Dr. Sherita Hill Golden has nearly 25 years of experience specializing in endocrinology, diabetes and metabolism as well as internal medicine. She currently serves as a professor of endocrinology, diabetes, and metabolism at the John Hopkins University School of Medicine and she is vice president and Chief Diversity Officer for Johns Hopkins Medicine.
Know Diabetes by Heart is a joint initiative brought to you by the American Heart Association and the American Diabetes Association. Its purpose is to reduce cardiovascular deaths, heart attacks, heart failure and stroke in people living with type 2 diabetes.
WHAT IS THE LINK BETWEEN TYPE 2 DIABETES AND HEART DISEASE?
People living with diabetes are two times more likely to develop and die from heart disease. Yet in a survey of people age 45 and older with type 2 diabetes, only about half have discussed their risk for heart attacks, stroke, heart failure or heart disease with their doctors.
WHAT CAN PEOPLE LIVING WITH TYPE 2 DIABETES DO TO REDUCE THEIR RISK OF HEART DISEASE?
There are many things people living with type 2 diabetes can do to reduce their risk of heart disease, including:
- Talk to their doctor at their next appointment about ways to reduce their risk for heart disease.
- Implement lifestyle changes – including medical nutrition therapy, weight loss and increased physical activity.
- Quit smoking.
- Properly manage stress.
- Monitor and keep track of their blood glucose, blood pressure, cholesterol and body weight as directed by their doctor.
- Take medications as prescribed by their doctor.
- Visit KnowDiabetesbyHeart.org for resources to help continue the conversation with loved ones and doctors.
ARE THE SYMPTOMS SIMILAR FOR TYPE 2 DIABETES AND HEART DISEASE?
Common symptoms of diabetes include frequent urination, feeling very thirsty, feeling very hungry (even though you are eating), extreme fatigue, blurry vision, cuts or bruises that are slow to heal, or tingling, pain or numbness in the hands/feet. However, some people with type 2 have no symptoms at all.
Common heart attack symptoms include chest discomfort, discomfort in other areas of the upper body including the arms, as well as shortness of breath, breaking out in a cold sweat, nausea and light-headedness.
Signs of a stroke include face dropping, weakness in the arm and/or leg and difficulty speaking, such as slurred speech or the inability to respond to a question or repeat a phrase.
WHY ARE SOME POPULATIONS MORE SUSCEPTIBLE TO TYPE 2 DIABETES AND HEART DISEASE? IS TYPE 2 DIABETES OR HEART DISEASE HEREDITARY?
Type 2 diabetes has a stronger link to family history and lineage than type 1 diabetes, and it is also dependent on environmental factors and lifestyle. Some populations are especially vulnerable to diabetes and its complications, including Latinos/Hispanics and African-Americans.
This is due to genetic factors, as well as non-medical issues that can contribute to this problem (such as disparities in income, education and access to healthcare).
Genetic factors can also play a role in developing heart disease, and the risk is heightened when combined with unhealthy habits and behaviors, such as a poor diet and smoking.
IF YOU HAVE A FAMILY HISTORY OF HEART DISEASE OR DIABETES, WHAT CAN YOU DO TO GET AHEAD OF IT AND WHEN SHOULD YOU BE TESTED?
If you’re worried about type 2 diabetes and your heart health (with or without a family history of heart disease), make an appointment to talk with your doctor. This can be an important step to lowering your risk for heart disease, stroke and heart failure as result of type 2 diabetes. Some discussion-starter questions to ask your doctor about diabetes and your heart are:
- What changes can I make to take care of my heart?
- What can I do before my next appointment?
- How will I know if the changes I’ve made are making a difference?
- What resources can help me learn more?
Together, you and your doctor can create a management plan to help you take control of your type 2 diabetes and lower your risk for heart disease.
IS IT TRUE THAT TYPE 2 DIABETES AND HEART DISEASE CAN BE REVERSED?
People with type 2 diabetes who can get their HbA1c below 6% without taking diabetes medication are considered to have “reversed” or “resolved” their diabetes. Before choosing to come off your diabetes medication, it is important to speak with your healthcare professional to determine if this is the best and safest choice for you.
Similarly, some heart disease risk factors can be reversed through medication and lifestyle changes, but your doctor can help decide the best approach for you.
WHEN SHOULD YOU GET TESTED FOR DIABETES AND HEART DISEASE?
If you are experiencing the symptoms of type 2 diabetes or heart disease listed above, schedule an appointment with your doctor to discuss your symptoms and risk level. Only your doctor can tell for sure if you have diabetes or prediabetes, which may not have any noticeable symptoms, so regular appointments are important to your heart health plan.
CAN TYPE 2 DIABETES CAUSE CONGESTIVE HEART FAILURE?
Yes, in fact, people living with diabetes are 2.5 times more likely to develop and die from congestive heart failure than those without type 2 diabetes. This is due to increased risk factors that are common in people with type 2, such as high body mass index (BMI), high blood pressure or history of a heart attack.
WILL A PLANT BASED OR VEGETARIAN DIET HELP WITH PREVENTING THESE DISEASES?
Following a vegetarian diet (or a diet with less meat in general) can help lower cholesterol and blood pressure, and reduce the risk for type 2 diabetes, heart disease and stroke. Research has found that even if you’ve eaten a poor diet for half of your life, adding more healthy plant-based foods as an adult can help reduce your risk for these conditions.
WHAT CAUSES HEART DISEASE IN PEOPLE WITH DIABETES?
Diabetes is associated with a buildup of plaque that can clog arteries, leading to a heart attack, stroke, heart failure or heart disease. People living with type 2 diabetes often have risk factors such as high blood pressure, unhealthy levels of cholesterol, obesity and lack of physical activity, which all contribute to their risk for developing heart disease. The longer you live with type 2 diabetes, the higher your cardiovascular risk.
HOW IS HEART DISEASE TREATED IN THOSE WITH DIABETES?
If you have type 2 diabetes and are concerned about heart disease, schedule an appointment with your doctor to talk about your treatment options. After discussing your health history and risk levels, your doctor can determine the best approach for managing the condition.
WHERE CAN PEOPLE FIND OUT MORE INFORMATION?
People living with type 2 diabetes can make practical, meaningful changes to reduce their risk. Heart attacks, strokes or heart failure are not inevitable. There are simple steps you can take to avoid this heart-breaking complication. If you or a loved one is living with type 2 diabetes, visit KnowDiabetesbyHeart.org to:
- Download a discussion guide with the top four questions for your next appointment with your doctor;
- Sign up to receive the Living with Type 2 Diabetes Program, a free, year-long program, to reduce your risks and receive ongoing support for your personal health journey; and
- Dial in to our ongoing Ask the Experts series, where you can personally talk to various experts about managing your conditions.
Dr. Golden answers your “Text Tom” questions below:
Can fibroids cause / contribute to diabetes?
There isn’t any concrete scientific evidence that shows a direct tie between fibroids and type 2 diabetes. However, there have been studies that show that in some black women with diets that result in higher blood glucose levels there may be a slightly greater risk for uterine fibroids. Similarly, foods with high glycemic index and load are known to increase your risk for diabetes and heart disease.
Is there a new standard to determine if you’re diabetic?
The standard to determine diabetes hasn’t changed. You can learn more about how diabetes is diagnosed at www.diabetes.org/a1c/diagnosis.
If you are concerned about your risk for diabetes, or if you’re exhibiting any symptoms, please visit your doctor to be tested. You can also visit the American Heart Association’s and the American Diabetes Association’s Know Diabetes by Heart website for information to help guide the conversation with your doctor.
What’s new? There’s more emphasis on heart health for people with diabetes, updated guidance on new medicines that can help people with both type 2 diabetes and heart disease, and a spotlight on personalized comprehensive care that includes assessing patients’ motivations, support systems, and mental health.
Can diabetic itching be confined only to your back?
Diabetes can cause localized itching, potentially due to dry skin, poor circulation or yeast infections. To help relieve this itching, limit how often you bathe (especially when humidity is low) and use a mild soap with moisturizer when showering. If you’re still experiencing discomfort, make an appointment with your doctor so they can provide the right treatment plan for you.
I have low cholesterol and I am a diabetic. They said they found some blockage in my arteries and they didn’t put a stent in. So what do I do next?
Diabetes can lead to artery build-up even if you don’t have high cholesterol. I encourage you to speak with your doctor about their treatment decisions (and consider seeking a second opinion, if you still feel unsure) and discuss the best next steps given your medical history.
PHOTO: Dr. Golden courtesy
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