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Diabetes is a complex illness affecting millions worldwide, and the long-term consequences therefrom on the human body systems are numerous, including the cardiovascular system. One of the most significant aspects of diabetic care is the identification of precursory warning of heart disease. Many manifestations of cardiovascular disease overlap with complications of diabetes and are, therefore easily overlooked.

Dr Ravinder Singh Rao, an interventional structural cardiologist, says that warnings of heart disease are mistaken for just an extension of blood sugar control problems.

“It may delay the proper diagnosis and treatment, hence dangerous to bring about severe cardiovascular conditions like heart attacks and strokes. Diabetic patients will, therefore, need to recognise how to distinguish symptoms of high blood sugar from possible problems in the heart,” he says.

There has been an evident link between chronic diabetes and severe heart diseases, which can have a life-threatening impact on an individual’s health. Dr Rao explains that high blood sugar levels cause both blood vessels and nerve damage and can even make an individual develop several conditions including atherosclerosis (the constriction of the arteries) and coronary artery disease.

Such conditions make diabetes patients more prone to attacks from heart failure and other forms of cardiovascular diseases. It is observed that there is a significant indication that heart disease remains the leading cause of death in diabetes. Another challenge in the overlap includes symptoms which closely resemble each other between high blood sugar and heart disease, which implies that treatment and diagnosis might be hindered.

Chest pain is one of the classic symptoms of heart disease but may be very non-specific in diabetics. “Diabetic patients might be subjected to chest discomfort due to uncontrolled blood sugar levels, which is referred to as diabetic angina. High blood sugar may also make patients susceptible to acid reflux or gastrointestinal disorders that may cause chest discomfort and can behave just like those usual pains caused by heart disease,” Dr Rao says.

This makes it difficult for patients to understand what the situation is, making them less likely to rush to see a doctor. Additionally, Dr Rao points out that unregulated blood sugar may also destroy the heart's pain-sensitive nerves, resulting in fewer or no common chest pain experienced during heart attacks in diabetic neuropathy.

“This is called a "silent" heart attack, which typically occurs in the context of long-term diabetes,” he says.

Weakness and Fatigue

Another symptom common to the two diseases is fatigue. Dr Rao explains that in diabetes, excessive blood glucose makes a person feel lethargic and weak. Heart disease, particularly heart failure, makes people too exhausted since the heart cannot pump enough oxygenated blood throughout the body.

Fatigue is one simple consequence of diabetes, but, when associated with shortness of breath or swelling in the legs, people may hint at heart disease.

The most significant risk of an incorrect diagnosis of heart symptoms in diabetic patients is delayed treatment. “Mistaking the cause for an issue related to blood sugar or complications due to diabetes, when a heart attack or cardiovascular event takes place, can delay patients getting medical interventions like aspirin, clot-busting drugs, or angioplasty-all of which are lifesaving during a heart attack,” says Dr Rao.

In addition, Dr Rao says, patients with diabetes may not present symptoms of heart disease as clearly because of nerve damage and other complications. “For instance, diabetic neuropathy may dull pain sensations such that a patient may not realise a heart attack until the moment it occurs when there is no more chest pain, which is the hallmark symptom of a heart attack in many people,” he explains. Thus, diabetic patients may not realise the severity of their heart problems until it is too late.

With diabetes, the symptoms of heart disease may be indistinguishable from those caused by blood sugar. Therefore, in the case of wrongly diagnosing heart-related problems as complications of diabetes, a patient might be delayed from starting his treatment, putting them at more risk.

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