If you have diabetes, you’re twice as likely to have heart disease or a stroke than someone who does not have diabetes, and to experience these at a younger age, according to the Centers for Disease Control and Prevention (CDC).Adults with diabetes are two to four times more likely to die from heart disease than adults who do not have the condition, says the American Heart Association (AHA).Among people age 65 and older who have diabetes, an estimated 68 percent die from some form of heart disease and 16 percent die of stroke, according to the AHA.Heart disease and stroke are the most common causes of death in adults with diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
This means that if you have type 2 diabetes, managing your condition effectively means paying attention to more than just your blood sugar levels. Managing your diabetes and working to reduce your heart disease risk aren’t separate goals — they’re closely related. And with few exceptions, a healthy choice for your diabetes means a healthy choice for your heart, and vice versa. Here are eight ways to manage your diabetes and improve your heart health, and why experts believe they’re beneficial for both.
1. Get plenty of physical activity.
Exercise has consistently been shown to lower the risk of cardiovascular disease in people with diabetes, notes Micah J. Eimer, MD, a cardiologist at Northwestern Medicine’s Bluhm Cardiovascular Institute in Chicago. Because of this, a primary focus should be on aerobic exercise — like walking, jogging, biking, or swimming, says Dr. Elmer. Aerobic exercise strengthens your heart, which helps it pump more efficiently and improves blood flow throughout your body. Be sure to work with your diabetes healthcare team to plan any exercise. If you’re new to exercise, you should start slow and talk to your doctor before embarking on any physical activity. Eimer also recommends resistance exercises because muscles are a major consumer of glucose (sugar) in the body. “I’m a big believer in the value of resistance training,” says Eimer. Research has shown that the combination of aerobic and resistance exercise may be even more beneficial for people with type 2 diabetes. A review of 53 studies published in March 2017 in BMJ Open Sport and Exercise Medicine concluded that while both aerobic exercise and resistance training lead to improvements in blood sugar regulation, exercise regimens that include both forms of workouts may be more effective than either type of exercise alone. The American Diabetes Association (ADA) notes that physical activity sensitizes your body’s cells to insulin, helping them use the hormone to take up glucose more efficiently. The ADA recommends a mix of cardiovascular and resistance exercise — ideally, every day — for people with type 2 diabetes. It also emphasizes the need to minimize sedentary time and to break up long periods of sitting with short bursts of activity. If you’re unsure how much of various activities you should be getting, your doctor may suggest meeting with a personal trainer, or you may benefit by seeing an exercise physiologist who can write you a “prescription” for an activity program, says Ann Feldman, MS, RD, a nutrition and diabetes educator at the Joslin Diabetes Center in Boston. Specifically, you should limit saturated fat — found in meat, dairy products, and some tropical oils — since it can elevate levels of unhealthy LDL cholesterol in your blood, leading to the buildup of fatty deposits called plaque in your arteries. You should also avoid refined carbohydrates, including the refined sugars and processed grains found in many snack foods and desserts — “everything that you want to eat,” Eimer laments. These foods, he says, can raise blood sugar levels more quickly and are associated with higher rates of heart disease. As far as what you should be eating, Eimer says that “when people ask me to describe in a word what they should do, I say, ‘Mediterranean diet’” — that is, a diet based on whole grains, legumes (peas, beans, and lentils), fish, lean meats and poultry, healthy fats from olive oil and nuts, and plenty of fruits and vegetables.
3. Try to maintain a healthy weight
Being overweight or obese is often complicated by metabolic factors that raise both your blood sugar and your heart disease risk — especially if you carry excess fat in certain areas of your body. “If you have a lot of abdominal body fat or visceral body fat, which is [concentrated] around the organs,” says Feldman, “that is correlated with insulin resistance.” But, she says, “if you lose weight, your blood glucose levels can come down. You can see a decrease in your cholesterol and your triglycerides.” Your blood pressure can also come down if you lose weight. Even modest weight loss can help. The CDC notes losing five to 10 percent of your body weight can help improve your blood pressure, cholesterol, and blood sugar levels. Losing weight can be difficult, so your first step should be to avoid gaining any more weight. Eimer prefers to emphasize healthy behaviors rather than the desired result of weight loss. “When I have a patient who is inactive and overweight,” he says, “I try to get them to focus on increasing their activity. That will usually reduce weight.” Even if it doesn’t, though, the person will be healthier overall.
4. Don’t smoke
In addition to potentially raising your blood sugar in the short term, smoking can worsen the effects of diabetes complications, Feldman notes. In general, your doctor can help guide you in your attempts to quit smoking. But if you have trouble quitting, you may be referred for smoking cessation, says Feldman. While the risk of lung cancer is better known, smoking also greatly increases the risk of heart disease by damaging blood vessel walls and increasing the buildup of plaque, according to the CDC.
5. Drink alcohol only in moderation, if at all
While some studies have suggested there may be an association between light or moderate drinking and benefits for the heart, especially from red wine, the AHA notes that no research has proven there’s a definitive link between alcohol consumption and improved heart health. The bottom line: The AHA does not recommend drinking wine or any other form of alcohol in an attempt to gain any possible health benefits, and they note that flavonoids and other antioxidants in red wine that may potentially be good for the heart are also found in other foods such as blueberries and grape juice. So what does this mean for people with type 2 diabetes? The ADA suggests that they drink in moderation if their doctor says it’s okay and their diabetes is well-controlled. Alcohol may interfere with diabetes medications and can cause your blood sugar to rise or fall depending on the content of the drink. The ADA notes that drinking alcohol can lower blood glucose for up to 24 hours, and recommends that people with type 2 diabetes eat a meal or a snack when they drink to prevent blood sugar from getting too low. And they suggest checking your blood sugar more often on the day you drink as well as on the following day to keep track of how alcohol affects your blood sugar.
6. Reduce stress
Stress is known to raise blood sugar, Feldman says, which many people find out firsthand when doing routine checks throughout the day. And during times of stress, it can be harder to deal with the daily management of your disease, including controlling blood sugar levels, according to the CDC. When it comes to stress and heart disease, “I think there’s clearly a relationship,” Eimer says, but “I don’t know how we would quantify it, because it’s hard to measure stress.” Exercise is great at reducing stress, and Eimer cites this effect when he recommends activity to patients. But studies have shown that certain techniques, such as biofeedback, meditation, and psychotherapy, may also help reduce stress, so Eimer says that if someone is unable or unwilling to exercise more, these methods may be worth trying.
7. Get plenty of sleep
“Stress and lack of sleep — these are killers,” Feldman emphasizes, adding that if you chronically don’t get enough sleep each night, you’re at higher risk of developing both heart disease and type 2 diabetes. The National Sleep Foundation recommends that adults get between seven and nine hours of sleep every night. There’s some evidence that too little — or too much — sleep could raise your blood sugar if you already have diabetes. A study published in May 2019 in the journal Diabetes Care found that adults with prediabetes or untreated type 2 diabetes who slept less than five hours or more than eight hours per night had higher blood glucose levels than adults who slept between seven and eight hours.
8. Get help for depression
“Depression can make it difficult for a person to maintain a healthy lifestyle and follow recommended treatments” for both diabetes and heart health, Feldman says. “So that’s another thing that should be screened for.” According to the Mayo Clinic, people with diabetes are at increased risk for depression; also, depression may increase a person’s risk of developing type 2 diabetes. Unfortunately, Feldman says, many people are reluctant to report signs of depression because they feel that they’re admitting weakness. “The stigma associated with going to behavioral health [treatment] should be lifted,” she adds. “And physicians should freely refer patients to behavioral health if they feel that the patients need it.” If needed, try working with your doctor to help you find providers in your insurance network. Additional reporting by Katherine Lee
