Comorbidity: Diabetes

Specific conditions such as diabetes are known to have an effect on heart failure (HF) and heart failure can also impact the management of other preexisting medical conditions. The presence of these comorbidities can affect the course of selected treatment and clinical outcomes.¹ Comorbidities the presence of other diseases or illnesses, including hypertension, diabetes mellitus, obesity, hyperlipidemia, and metabolic syndrome.¹

Diabetes – the basics

Diabetes is a disease in which blood glucose levels in the body get too high. Blood glucose, also known as blood sugar, is how the body gets energy from digesting food. This process is facilitated by a pancreatic hormone called insulin. If the body doesn’t make enough insulin or use it properly (insulin resistance), the blood sugar needed for energy doesn’t make it into your cells, it just stays in the blood.² Too much glucose in your blood can make your body hungry for energy and contribute to the medical problems with the eyes, kidneys, nerves, and heart.^2-3 Diabetics generally develop heart disease at a younger age than people without diabetes.⁴

With insulin resistance, the pancreas loses its ability to produce insulin over time.³ To accommodate the elevated blood sugar levels, the pancreas releases additional insulin to try to normalize levels. When this process no longer works, blood sugar levels rise. Risk factors for insulin resistance are obesity and physical inactivity. These are also risk factors for heart failure.^3-4 Allowing diabetes to be poorly managed or go untreated can lead to complex and severe medical problems.

Link between diabetes and heart disease

Heart failure and diabetes are pathophysiologically linked.⁵ This means that there are common changes in function caused or resulting from the diseases. People with diabetes tend to develop heart disease at a younger age than people without diabetes. The most common causes of death in adult diabetics are heart disease and stroke. This cause of death is about twice the rate than for those without diabetes.⁴

High blood glucose levels can damage your blood vessels and the nerves that control your heart and blood vessels. The longer a person has diabetes, the more likely some kind of heart disease will develop.⁴ There are common risk factors for both diseases including hypertension, coronary artery disease, kidney disease, and obesity.¹ Diabetes, together with HF, is associated with increased morbidity and mortality.¹

Steps to take

There is no cure for diabetes, so good management is important in decreasing the risk of developing heart failure or stroke. Some people have a family history of heart disease which they cannot avoid, but there are action steps to take. Lifestyle changes can help prevent heart disease can also improve diabetic management.⁶

• Blood sugar control. Keep blood glucose levels within the target range, this is called glycemic control. Your provider will determine the right range for you.
• Blood pressure control. High blood pressure causes the heart to have to work harder to pump blood. This can strain the heart muscle, damage blood vessels, and increase your risk of more severe medical problems including the eyes and kidneys.⁶
• Watch your cholesterol. Monitor your HDL (good) and LDL (bad) cholesterol levels. Consult your healthcare provider about diet and medications to help you keep cholesterol levels under control.^4,6
• Don’t smoke. Smoking and diabetes can both cause blood vessels to narrow. Smoking increases the likelihood of complications such as stroke, and diseases of the lungs, kidneys, eyes, and can cause damage to the blood vessels in the legs which could lead to amputation.⁴
• Stay Active. The American Heart Association and the American Diabetes Association both recommend regular exercise. Check with your healthcare provider before changing your exercise program.
• Watch your diet.Eat heart-healthy, low-fat meals. Whole grains, fruits and vegetables, and limiting alcohol can help you manage your diabetes and your heart.

Medications

Diabetes and heart disease may both be treated with prescription medications. It is important to take all medications as prescribed because there can be serious side effects if they are not taken the right way.⁶

Some diabetes medications may cause an increased risk of heart failure.⁵ It is always important to tell your healthcare provider about your health history and all the medications, vitamins, and supplements you take because some can alter effects on your metabolism.⁷ It is important to manage glycemic control while addressing cardiovascular issues.⁵