Link Between Heart Disease & Diabetes
By Sarfraz Zaidi
Thousand Oaks, CA



Heart disease - the number one killer of diabetics?

Believe or not, it’s true. Compared to non-diabetics, patients with diabetes have a six-fold increased risk for a heart attack.

The reason for this increased risk is a phenomenon called Insulin Resistance, the root cause for Type 2 diabetes, as well as heart attacks and strokes. That’s why now we treat diabetes by treating insulin resistance.


Insulin resistance 

Insulin is a chemical produced by the pancreas in our body. One of the main functions of insulin is to drive glucose from the blood into the cells, especially muscle cells, where it is used as a fuel to produce energy.

Think of insulin as the doorman who opens the door for glucose to get into the cell. In individuals prone to Type 2 diabetes, the hinges on the door of the cell are rusty. Consequently, insulin cannot easily open the doors.  Now instead of one doorman, you need three or four doormen to pry the door open. This is called insulin resistance.

In response to insulin resistance, the pancreas produces more and more insulin, which keeps blood sugar normal for some time. The large amount of insulin is called Hyperinsulinemia. If insulin resistance is not treated, the pancreas eventually becomes exhausted and insulin production starts to drop. This causes blood sugar to start rising and eventually, a person becomes diabetic.

It takes about one to two decades, yes, 10 to 20 years, of insulin resistance before a person becomes diabetic. During this time, insulin resistance and hyperinsulinemia causes many other changes in our body which are quite harmful.


Heart attack and stroke

For example, insulin resistance increases serum triglycerides (the fat in the blood), lowers HDL cholesterol (the good cholesterol) and changes LDL cholesterol (the bad cholesterol) from type A (less dangerous) to Type B (more dangerous). Hyperinsulinemia increases blood pressure and causes narrowing of the blood vessels in these patients.

In addition, Insulin resistance makes it easier for blood to clot and impairs our body’s natural ability to break down any clots. 

All of these abnormalities set the stage for a heart attack and stroke.


Treating diabetes

Doctors involved in research for treatment of diabetes eventually realized that to effectively treat Type 2 diabetics, insulin resistance must be treated.

That’s why today’s treatment for diabetes includes medications which treat insulin resistance at the three levels - the liver, muscle and fat.

Besides controlling blood glucose, these specific diabetes medications also increases HDL cholesterol and re-establish the body’s ability to break clots and, therefore, reduce the risk for heart attack and stroke.

By reducing insulin resistance, these medications reduce the burden of excessive insulin production by the pancreas. Relieved of the stress of overproduction of insulin, the pancreas begins to work efficiently once again. As a result, patients usually do not have to resort to insulin injections.


Eating right

Diet is an extremely important and often misunderstood part of diabetic treatment. Patients with Type 2 diabetes on oral medications need to eat only three small meals a day.

No snacks. Reduce the amount of bread, pasta and rice. Avoid cereals, donuts, muffins, croissants and other bakery products. Say no to desserts and pizza. Don’t drink sodas or juices as they are loaded with sugar.

Fruits are good and bad for us. They provide us with vitamins, but are loaded with natural sugar. Therefore, eat no more than one to two fresh fruits a day. Choose fruits such as apples, blueberries, strawberries, plums, apricots, and peaches. Avoid fruits such as bananas, grapes and mangoes. Take a daily multivitamin to keep your vitamins optimized.


An exercise plan

Daily exercise is crucial to the proper management of diabetes. Aerobic exercise for about 30 minutes a day reduces insulin resistance and blood sugar starts decreasing. Start exercise slowly by walking for about 10 minutes. Gradually increase to brisk walking for about 30 minutes a day. Before embarking on any exercise plan, discuss it with your physician.


Manage your stress

Stress worsens your insulin resistance through the mind-body connection. Next time you are getting upset, frustrated or scared, remember you are worsening your insulin resistance and diabetes. You can reduce your stress level by simply letting go and living in the present moment.

For details on diet, exercise, stress management, vitamins and medications, refer to Dr. Zaidi’s book, “Take Charge of Your Diabetes.”

For details on diet, exercise, stress management, vitamins and medications, refer to Dr. Zaidi’s book Take Charge of Your Diabetes which can be bought at the major book stores, or Dr.Zaidi’s website,

Dr.Zaidi is a Clinical Assistant Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.



Editor: Akhtar M. Faruqui
2004 . All Rights Reserved.