Is it possible to live well with heart failure and type 2 diabetes? Rob Obey says yes, as long as you know about and manage both conditions.

Before I was diagnosed with type 2 diabetes, I knew very little about the condition. I knew that diabetics had to track their sugar intake and some needed medication, but that was the extent of my knowledge.

Then I got incredibly ill. For the life of me, I couldn't work out what was wrong. After trying to manage everything for a couple of days, I called my doctor out of sheer desperation. He listened to what I had to say, then booked me in for some emergency blood tests. Within 48 hours, I had yet another diagnosis: type 2 diabetes and more medication to go along with it. 

I'm happy to say the medication is working. There have also been some positive effects I didn't expect, and I'll come to those later.

But, as you may know, if you've read my other articles, I also live with and manage heart failure. That's what sparked today's article - heart failure and type 2 diabetes. Is there a link? How do I manage both? Did having one make it more likely I'd get the other?

It's a positive maze of questions. Like the avid researcher I am, I spent hours trying to work out all the twists and turns to get to the answers. Let's start with a brief explanation of diabetes.

Type 1 and type 2 diabetes: what's the difference? 

Diabetes is a condition that causes a person's blood sugar to become too high. This is linked to insulin production - a hormone made in the pancreas. Suppose your pancreas doesn't create enough insulin (or any insulin at all). In that case, you will have uncontrolled glucose levels in your blood. 

Unsurprisingly, type 1 and type 2 diabetes have many things in common. Still, people have difficulty telling the difference between the two.

Firstly, type 1 diabetes is much rarer than type 2. Both lead to serious health complications if left unmanaged, but type 1 only accounts for approximately 5% - 10% of diabetes in the US.

Type 1 diabetes happens when your pancreas can't make insulin. Type 2 means that your body can produce insulin, but either not enough or not of a quality to work properly. 

Lifestyle is not a contributing factor to type 1. On the other hand, there are several lifestyle risk factors for type 2 diabetes, such as:

• Your weight - such as being overweight or obese 
• Lack of exercise 
• Where the most of the fat is stored in your body. If you carry a lot of weight in your stomach area, you may be more at risk of type 2 diabetes
• Family history 
• Race and ethnicity 
• Age (especially 45+) 
• Pregnancy 

Type 2 diabetes is chiefly managed with diet, exercise, and medication.

The relationship between diabetes and heart conditions

Some time ago, I read that people with diabetes were at risk of developing heart disease.

I'm a little bit unusual in the sense that I had heart failure before I was diagnosed with type 2 diabetes. 

Most likely, my diabetes was caused by a poor diet, lack of exercise, and being morbidly obese. Unlike type 1 diabetes, the symptoms of type 2 are more general and gradual. It's possible to live with type 2 diabetes for years without knowing you have it - until you become ill, the same way I did. 

I'm not qualified to give a medical explanation for the relationship between diabetes and heart conditions. Instead, I've taken this from Medical News Today:

High sugar levels in the blood of people with uncontrolled diabetes can damage blood vessels over time. It can also damage nerves throughout the body, including those that control the heart and blood vessels.

Some studies suggest high blood sugar may increase inflammation in the blood vessels and disrupt normal blood flow in the heart. Long-term inflammation in the arteries results in a buildup of cholesterol and plaque. This means that the heart has to work harder to pump blood.

The longer a person has uncontrolled diabetes, the higher their risk of heart disease. Managing blood sugar levels reduces a person’s risk of complications.

“Diabetes and Heart Disease: What is the Connection?” Medical News Today

As I said before, many people live with undiagnosed diabetes. If left unchecked, diabetes can lead to heart complications such as heart failure. Is it possible that my heart condition was caused by uncontrolled diabetes? 

Recognizing the symptoms of type 2 diabetes when you have heart failure

The signs of type 2 diabetes are easy to miss and even easier to explain away. Unfortunately, these symptoms tend to creep up on you, so burying your head in the sand won't change the situation.

Here are some symptoms of type 2 diabetes to watch out for: 

• An urge to go to the toilet a lot, especially at night 
• Unquenchable thirst, no matter how much you drink 
• Feeling exhausted, no matter how much sleep you get 
• Losing weight without dieting 
• Getting itchy "down there" or developing thrush 
• Cuts and wounds taking longer to heal or not healing at all
• Eyesight becoming blurred 
• Increased hunger 

I started to suspect something when I caught myself drinking glass after glass of water and still wanting more. My mouth felt like sandpaper whenever I talked. Due to my heart failure, I'd been told not to drink more than 1.5 liters of fluid a day - but the thirst was driving me mad! I drank over 5 liters of water daily at the peak of it all and still ached for more.

My drinking water habits had a knock-on effect on my toilet schedule. I would wake up 2 or 3 times a night to use the bathroom. This getting up and wandering about also affected my daily routine. I was tired throughout the day, even though I fought to keep the same sleeping pattern I'd always had.

As I’m a full-time family caregiver, feeling tired and stressed all the time isn't ideal. Some days, I needed to return to bed and get the shut-eye I needed. When I managed to stay awake, I rushed to the toilet every 20 minutes. This made leaving the house almost impossible, as I wanted to avoid getting caught short.

Two more symptoms were also getting harder and harder to handle. I was plagued by a constant stomach ache that wouldn't shift. I felt light-headed whenever I stood up too quickly or moved my head.

The light-headedness didn't worry me too much, as I'd had it before as a side-effect of my heart failure medication. But the stomach ache was becoming too much to bear. 

All too soon, another complication rose to the surface. Known as peripheral neuropathy, the best way to describe it is losing sensation in your extremities - especially your hands and feet. 

This wasn't painful, but it made day-to-day activities dangerous. Pain may be a burden, but it's the best warning sign for when to stop doing something. Using knives, holding hot drinks, and lifting pans are risky when you can't feel them. Just because something doesn't hurt, it can do untold damage to your body. A knife slip can lead to a bad cut, which, with my healing issues, can easily become infected. 

Having no sensation in your feet and toes can also affect your balance. I often stubbed my toe on the furniture or scraped myself on the walls.

I had no idea how much I needed to look after my feet until I met with my podiatrist. She gave me a pedicure and a very graphic leaflet about the risk of amputation if I unwittingly hurt my foot. 

See, diabetes (both types) can lead to nerve damage and poor circulation. This means that minor cuts and scrapes on the feet can get infected and become ulcers.

Ulcers are open sores that can lead to a breakdown of skin and other tissues. If the ulcer is left untreated (or unnoticed), the tissue and skin around it can "die off" (gangrene), which may lead to amputation. 

Trust me, I'm now very, very careful when it comes to my feet!

How are type 2 diabetes symptoms connected to heart failure?

First of all, some diabetes symptoms overlap with heart failure. The main one is tiredness or fatigue.

It’s no secret that heart failure affects how blood is pumped around your body. When your circulation is affected, can make diabetes symptoms much worse. If your extremities aren't getting the blood they need, this can lead to peripheral neuropathy. As I've said above, peripheral neuropathy leads to numbness or loss of sensation, leading to unnoticed cuts and scrapes. Which, in turn, can cause wounds to become infected and all the complications that arise with that.

The high blood sugar levels tied with diabetes can also cause damage to blood vessels to and from your heart. The sugar sticks to your red blood cells, causing build-up and blockages. With a severe enough blockage, the heart becomes starved of the oxygen it needs and essential nutrients.

In short, both feed into one another, forming a toxic relationship.

Managing diabetes when you have heart failure

Whether your condition is controlled by diet, medication, or both, there are things you can do to help yourself.

As mentioned, one of the first and most common symptoms of diabetes is thirst. As a heart failure patient, you may need to track and/or curb your fluid intake.

A great tip is to suck an ice pop or ice cube. Either can quench the thirst without overloading you with fluid.

Of course, you should eat healthy food regardless, especially with diabetes. No matter how much you crave sugar, you must make a concerted effort to reduce your intake.

As hard as it is when you have heart failure, exercise is beneficial in so many ways. The main two are increased circulation and weight loss.

If you smoke, now would be a good time to stop. Work with your healthcare team to learn the best ways to manage diabetes.

This leads me nicely to some unexpected benefits of diabetes.

Glass half-full: some unexpected benefits of diabetes

Diabetes is a tough condition to manage – especially as it never goes away. It’s always at the forefront of my mind, and hours go into researching and monitoring both my conditions.

So, I don’t mean to sound flippant, and it’s not my intention to offend anyone. These are some benefits I found among the mess, and that’s not to say everyone will have them or feel the same way.

But, before I received my type 2 diabetes diagnosis, I lost two stones without trying. Although I was panicking, losing this weight helped my heart health. Carrying extra weight was putting strain on my heart, so the loss was a blessing in terrible circumstances.

Secondly, I no longer want or even like sweet food. I haven’t eaten chocolate since I was diagnosed, and I don’t miss it at all. I also used to love spicy food and ate it in unhealthy amounts. Again, my tastes have changed. I miss spicy foods, but avoiding them can only improve my health.

Finally, and this is massive, the medical monitoring I've received since being diagnosed has been second to none.

Because I'm classed as stable on my heart failure medication, I'm pretty much left alone.

Now, I'm constantly monitored. One mention of diabetes and I'm a priority.

Within weeks, I saw two nurses, a doctor, and a podiatrist. Then, they all made follow-up appointments.

Let's hope this level of care continues.

The takeaway

If you have any common symptoms of diabetes, don’t delay getting checked out. Some days (like hot ones), it's natural to feel thirstier than usual. However, if you have a dry mouth and the thirst is unquenchable, check it out with your doctor. Remember, the sooner you get checked, the quicker you and your health team can exercise some damage control.

Keep in mind that diabetes can often imitate other conditions or vice versa. Stay alert, and don't ignore symptoms even if you're used to having them. With diabetes, you may notice other symptoms on top of what you managed before. Can a loss of sensation in your hands and feet be explained away by another condition? Or should you get yourself checked? I suggest the latter option.

If you are diagnosed, absolutely follow any advice you are given. Unbalanced blood sugar levels can play havoc with your body and may cause damage to your heart.

Pay very close attention to your feet. Any cut, swelling, infection, or bruising should be checked by a doctor within 24 hours. There is too much risk to ignore even the most minor of injuries. It's always better to be safe than sorry.

The good news is diabetes is treatable. For me, medication and lifestyle changes brought the condition under control quite quickly. It’s difficult to tackle diabetes and heart failure together. Still, I’d rather put in the effort than face any nastier – or fatal – consequences.

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content in and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen. 

NPS-ALL-NP-01148 NOVEMBER 2023