National Diabetes Heart Connection Day

When it comes to how diabetes can affect your heart, or other parts of your body like the eyes, genitals, nerves, and more, it's all about the blood vessels. (2) When exposed to regularly high blood sugar levels, termed hyperglycemia, blood vessels are prone to react in a number of ways: 

• Endothelial Dysfunction: Chronic hyperglycemia can impair the function of the endothelium, a thin layer of cells lining the inside of blood vessels. The endothelium plays a crucial role in regulating vascular tone, blood flow, and the prevention of clot formation. When it's damaged by high blood sugar, it can lead to endothelial dysfunction, which reduces the ability of blood vessels to relax and constrict properly.
• Increased Inflammation: High blood sugar can trigger an inflammatory response within blood vessels. Inflammation is a key factor in the development and progression of atherosclerosis, which is the buildup of fatty deposits and plaque in the arteries.
• Oxidative Stress: Elevated blood sugar levels can lead to the production of excess free radicals and oxidative stress. This oxidative stress can cause damage to blood vessel walls, making them more vulnerable to atherosclerosis.
• Formation of Advanced Glycation End Products (AGEs): High blood sugar can result in the formation of AGEs, which are harmful compounds that can accumulate in blood vessel walls and promote inflammation and atherosclerosis.
• Microvascular Complications: High blood sugar can damage the smaller blood vessels, particularly in the eyes, kidneys, and nerves. In the context of blood vessels, this can lead to conditions like diabetic retinopathy (eye damage) and diabetic nephropathy (kidney damage).
• Impaired Blood Flow: Over time, damage to blood vessels from chronic hyperglycemia can result in narrowing and blockages, reducing blood flow to vital organs and tissues, including the heart and brain.

Especially in the case of type 2 diabetes, these vascular complications are why individuals with diabetes are at increased risk of developing heart disease, stroke, peripheral artery disease, and other cardiovascular problems. 

As discussed in a past CallonDoc article titled “Warning Signs and Symptoms of Prediabetes,” there are seldom warning signs for type 2 diabetes, unfortunately, that also goes for diabetes-related heart disease. Heart diseases related to diabetes are not necessarily related to late-stage diabetes either. While it is true that the risk of heart disease tends to increase with the duration and severity of diabetes, diabetes-related heart disease can occur at various stages of diabetes, including early stages where there are few to no symptoms at all. However, the symptoms that can be noticed most often include: 

• Chest Pain or Discomfort: People with diabetes can experience chest pain or discomfort, which may be indicative of reduced blood flow to the heart muscle, a condition known as angina.
• Shortness of Breath: Difficulty breathing or shortness of breath, especially during physical activity or when lying down, maybe a sign of heart failure, a condition that can be linked to diabetic cardiomyopathy.
• Fatigue: Persistent tiredness or fatigue, even with minimal physical exertion, could be a symptom of reduced heart function or heart failure.
• Rapid or Irregular Heartbeat: Arrhythmias, such as atrial fibrillation, can occur in individuals with diabetes-related heart disease, leading to a fluttering or irregular heartbeat.
• Swelling: Edema or swelling in the legs, ankles, or abdomen can be a sign of heart failure, which is more common in people with diabetes.
• Dizziness or Fainting: Feeling lightheaded, dizzy, or fainting may result from arrhythmias or decreased blood flow to the brain due to heart disease.

It's important to remember that the way to get an early indication of diabetes-related heart diseases is to get regular testing. Those with type 1 diabetes and those prone to type 2 diabetes normally get tested more than once a week, with some people getting tested more than once a day. In a clinical setting, this is as simple as a finger prick, with a drop of blood being all that is needed for the doctor to give you a result. Similarly, there are at-home tests with devices like continuous glucose monitors or blood sugar meters that function in the same way. A normal basis for healthy individuals looks like testing every one to three years, depending on their diet and frequency of exercise. Each method ultimately uses a drop of your blood to produce results. 

For those that develop type 2 diabetes, heart disease comes gradually through lifestyle and regular habits. With high blood sugar gradually damaging blood vessels around the heart and body, a person’s diet is the primary route toward developing or avoiding diabetes-related heart diseases. A diet that is high in unhealthy fats, sugars, and processed foods while low in fruits, vegetables, whole grains, and lean proteins is an example of how type 2 diabetes develops. Additionally, other factors that can play a role include: 

• Age
• Genetics
• Physical Inactivity
• Obesity
• Insulin Resistance
• Hypertension
• Stress
• Sleep Apnea
• Smoking 

Diabetic cardiomyopathy is the specific type of heart failure commonly associated with diabetes. It is a condition characterized by changes in the structure and function of the heart, including thickening of the heart muscle and impaired contractility, which can lead to heart failure. This condition is distinct from other types of heart failure and is primarily driven by the effects of diabetes on the heart, particularly in individuals with poor blood sugar control. (3)

Many professionals base diabetic cardiomyopathy on three major stages: early, middle, and late if there is an absence of hypertension and coronary atherosclerosis. (4) As discussed in a 2013 study, these stages appear as: 

• Early Stage of Diabetic Cardiomyopathy:
  • Cellular and metabolic changes in the heart.
  • Absence of obvious systolic dysfunction.
• Middle Stage of Diabetic Cardiomyopathy:
  • Increased apoptosis (cell death).
  • Slight increase in left ventricular size.
  • Diastolic dysfunction.
  • Ejection fraction (EF) is less than 50%.
• Late Stage of Diabetic Cardiomyopathy:
  • Alteration in microvasculature compliance.
  • Further increase in left ventricular size.
  • Significant decrease in cardiac performance.
  • Progression to heart failure.

When it comes to specifically testing heart health for those with diabetes, there are three non-invasive tests and two invasive tests. (5) A non-invasive test is a diagnostic procedure that does not require penetration of the body or the use of instruments that enter the body, typically relying on external imaging or measurements. In contrast, an invasive test involves the insertion of medical instruments, such as catheters or endoscopes, into the body to directly access and evaluate internal structures or organs. For diabetes-related heart diseases, these tests include: 

• Non-Invasive:
  • Echocardiogram: Often called an "echo," is a non-invasive medical imaging procedure that uses high-frequency sound waves to create a real-time visual representation of the heart's structure, function, and blood flow, providing valuable information for diagnosing and monitoring various heart conditions.
  • Electrocardiogram: An Electrocardiogram (ECG or EKG) test is a non-invasive diagnostic procedure that records the electrical activity of the heart by placing electrodes on the skin to create a visual representation (electrocardiogram) of the heart's rhythm and detect irregularities or abnormalities.
  • Exercise Stress: Often known as a treadmill test, is a diagnostic procedure that assesses the heart's response to increased physical activity by monitoring the electrocardiogram (ECG) and other vital signs while a person walks on a treadmill or uses another form of exercise equipment.
• Invasive: 
  • Nuclear Stress: A nuclear stress test is a diagnostic imaging procedure that combines the use of a radioactive tracer and imaging equipment, such as a gamma camera, to assess blood flow to the heart muscle and identify areas with reduced blood supply, helping to diagnose and evaluate heart conditions.
  • Coronary Angiogram: A coronary angiogram is an invasive diagnostic procedure that involves injecting a contrast dye into the coronary arteries and using X-ray imaging to visualize and assess the presence of blockages or narrowings in these blood vessels, helping diagnose and guide treatment for coronary artery disease.

As discussed in an earlier CallonDoc article titled “The CallonDoc Guide to Type 2 Diabetes,” the primary ways to avoid type 2 diabetes can be condensed down to a healthy diet, plenty of exercise, getting plenty of sleep, and avoiding unhealthy habits like smoking. Preventing diabetes-related heart diseases is similar in the habits and actions you can take, with examples including: 

• Blood Sugar Control: Maintain good blood sugar control through regular monitoring, medication adherence, and lifestyle modifications to reduce the risk of heart disease.
• Blood Pressure Management: Keep blood pressure within a healthy range (usually below 130/80 mm Hg) with medications, if necessary, and lifestyle changes.
• Cholesterol Management: Maintain healthy cholesterol levels by managing LDL ("bad") cholesterol, HDL ("good") cholesterol, and triglycerides through diet, exercise, and medications when prescribed.
• Healthy Diet: Adopt a heart-healthy diet that is low in saturated and trans fats, cholesterol, and sodium while being rich in fruits, vegetables, whole grains, and lean proteins. Monitor portion sizes and reduce sugar intake.
• Regular Exercise: Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week, as this helps improve insulin sensitivity, control weight, and enhance cardiovascular health.
• Weight Management: Achieve and maintain a healthy weight or lose excess weight through a balanced diet and exercise to reduce the risk of heart disease.
• Smoking Cessation: Quit smoking or avoid exposure to secondhand smoke, as smoking significantly raises the risk of heart disease in people with diabetes.
• Stress Management: Practice stress-reduction techniques such as mindfulness, meditation, or relaxation exercises to help reduce emotional and physical stress.
• Regular Check-Ups: Attend regular medical check-ups to monitor blood sugar, blood pressure, cholesterol levels, and overall heart health. Discuss medications or adjustments with your healthcare provider.

CallonDoc tests individuals with type 2 diabetes, making life easier for many Americans across the 50 states. While we can’t treat heart disease, we do work to spread awareness about how untreated diabetes can lead to heart disease as well as provide health-related education to keep you and your loved ones informed on how to live a  healthy life. Share this blog, check out our other blogs for more wellness information, and get testing or treatment online with Call-On-Doc!

1. Making the DIABETES HEART Connection, https://diabetesheartconnection.org/.
2. “Complications of diabetes | Guide to diabetes.” Diabetes UK, https://www.diabetes.org.uk/guide-to-diabetes/complications.
3. Kenny, Helena C., and E. D. Abbot. “Heart Failure in Type 2 Diabetes Mellitus.” AHA Journals, American Heart Association, 03 01 2019, https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.311371.
4. Chavali V, Tyagi SC, Mishra PK. Predictors and prevention of diabetic cardiomyopathy. Diabetes Metab Syndr Obes. 2013 Apr 11, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629872/. 
5. “Heart Health Tests for People with Diabetes.” American Heart Association, 5 May 2021, https://www.heart.org/en/health-topics/diabetes/symptoms-diagnosis--monitoring-of-diabetes/heart-health-tests-for-diabetes-patients.