We were contacted by Mr. Raj Agarwal who is a 55 year old, with type 2 diabetes since the last 10 years. He complained of swelling in his ankles and feet, shortness of breath, and weight gain. Recently, he faced congestive heart failure. He was confused as to why he suffered a heart attack, whether he had any heart disease(s) now and was it related to his diabetes?

To answer his question, it is important to understand what changes a diabetic’s body goes through during the course of the disease. The general concern of a diabetic is of losing their vision or having an amputation, while they have greater risks, such as of the heart and brain damage.

About 65% of people with type 2 diabetes die of heart disease or stroke, as diabetics are two to four times more likely to die of heart disease than people without diabetes.

What is the cause of heart disease and stroke in people with diabetes?

The most common cause of heart disease in a person with diabetes is hardening of the coronary arteries. There is a buildup of cholesterol in the blood vessels that supply oxygen and nutrition to the heart. This buildup usually begins before the raised blood sugar level in type 2 diabetics.

These cholesterol plaques break apart and the body tries to repair the arteries by sending platelets to seal it up.  As the artery is small, these platelets block the blood flow, not allowing oxygen delivery which results in a heart attack. The same process may happen in other arteries also, leading to reduced blood flow to brain, causing stroke; or even this decreased blood flow to hands and legs that may even lead to peripheral vascular disease.

How to diagnose heart disease?

There are some common symptoms of heart problems that include tightness in the chest, breathlessness, pain in arm or leg, palpitations, faster heartbeat, weakness or dizziness, nausea, sweating etc.

In case the above sign and symptoms are noticed, the doctor or the health care provider should be contacted immediately. This can lead to timely diagnosis & appropriate care of the patient.

Delay in diagnosis of heart attack

People with diabetes often have atypical heart attack symptoms, with over 30% of diabetics having symptomless heart attacks as compared to non-diabetics. Such a high incidence is linked to sensory neuropathy in diabetics leading to numbness, tingling, or pain in feet & legs, caused by nerve damage.

Steps to avoid heart diseases

For a diabetic, it’s important to control the blood glucose levels, blood pressure and cholesterol. This reduces the risk of coronary heart disease and other cardiovascular diseases. A few pointers to help in this include:

  • Control your blood sugar: If you’ve been prescribed medication, take it. To make sure your blood sugar is in the safe zone, get a haemoglobin A1C test at least twice a year. (Aim for below 7%). For a better sense of your daily blood sugar use a blood glucose monitor. (It should be 90 to 130 mg/dL before meals and less than 180 mg/dL one to two hours after eating.)
  • Eat heart-healthy foods: Enjoy whole-grain breads and cereals, fruit, and vegetables, and cut back on foods loaded in saturated fat and cholesterol. Also avoid processed foods with trans-fat. Follow plate method to ensure you are having healthy meals.
  • Check your blood pressure regularly: It should be below 130/80 mmHg in general and your doctor can also give information on the normal range as per the age.
  • Manage your weight: A dietitian can help you lose weight safely. You need to plan meals carefully keeping in mind your daily calorie intake and also your nutritional requirement, while keeping your blood sugar in the safe range.
  • Give up smoking and limit your alcohol intake.
  • Have your cholesterol checked: You should have your cholesterol tested at least once a year. Aim for an LDL level that is below 100; an HDL level that is above 40 if you’re male and above 50 if you’re female; and triglyceride level that is below 150.
  • Maintain an active lifestyle by doing exercise for minimum 30 minutes a day, at least 5 days a week. You can also meditate for few minutes daily to reduce anxiety and stress.


  1. http://www.health.com/health/gallery/0,,20488762,00.html#protect-your-heart-2
  2. http://www.webmd.com/diabetes/type-2-diabetes-guide/heart-blood-disease#3
  3. https://www.bhf.org.uk/heart-health/risk-factors/diabetes
  4. https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/heart-attack/
  5. https://www.thediabetescouncil.com/the-connection-between-diabetes-heart-disease-and-stroke/
  6. http://www.diabetes.co.uk/diabetes-complications/preventing-heart-disease.html



  1. Everybody needs to read this especially when heart attacks are so prevalent and lifestyle which we have is distant from physical exercise and healthy food
    Thanks for this important information !


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