Ask a DCES: What’s the Connection Between Heart Disease and Type 2 Diabetes?


Do you ever wish you could ask a diabetes care and education specialist (DCES) anything about type 2 diabetes? In our new monthly Ask a DCES column, you can get your most burning questions answered by a DCES professional—in Canada, the equivalent is a certified diabetes educator—on various topics, including diet, medication, exercise, and mental health. Want to submit a question to us? Email us at!

Dear DCES:  What is the risk of me getting heart disease if I have diabetes? How are they related?

Dear Reader:

It’s so good to hear that you are thinking about this! Many people with diabetes are surprised to hear there is a connection between diabetes and the heart and blood vessels. People with diabetes have an increased risk of heart (cardio) and blood vessel (vascular) conditions, especially if their blood glucose (sugar) frequently stays above the recommended range, which for most people is 4.0–7.0 mmol/L72–126 mg/dL. The reason for this is that high blood glucose levels damage the inner linings of both big and small blood vessels. This leads to a build-up of a fatty, waxy substance called plaque inside the blood vessels.  Over time, the plaque hardens and makes your blood vessels stiff, which keeps the blood from delivering enough oxygen.  The hard plaque can also break off and cause a blood clot that blocks normal blood flow.

So, when it comes to treating diabetes, keeping your blood vessels healthy is important. Your diabetes care team can work with you to understand all the prevention tools available, which generally fall into two categories: lifestyle and medication.

Read on as we explore in more detail the lifestyle factors and medications you need to know about to lower your risk for cardiovascular conditions. The information has been organized into seven self-care behaviors you can use to lower your risk.

Healthy Coping and Cardiovascular Disease

The Connection

Diabetes places extra demands on your focus and time. This may cause more stress. Constant stress over a long period of time can contribute to long-term problems for the heart and blood vessels. The substances your body makes in response to stress, called stress hormones, can lead to increases in your glucose, heart rate and blood pressure. How you respond to stress can also affect cholesterol levels. This long-term ongoing stress can increase the risk for high blood pressure, heart attack, or stroke. Therefore, it’s important to find ways to cope with and reduce stress.

Practical Tips to Stay Healthy

When drinking alcohol, drink in moderation which is defined as no more than one drink per day for women and two drinks per day for men. Frequent or excessive alcohol intake is associated with increased rates of high blood pressure, obesity and stroke; but the incidence of heart disease with moderate alcohol intake is low.

Yoga and regular meditation can mitigate heart disease and other health risks. There are apps you can download to guide you through a meditation session.

Find your support network. There are several online peer support groups you can tap into where others with the same challenges in managing diabetes help each other. You can learn more about peer support resources at

Questions to Ask Your Health Care Team

What suggestions do you have for helping me lower my stress?
Do you think I need a referral to a mental health professional?

Healthy Eating and Cardiovascular Disease

The Connection

What you eat can affect your levels of blood glucose, blood pressure and cholesterol.  When these levels are higher than recommended, this puts you at a greater risk of developing cardiovascular disease. Eating what is referred to as a “heart-healthy eating pattern” is an important tool in your toolbox to lower your risk.

Practical tips to stay healthy

When deciding what foods and eating patterns to recommend, your diabetes care team follows the scientific evidence. Lots of research has been done to identify what has the best results for people living with diabetes and related conditions. There are some overall recommendations for everyone with diabetes listed below. Of course, you might be wondering what YOU can eat. A registered dietitian nutritionist is specially trained to help you answer that based on your age, diabetes type, medications, cholesterol levels and health conditions.  Ask your provider to refer you if one is available in your area.

Some of the general recommendations include:

  • Adopt an eating pattern that keeps blood glucose in balance, such as eating fewer carbohydrates like starchy vegetables (corn and peas, for example), bread and rice.
  • Eat less than one teaspoon of salt per day.  This is because salt causes the body to hold onto water. This increases the volume of blood in the bloodstream. Increased blood volume means more work for the heart and more pressure on blood vessels.
  • Eat 8–10 servings of fruits and vegetables per day.
  • Eat 2–3 servings of low-fat dairy products per day.
  • Eat a reduced amount of saturated fat and trans fat, like those found in fried or processed foods.
  • Eat fatty fish like salmon, tuna, sardines, mackerel and trout once or twice a week.
  • Eat more fiber such as in oats, legumes (such as beans, nuts and peas) and citrus (such as oranges, grapefruit, lemons and limes)

Questions to Ask Your Health Care Team

  • How does my current eating pattern compare to what is recommended for ideal heart health?
  • There are so many changes I need to make; where do I start?

Physical activity and cardiovascular disease

The connection

Physical activity is a general term that includes all movement that increases the amount of energy your body uses. That could include walking, dancing, stretching or even gardening. Exercise is a more specific form of physical activity that is structured and designed to make you more physically fit. Both are important. Exercise has been shown to improve blood glucose management, reduce cardiovascular risk factors, contribute to weight loss and improve well-being.

Practical tips to stay healthy

You can lower blood glucose levels by decreasing your overall amount of time sitting.  If you have to sit for long periods of time, try doing an activity every 30 minutes such as briefly standing, walking, or performing other light physical activities.

The optimal schedule to aim for is:

  • 150 minutes of physical activity spread out over at least 3 days per week.
  • No more than two consecutive days without exercise.
  • Resistance training twice per week. This is any form of exercise where you lift or pull against resistance, including working out with dumbbells, resistance bands, water bottles or body weight.

The most important action is to just get started.  Do something you enjoy and track your progress.

Questions to ask your health care team

  • Knowing my medical condition and problems, how should I increase my activity?
  • Is there anything I need to change with my diabetes medication when I become more active?

Medications that prevent or treat cardiovascular disease

The connection

Taking medications to lower blood glucose, blood pressure and cholesterol may be necessary for addition to lifestyle changes to lower your risk of cardiovascular disease. The good news is that some of the medications prescribed to lower blood glucose have been proven to have other positive effects that lower your risk of cardiovascular disease.

Practical tips to stay healthy

Medications work together with a healthy lifestyle, so it’s important to do both.

Here is a summary of the common medications you may be prescribed to lower your risk:

  • Statin medications for cholesterol-lowering have been shown to decrease heart attacks and strokes and reduce deaths.
  • Medications called angiotensin-converting enzymes (ACEs) or angiotensin receptor blockers (ARBs) for lowering blood pressure have benefits beyond blood pressure management, including kidney and heart protection. They have been shown to reduce heart attacks and strokes.
  • Aspirin for people over 50 with heart disease risk factors or clogged arteries reduces the risk of developing blood clots.
  • Medications for type 2 diabetes known as SGLT2 inhibitors lower blood glucose, help you lose weight, lower blood pressure, decrease your risk of cardiovascular disease and delay the worsening of kidney disease.
  • Medications for type 2 diabetes known as GLP1 receptor agonists lower blood glucose, help you lose weight and decrease your risk of cardiovascular disease. They are linked to fewer heart problems in people with diabetes who have heart disease.
  • A prescription form of purified fish oil that lowers triglycerides has been shown to decrease cardiovascular risk in people who are already on statin medication.

Questions to ask your health care team

  • Am I on the best medication plan for lowering my heart disease risk?
  • Are there any supplements I should take that would help and be safe or that I am taking and should stop?
  • What medication side effects should I report?

Monitoring and cardiovascular disease

The connection

Monitoring your glucose, blood pressure, cholesterol levels and other important indicators allow you to know where your numbers are compared to the levels recommended to reduce cardiovascular risk. This is important because high levels of blood glucose, blood pressure and cholesterol often do not cause any noticeable symptoms or may be confused with symptoms of unrelated conditions.

Practical tips to stay healthy

With more health care offices offering remote monitoring and telehealth visits, you play more of an active role in your health and communication with your health care team. For this form of care to work well, you may need to invest in monitoring equipment, such as a home blood pressure monitor and weight scale.

You need to know the recommended target ranges, how often and what to monitor.

Type of check How often Target range
Glucose using either blood glucose monitoring (BGM) or continuous glucose monitoring (CGM) The best times to monitor are fasting, before meals, 1–2 hours after meals and bedtime. If using a CGM, it’s best to look at 14 days of data to determine trends. 70% of readings between 72–126mg/dL

<3% of readings below 72mg/dL

<1% of readings below 50mg/dL

Blood pressure At every office visit and with any change in medications. At every office visit and with any change in medications.
<140/90 mmHg. If high risk, <130/80 mmHg
Cholesterol levels At least annually. HDL cholesterol > 40mg/dL for men and >50mg/dL for women

LDL cholesterol <100mg/dL

Triglycerides <150mg/dL

A1C Every 3 to 6 months. Less than 7% for most people.
Weight At every office visit and home if possible. Losing 7–10% of your body weight improves your health. That would be 14 to 20 pounds for a person who weighs 200 pounds.

Questions to ask your health care team

  • What are my results for A1C, blood pressure and cholesterol?
  • Is there an app I could use for tracking?
  • How can I find out more about using a continuous glucose monitor?

Reducing risks of cardiovascular disease

The connection

When blood glucose is high, triglycerides and cholesterol levels also tend to be high. This is because, with type 2 diabetes, the body is resistant to the effects of insulin. This insulin resistance not only causes the glucose to be higher but also the fats in the blood. This increases your risk of cardiovascular disease. Therefore, managing your risk is not just managing blood glucose but also blood pressure and cholesterol.

The same lifestyle factors that raise risk in people without diabetes, such as smoking, unhealthy weight and unhealthy teeth and gums, also increase risk in people with diabetes.

Prevention is critical in reducing risks, especially because many of the problems that can arise over time have no signs or symptoms until there is a real problem. You won’t know you have a problem developing unless you get checked. There are several types of checks you can ask your provider to refer you to that will help you stay healthy.

Practical tips to stay healthy

Like diabetes, smoking doubles the risk of heart attack and death. The good news is that one year after stopping smoking, heart disease risk decreases by 50 percent. After five years of not smoking, your risk of stroke is like a non-smoker. It takes 15 years of not smoking for your risk of heart disease to become the same as a non-smoker, so the earlier you can stop, the better.

If you have been told you are overweight, losing weight can lead to improvement in blood glucose levels. That’s because weight loss makes your body more sensitive to the effects of insulin. Weight loss can also lead to lower cholesterol and blood pressure levels.

Did you know that diabetes and the health of your gums and teeth are related? The more excess glucose you have in your bloodstream, the higher the level of glucose in your saliva. The extra glucose then combines with the normal bacteria in your mouth to cause teeth and gum problems. These problems can make diabetes harder to manage and can raise your risk of cardiovascular disease. Therefore, keeping up with your daily oral hygiene and getting regular dental checkups helps manage diabetes.

Get the recommended checks and preventive measures for your health listed below:

Type of check When to get checked
Immunizations Flu shot every year.
Foot exam Completed by your provider or podiatrist (foot doctor) annually.
Dilated eye exam At diagnosis and every one to two years after.
Hearing loss At least annually and when you have symptoms.
Sleep apnea If you have problems with snoring or daytime drowsiness.
Diabetes distress or depression If you are struggling with the demands of managing diabetes, no longer enjoy things you used to, or have a change in appetite or sleep.

Questions to ask your health care team

  • What else should I be paying attention to in making sure I am as healthy as possible?
  • How will I know if all I am doing is helping me?

Problem-solving and cardiovascular disease

The connection

Your diabetes treatment plan should be designed together with your diabetes care team and fit with your individual lifestyle and needs. But sometimes problems arise and diabetes changes. Applying a problem-solving approach will help you find solutions so you can stay on track and continue to lower your risk of cardiovascular disease. The earlier new problems are identified, the more likely for a good outcome.

Practical tips to stay healthy

The problem Possible explanation Possible solution
You have been doing your self-care consistently but you’re no longer able to reach your targets that you know to lower your cardiovascular disease risk. Type 2 diabetes is a progressive disease. You may need more medications to meet your goals over time. This is not a failure on your part, just a normal progression of the disease. Don’t wait too long to make changes or discuss changes with your healthcare team.  Change is a normal part of diabetes care.
You occasionally have symptoms like sweating and weakness. How do you know if these are serious? The symptoms of a heart attack may look like low blood glucose (nausea, sweating, weakness). Symptoms of a stroke spell BE FAST: Balance issues (dizziness), Eyes (vision changes), Face (drooping or severe headache), Arms (weakness, numbness), Speech (trouble speaking, confusion), Time (to call 911). Be in tune with your body and don’t ignore symptoms.

Questions to ask your healthcare team

  • I am finding [insert problem] challenging.  What can I realistically do to make it easier?
  • What changes would you recommend for helping me reach my target goals again?

Now that you know more about the connection between diabetes and cardiovascular disease, actions to take and questions to ask, you are on the way to a healthier you!

Learn more

This content was produced in partnership with the Association of Diabetes Care and Education Specialists (ADCES), a Founding Partner of Beyond Type 2. 

Written By Jodi Lavin-Tompkins, M. Sc. inf., inf. aut., BC-ADM, EAD, Posted , Updated 09/02/23

Jodi Lavin-Tompkins is a North Carolina native and a master’s prepared nurse with over 30 years’ experience in diabetes care. She is currently the director of accreditation/content development at the Association of Diabetes Care & Education Specialists. Jodi’s career has spanned working in academic settings as a nurse practitioner to positions in the pharmaceutical and medical device industries, to managing a diabetes self-management education and support program in a large midwestern health system. She is passionate about making sure people with diabetes have the knowledge and skills they need to manage diabetes to the best of their abilities. To Jodi, diabetes is personal; her mother, father, brother, niece, cousin, aunt and uncle all have diabetes.