What is the connection between diabetes and heart disease?

If you've been diagnosed with diabetes, you might be wondering about the connection between diabetes and heart disease. In this guide, we've answered some common questions to help you understand how the two are related.

There's no objective answer to that. But the experts we talk with probably would point to our growing understanding of free radicals and the damage they can cause to the bloodstream.

• Ever since the discovery of insulin allowed people with diabetes to live long enough to develop diabetes-related complications, researchers have been trying to tease out the underlying problem that contributes to increased rates of heart disease as well as blood vessel and nerve damage in people with diabetes.
• Now they know that they can blame much of the damage on unstable, highly reactive atoms or groups of atoms called free radicals.
• Everyone has free radicals — they're created as a by-product of many bodily processes, including breathing.
• Because free radicals are missing an electron, they constantly seek to "steal" electrons from normal molecules. When they succeed, they damage the molecules, unleashing a chemical cascade that can harm cells, including those that line arteries and make up nerves.
• Studies now show that the high blood sugar related to diabetes — especially high blood sugar after meals — triggers excess production of free radicals. This helps explain why so many studies find that people who maintain tight blood-sugar control are less likely to develop diabetes-related complications.
• While high blood sugar creates excess free radicals, so do blood-sugar swings (one reason to take regular blood sugar readings and not rely on your A1C score alone).
• Continuous glucose sensors and software that downloads meter readings may both become increasingly important treatment tools to help reduce swings.
• Getting more antioxidants from fresh produce can help prevent the collateral damage often brought on by diabetes.

Cardiovascular disease and diabetes often appear together. It isn't entirely clear how the two diseases affect each other, but some connections are clear enough: If you have diabetes, you're two to four times more likely than the general population to have heart disease.

• Heart attacks ultimately kill 80 percent of people with diabetes. In fact, having diabetes puts you in the same danger zone as a person who has already had a heart attack.
• Heart attack is just one of several problems to watch for when you have cardiovascular disease. Most of them come down to two basic conditions, both of which you can take steps to control.

Cardiovascular is an umbrella term that includes both the heart (the cardio part) and the blood vessels (the vascular part). In a healthy person, a strong heart sends blood through the body via a network of smooth and elastic blood vessels. But problems arise when blood vessels become stiff, narrowed or clogged — a condition known as atherosclerosis.

• Atherosclerosis can occur in a number of ways related to diabetes. High blood sugar can slow blood circulation and promote the formation of clots. Being overweight (especially if you carry fat mostly in the abdomen) and having high levels of blood fats such as cholesterol and triglycerides (common with diabetes) can lead to obstructions in blood vessels.
• Depending on where they occur, these slowdowns in blood flow can trigger problems.

Like diabetes, high blood pressure is a silent condition, and the two diseases often develop in tandem.

• If you have diabetes, you're twice as likely to have high blood pressure as the average person is, and about 60 percent of people with type 2 diabetes have it.
• Controlling high blood pressure is critical if you have diabetes because the damage it causes contributes not only to atherosclerosis but also to kidney and eye disease. All told, it is responsible for 35 to 75 percent of all complications that go along with diabetes.
• You need a certain amount of blood pressure (the force that blood exerts against artery walls) for good circulation. But too much gradually weakens the heart by making it work harder and damages the lining of blood-vessel walls, making it easier for atherosclerosis to set in.
• High blood pressure can also weaken arteries in the brain and cause them to balloon, a condition called a brain aneurysm. The bursting of an aneurysm is potentially fatal.
• According to the Canadian Diabetes Association, you should strive to keep your blood pressure down to at least 130/80 mmHg if you have diabetes — and lower than that is even better.

There's an obvious connection between diabetes and heart disease, as the two often develop simultaneously. Take control of your health by making heart-smart lifestyle changes to reduce your risk.