Diabetes and Your Heart – Why Controlling Blood Sugar Alone Is Not Enough

Find out how to properly manage your diabetes to improve your health.

By Dale Park, CSO, Sharecare Reality Lab

If you or a loved one has diabetes, you know about the daily challenges of managing the condition and staying healthy. Real success is possible when you understand how the disease affects both your short-term and long-term health. For example, many people think that if they keep their blood sugar under control then they don’t need to be concerned about the long-term effects of diabetes. After all, isn’t diabetes a disease caused by the inability to properly regulate blood sugar? No doubt, blood sugar is the first thing you need to learn how to manage. But is it enough?

Did you know that people with type 2 diabetes are ten times more likely to have serious cardiovascular problems? Your heart and vasculature are especially vulnerable to the many complex changes that diabetes causes throughout the body. Over many years, the high blood sugar that is a result of type 2 diabetes unleashes a chain of events that damage the body.

How Diabetes Impacts Your Body  

Here are just a few of the metabolic changes associated with diabetes:

  • Loss of the body’s natural ability to regulate blood sugar.
  • Changes in the levels and types of fats circulating in the blood. 
  • Unwanted formation of new end-products that cause damage to blood vessels. 

These and other changes place dangerous levels of stress on your heart. And what’s worse, you may not even know it until serious damage has already happened. So it’s not surprising that cardiovascular disease is the number one cause of death in people with diabetes.

Wouldn’t it be great if the metabolic changes that harm your heart could be reversed by just keeping blood sugar in range? Studies have shown that it’s not that simple. People who kept their blood sugar under tight control for two or more years did not reduce their risk of dying from a heart attack or stroke, although they did have fewer cardiovascular events. The lesson from more and more studies is that the metabolic changes caused by diabetes are long-lasting. And while blood sugar is known to be the cause of these changes in the first place, reversing high blood sugar alone is not a quick fix.  Blood sugar is just the first step, especially when it comes to heart disease. 

How the Heart Copes With Metabolic Changes 

The heart is a high-performance muscle. It beats approximately 60-100 times every minute of every day for your entire life. Your heart relies heavily on quick sources of energy so it can continue to perform flawlessly day-in and day-out. But diabetes changes several factors that force your heart to adapt. For one thing, diabetes changes the way certain types of fats (called fatty acids) circulate through the blood. This, in turn, causes your heart to rely on fats as an energy source. Overall the heart is forced to work harder causing damaging stress on the muscle walls. 

As your heart responds to the metabolic changes of diabetes, it slowly adapts and grows in abnormal patterns, which can lead to a disease called heart failure. That simply means the heart gradually loses its ability to pump or fill with blood normally because of changes in the heart walls’ shape, size, and strength. Eventually, the heart fails to effectively fill with blood or pump blood to the body. So, it’s important to learn about ways to slow or stop these changes that are altering the function of the heart and taking it down the path to heart failure. This includes lifestyle changes in addition to controlling blood sugar.

Another unique problem with diabetes is that it tends to accelerate the formation of deposits (plaque) that can block the flow of blood in arteries, especially around the heart. The reason?  You guessed it… metabolic changes. And again, studies show that after three-to-six years of careful control over blood sugar, the rate of plaque formation is not reduced, although there is a benefit after 10+ years. It seems that blood vessels develop a “metabolic memory” based on the formation of end-products originally caused by high blood sugar. This is part of the reason people with diabetes are at a higher risk for coronary artery disease even when blood sugar is kept in check.  

How to Improve Heart Health 

So, aside from managing blood sugar what else can you do to help your heart?  What we’re trying to do is “forget” the metabolic memory that puts stress on the heart. Based on what we know about the long-term risk of heart disease in diabetes, here are a few suggestions:

  • Many studies have demonstrated the benefits of weight loss and regular exercise. This is good advice for anyone, but it is especially beneficial for those with diabetes. 
  • Most people with diabetes struggle with high cholesterol. If you are taking medications to control cholesterol, it is important to follow your prescription directions. 
  • Avoid meats and fatty foods that are cooked by browning or searing. Browned foods generate end-products that contribute to the metabolic memory discussed earlier. 
  • Newer medications for controlling blood sugar are showing a benefit in reducing heart disease risk. Ask your doctor if these medications could be an option for you. 

We’ve learned that controlling blood sugar alone may not be enough to protect your heart from long-term risks caused by diabetes. But by understanding these risks you will be better prepared to make truly effective lifestyle changes. The good news is that anything you do to protect your heart will also be of great benefit to your overall health.   

Article written by Dale Park, CSO, Sharecare Reality Lab
Mr. Dale Park co-founded Sharecare Reality Lab in 2011 and serves as its CSO and treasurer.