Diabetes and heart disease

Susan and Jonathan are among a growing number of people living with both conditions.
Susan Trim

Heart & Stroke volunteer Susan Trim focuses on healthy eating and regular activity to help control her diabetes and heart disease.

Diabetes runs in Susan Trim’s family. But still, the St. John’s resident, now 56, was not fully prepared when she was diagnosed with type 2 diabetes in her late 40s. “I was reasonably healthy, so it was a bit of a surprise,” she recalls

She focused on eating a healthy diet and went for regular walks and often visited the gym after her workday at the provincial government. She started diabetes medication and the disease stayed well under control.

Then in 2015, Susan went on vacation with her parents. “At Lake Louise, I could not walk uphill. I could not keep up with my 80-year-old parents.” She emptied her asthma inhaler trying to get more breath.

Back home, a series of tests revealed Susan had sarcoidosis, an inflammatory disease that had attacked her heart. The damage led to heart failure, which occurs when the pumping action of the heart is not strong enough to move blood around properly.

Three months of steroids successfully treated Susan’s sarcoidosis; however, she’s left with damage to her heart tissues. 

Plus, she said, “The treatment kicked my diabetes out of control.” She felt terrible and could not sleep. She had no energy for exercise. Susan went from taking merely one pill for diabetes to six. That’s in addition to medication for her heart.

The heart disease link

While diabetes didn’t have anything to do with Susan’s heart disease — sarcoidosis develops for unknown reasons — the two conditions are often inextricably linked. 

People with diabetes run a higher risk of developing heart disease, and it’s not just heart attacks. 

“There’s not enough discussion of the fact that there’s a very tight link between these two diseases,” says Dr. Doreen Rabi, a clinical endocrinologist in the department of medicine at the University of Calgary.

The majority of people with diabetes have type 2, which develops later in life and involves the body’s cells not using insulin effectively. Type 1, which often starts in childhood, occurs when the ability to produce insulin is lost due to destruction of insulin making islet cells in the pancreas.

People with both types of diabetes have more sugar in their blood. This is hard on the blood vessels and leads to thickening and hardening of vessel walls, a condition called atherosclerosis. Blood clots can form within vessels damaged by atherosclerosis, which can trigger various health problems, including heart attacks.

Common risk factors

“People with diabetes also tend to have more problems with high blood pressure and high cholesterol,” says Dr. Rabi. In fact, diabetes and heart disease share many risk factors: being overweight, living a sedentary lifestyle and eating a poor diet.

“It’s a perfect storm in type 2 that increases the risk for heart disease,” says Dr. Rabi, whose research has been funded by Heart & Stroke donors. 

The impact is dramatic: People with diabetes are three times more likely than other adults to die of heart disease. 

Doreen Rabi

It’s a perfect storm in type 2 that increases the risk for heart disease.

Dr. Doreen Rabi

There’s also a gender difference: diabetes increases the risk of heart attacks, angina (chest pain) and heart surgery more in women than men. Female hormones are believed to protect younger women from heart disease, but diabetes appears to erase this protection.

Dr. Rabi says heart disease in women with diabetes can present differently; it’s more likely to impact the smaller blood vessels. “They may not feel the symptoms of heart disease the way men feel them.”

A two-way street

In rarer cases, heart disease can trigger the onset of diabetes. This is what happened to Jonathan English of Kingston, Ont. He’s now 33, but was born with a heart condition called transposition of the great arteries (TGA). He has had many surgeries over the years, including one to implant a pacemaker. 

“I don’t have the energy to take good care of myself,” says Jonathan. Diabetes runs in his family and he was diagnosed in his early 20s.  

At the time, he was working full time as an adaptive technologist and at the end of the day, he’d be too tired to exercise. Frozen food and takeout were the norm. “I was good at staying away from sugars, but I didn’t realize that carbs like pasta and white bread can be just as bad as sugar.”

Dual management

For people with both diabetes and heart disease, it’s a challenge to stay healthy. “I already have low energy, and my meds can zap me of more energy,” says Jonathan. “When I get sick from a cold, I’m sick for three to four months. It knocks me right out and I don’t go to the gym.” He is now taking better care of himself, exercising every day and cooking healthy foods.

A heart episode or a change in diabetes can throw the other condition out of control, which is what happened to Susan Trim. She also struggles when her doctors tinker with her medications, as some diabetes drugs interact with heart disease prescriptions.

Reducing risk

The one silver lining is that both conditions benefit from lifestyle changes. 

“We have very clear evidence that you can effectively put type 2 diabetes into remission,” says Dr. Rabi. “Through lifestyle changes and medication, we know people can reduce their heart disease risk.”

Achieving and maintaining a healthy weight, eating a better diet and regular physical activity can help change the outcome for people with diabetes who know they could also be at risk for heart disease. 

For those who are already diagnosed with both, adhering to medications, getting enough sleep, staying active and eating a balanced diet can lessen the severity of their conditions.

This approach is working for Susan. She’s exercising almost every day and eating as well as she can. She also volunteers with Heart & Stroke, sharing her lived experience as a member of our heart failure council.

Susan finds that both her conditions impact her energy level, so she focuses on managing her time. “People balance a lot of things. They balance work and life. I balance my energy.”