. Summing up, the normal blood pressure range for a healthy individual is 120/80 mm Hg or lower. However, your doctor may help you in understanding the target blood pressure to be maintained by you, based on your age and other medical conditions.

What are the symptoms of high blood pressure?

Blood pressure is the force that your heart uses to pump blood around the body. High blood pressure or hypertension, does not have any explicit symptoms as such. You could have high blood pressure and you would not know about it unless you take a regular test or monitor blood pressure at home. However, you could experience the following symptoms if you have severe hypertension:

If you notice any of these symptoms, then you must consult your doctor at the earliest. Early diagnosis of high blood pressure can help in avoiding serious complications such as heart attack or stroke. Timely intervention and treatment can reduce the impact of heart disease and diabetes.

Who is at risk of developing high blood pressure?

Health Complications That Can Arise Due to High Blood Pressure

High blood pressure especially if you are dealing with diabetes is not something to be ignored. It is imperative to seek a doctor’s advice and strictly follow the treatment plan that is prescribed. If high blood pressure is left undiagnosed on untreated, it can lead to these three major health complications:

What happens when you have diabetes along with high blood pressure during pregnancy?

Gestational hypertension is when you have high blood pressure during pregnancy. The normal blood pressure range during pregnancy is anything below 120/80 mm Hg. However, if your reading is beyond the normal blood pressure range during pregnancy and is more than 140/90 mm Hg, that indicates you have hypertension.

High blood pressure symptoms in women and gestational hypertension usually begins in your final trimester, after 20 weeks and won’t exhibit any major symptoms. It usually does not harm you or your baby and your blood pressure levels return to the normal range about 3 months after childbirth. There is usually no protein found in your urine and no damage to your organs.

However, some pregnant women with gestational diabetes also develop preeclampsia. Preeclampsia is a condition that is caused by a sudden increase in your blood pressure after 20 weeks of pregnancy. It leads to damage to your vital organs such as your kidneys and liver. Untreated preeclampsia can have a severe impact on the mother and the baby and could cause the mother to have seizures.

Some of the symptoms of preeclampsia are nausea or vomiting in the later stages of your pregnancy, having trouble breathing, unusual swelling in your hands and face, constant headaches and pain in your upper abdomen. If you experience any of these symptoms, make sure you get medical attention at the earliest.

The best ways to manage and control high blood pressure during pregnancy is by keeping up with your routine visits to the doctor, regularly taking your blood pressure medicines, staying active, avoiding obesity by getting more physical activity and following a nutritious diet and by staying away from smoking and alcohol.

Managing High Blood Pressure When You’re Diabetic

It is very important that you manage high blood pressure, especially if you are diabetic, to reduce the risk of heart diseases and diabetes. Diabetes and high blood pressure is a dangerous combination that can cause serious long-term complications and you must make small diabetes lifestyle modifications to ensure your safety.

Some of the most basic diabetes lifestyle modifications include controlling your blood sugar, maintaining a healthy and wholesome diet that includes foods that control high blood pressure and sugar spike, getting enough exercise and ensuring that you lose extra weight. These are essential steps in your diabetes and high blood pressure treatment.

If you have diabetes and high blood pressure, then some of the major things you must avoid are smoking, alcohol and eating a lot of salt. Also, stay as far away as you can from sugary drinks and processed fatty foods. Make sure you also lead a healthy and active lifestyle, follow your medication plan and take regular tests.

Caring for Someone Who is Diabetic with High Blood Pressure

It can be tough for you to see your loved one deal with diabetes and high blood pressure but as a caregiver, it is essential that you remain positive because your support and energy can make things easier for them. Make sure you offer them your unwavering support and offer them your assistance in whatever capacity needed.

You need to ensure they follow the best practices that will aid in their diabetes and high blood pressure treatment. Now that you know the irrefutable link between heart disease and diabetes, you need to see to it that your loved one undergoes regular testing, makes periodic visits to the doctor and follows their medication plan.

It is important for them to eat well and stay fit and you can help them make these lifestyle changes by adopting a few of these yourself. For example, you can join them in adding foods that control high blood pressure to your diet like citrus fruits, berries, spinach, etc and make the process easier. Another way you could help them remain fit is by creating a common fitness plan where both of you either walk, run, swim or work out together for 30 minutes every day.

These small changes from your side can go a long way in helping them feel better and positive.

There is a third type of blood fat called triglycerides. The triglycerides in the blood store unused calories and release them when needed to provide your body with energy. After a meal, our bodies convert the calories that we do not need for immediate use into triglycerides, which are then stored in fat cells. The triglycerides in the blood are usually released in between meals when the body needs energy.

You are prone to have high triglycerides if your diet consists of a lot of high-carbohydrate foods and if you regularly eat more calories than you burn. Which essentially means you do not follow a balanced diet or get enough exercise.

Some of the effects of high triglycerides include the hardening and narrowing of your arteries, which then impedes the blood supply to your heart. The effects of high triglycerides are that it drastically increases your risk of heart diseases, stroke and heart attack.

People with diabetes need to monitor their triglycerides because it can cause further damage to their bodies. Having high triglycerides is also a risk factor for type 2 diabetes or prediabetes.

You can control the level of triglycerides in the blood by exercising regularly, avoiding refined carbohydrates and sugar, choosing healthier sources of fat and limiting your alcohol intake.

Good Fat vs Bad Fat

Good fat or unsaturated fat is a healthy fat that your body requires daily. They differ from saturated fats by having fewer hydrogen atoms bonded to their carbon chains. Healthy fats are liquid at room temperature, not solid.

Foods high in good fats include vegetable oils like olive oil, sunflower oil, canola oil, nuts, seeds and fish.

A balanced diet is extremely important in order to curb your blood sugar levels. But no two diets are alike. So the calorie intake and fat intake also differs from person to person. But your good fat daily intake should be approx 7% of your daily calorie intake.

On the other hand, bad fat also called trans fats, even when consumed in small amounts can be detrimental to your health. It leads to weight gain, blocking of the arteries and increased risk of contracting other diseases.

Foods like fatty cuts of meat, hard cheese like cheddar, butter and ghee, cream, chocolate and cookies and some savoury snacks are known to contain trans fat and need to be either completely eliminated or consumed in extreme moderation for those with diabetes.

How does high blood sugar levels impact cholesterol levels?

High levels of blood sugar always have adverse effects on your health. It is associated with a plethora of health complications including cholesterol abnormalities. One of the most common factors of diabetes is insulin resistance and this also causes an abnormal cholesterol profile in the body. Diabetes often lowers good cholesterol in the body (HDL) and raises bad cholesterol levels with triglycerides and LDL. This, in turn, can affect your heart and increases your chances of having a heart attack or stroke.

Cholesterol and diabetes together could pose some serious issues and make you prone to heart ailments and stroke. You can stay safe by regularly taking a test for cholesterol levels to ensure they remain within the normal range. An LDL level below 100 mg/dL is considered ideal, while a reading between 130 – 159 is considered moderately high while anything over 160 is a cause of concern.

What is a lipid profile?

A lipid profile is a panel of tests that the doctor prescribes to measure the amount of cholesterol and triglycerides in the blood. The lipid profile measures lipids which are fats and fatty substances which are used as a source of energy. Lipids include cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The amount of fatty deposits or plaques can lead to narrowed or blocked arteries.

How is it done?

A lipid profile is basically a blood test and the results are derived from the sample of blood from a vein.

What is a normal lipid profile?

So as we have established, the lipid profile test ascertains the amount of cholesterol in the blood along with different forms of fat. If your blood report shows that your cholesterol levels are below 200 mg/dL, you are safe. But if you are way above this range it can lead to heart diseases.

Low-density lipoprotein (LDL) cholesterol

Low-density lipoprotein (LDL) cholesterol is considered bad cholesterol. In general, LDL results are as follows:

Triglycerides

One of the most important aspects you should look for in this report is triglycerides. These fats are linked to heart disease and diabetes. If you have high triglycerides, your total cholesterol and LDL levels may be high, as well.

What happens if cholesterol levels are left uncontrolled over a long period of time?

If cholesterol levels are high and are left uncontrolled and untreated for a long time it can lead to several fatal heart conditions such as heart failure, heart attack and cardiac arrest. The main risk from high cholesterol is that it makes the arteries narrow and can even build up walls in the arteries. This prevents blood from reaching the heart and can lead to cardiovascular diseases and even an irreversible heart attack. Therefore, it is essential if you are diabetic to do regular heart check-ups and find ways to reduce your risk of developing heart disease.

How to control high cholesterol levels when diabetic?

If you have high cholesterol and diabetes then your doctor will advise you to make a few changes in your food habits and ask you to get some regular exercise. Your doctor may also prescribe statins, which are medicines that are used to control and reduce cholesterol.

Just like how eating clean and working out helps in controlling blood sugar, the same two factors aid in lowering cholesterol as well. A well-balanced diet for cholesterol and diabetes would require you to have generous servings of fruits and vegetables and include sources of healthy fats such as nuts, avocado, flax seeds, fish and olive oil.

Make it a point to break a sweat and exercise regularly as it could directly help in reducing your cholesterol levels. Regular exercise would also help you lose extra weight and get rid of the unhealthy fat in your body.

What are some ways to prevent high cholesterol when diabetic?

Prevention is better than cure. Having cholesterol and diabetes can take a toll on your body. Since people with diabetes have an increased risk of developing high cholesterol, here are some preventive measures you can take to avoid such a situation:

• Lose extra fat and maintain healthy body weight.
• Prioritize fruits and vegetables and fibrous foods, restrict salt intake and avoid junk food.
• Quit smoking as soon as possible.
• Moderate your alcohol consumption, preferably avoid alcohol as far as possible.
• Make it a habit to exercise regularly – a minimum of 30 minutes for at least 5 days a week.

These changes to your lifestyle and diet can go a long way to reduce the risk of further complications. If you find it difficult to motivate yourself to exercise, then you can either find a workout partner or join a community gym and this would help you stay on track. If giving up smoking and alcohol is challenging, opt for alternatives such as chewing a stick of gum when you feel the urge to smoke and an alcoholic drink with a non-sugary beverage or fruit juice.

When it comes to diet alterations, a proper diet for cholesterol and diabetes control would lay emphasis on quality nutrition from a wide variety of fruits and vegetables coupled with whole grains such as brown rice and oats. Stay as far away as you can from saturated fats and red meat and focus on heart-friendly fatty foods such as avocados, nuts, fish, olive oil and the like.

What are the symptoms of diabetic heart disease?

Some of the most common diabetes and heart disease symptoms are:

• Pain or pressure in the chest
• Having difficulty breathing
• Breaking into a cold sweat
• Sweaty or clammy hands
• Feeling light-headed and dizzy
• Nausea
• Pain in your shoulders, jaw or left arm

If you feel you have any of above heart disease and diabetes symptoms, then get medical attention immediately.

Will Diabetes eventually lead me to heart troubles?

Diabetes could lead to heart ailments like diabetes and even heart disease are interrelated. People with diabetes are at a greater risk of getting heart ailments because diabetes can severely damage your blood vessels. Diabetes can lead to the accumulation of glucose in your red blood cells, which would then lead to blocked blood vessels and restricted oxygen supply to the heart.

The other common cause of heart disease among people with diabetes is the build-up of plaque in the arteries, which are the blood vessels that supply oxygen to the heart. This collection of plaque hardens the arteries and narrows them, which will reduce the flow of blood to the heart and could lead to a heart attack.

How long can you live with heart disease and diabetes?

Diabetes and heart disease becomes life-threatening only when it is left uncontrolled. If you take the right steps to control diabetes and prevent high blood pressure then you have a good chance of living a healthy life. Early detection is very important when it comes to diabetes as well as heart disease as this will reduce the risk of diabetes and heart attack. Make sure you take your medicines regularly and keep a tab on your blood pressure and blood sugar levels.

How do people with diabetes keep their hearts healthy?

People with diabetes can follow a few simple steps to keep their hearts healthy. This includes following a healthy heart diet plan that includes large quantities of fruits and vegetables and wholegrain foods. It is important that you restrict your salt and sugar intake and do not consume extremely fatty and processed foods as these steps help in preventing high blood pressure. In combination with a healthy diet, you can also perform exercises for a healthy heart. This includes basic aerobic exercises such as walking, running, cycling and swimming.

If you want to know how to keep your heart healthy and strong, then this is it – a mix of diet and exercise is the best way for people with diabetes to keep their hearts in top shape.

What is a silent heart attack in diabetes?

A silent heart attack in diabetes is when you suffer a heart attack but feel no impact of it. You may feel heartburn or slight discomfort but nothing major. This happens because heart disease and diabetes damage your blood vessels. Uncontrolled diabetes can lead to a condition called neuropathy, which causes altered or reduced sensation in your body. You may not feel the pain during a silent heart attack but it will take its toll on your body.

Can walking reverse heart disease?

Walking will not reverse heart disease but it can reduce the risk of heart disease. Any sort of aerobic exercise, such as walking, running, swimming or cycling causes the heart to pump blood faster and helps in strengthening your heart. Aerobic exercises are the best exercises for a healthy heart. You can also practice yoga for a healthy heart.

Can diet play a role in controlling cholesterol and triglycerides?

Yes, your diet plays a very important role in controlling cholesterol and triglycerides levels in your blood. An ideal diet plan must include a large variety of fruits and vegetables and sources of heart-healthy fats such as nuts, avocados, fish and olive oil. Eating whole grains such as brown rice, lentils and oats will add more fibre to your diet and help in keeping your cholesterol levels in check.
A healthy diet can work wonders in controlling and reducing your cholesterol and triglyceride levels.

My sugars are controlled but my triglycerides are not controlled even after following a strict diet regime?

Following a strict diet is very useful in controlling triglycerides but it is to be one in combination with more lifestyle changes. Make it a point to exercise for a minimum of at least five times a week to reduce your triglycerides and overall cholesterol, blood sugar and blood pressure level. Regular physical activity will also help you reduce weight, which would happen when you burn more calories. If you burn more calories, then you will be reducing triglycerides as well. Your doctor may prescribe you medication if a healthy lifestyle is not reducing triglycerides in the blood.