How Can I Make My Heart Healthier and Control My Sugar Better at the Same Time? 

This article is for people who have type 2 diabetes and are at risk for heart disease, or anyone who wants to learn more about the management of type 2 diabetes. The goal of this patient education activity is to help you understand how to lower your risk for heart disease when you have diabetes.

You will learn about:

• How lowering your blood sugar can make your heart healthier

• Which medicines can help lower blood sugar and make your heart healthier at the same time

• Tips for a heart-healthy lifestyle

• Questions to ask your doctor or healthcare provider

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Diabetes can affect different parts of the body, such as the eyes and kidneys. But did you know it can also affect the heart?

Having diabetes increases the chance (risk) for getting heart disease. This means that a person who has diabetes and heart disease is at higher risk for having a heart attack, stroke, death from heart problems or other developing heart failure, a different kind of heart disease.

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Lowering your blood sugar so that it is at a healthy level (between 80 and 130 mg/dL, fasting and between meals) can lower your risk for heart disease. When you practice a heart-healthy lifestyle and take medicines to lower your blood sugar, you're actually making your heart healthier.

Keeping your blood pressure and cholesterol in healthy ranges can also help lower the risk of heart disease when you have diabetes.

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The good news is, there are 2 kinds of medicines for people with type 2 diabetes that can help make your heart healthier while improving blood sugar. You might even be taking one of them already:

• GLP-1 RAs (glucagon-like peptide-1 receptor agonists): are medicines that work in many parts of the body. They work in the pancreas and liver to lower blood sugar and to keep it at a healthy level, mostly after meals. They also work in the stomach to slow down digestion and in the brain to decrease appetite. GLP-1 RAs come as a shot or pill.

• SGLT2 (sodium-glucose cotransporter-2) inhibitors: are medicines that work in the kidneys to remove extra sugar in the blood through the urine. SGLT2 inhibitors come as pills.

These medicines are very different from each other. Talk to your doctor or healthcare provider to find out your risk for heart disease and which medicine is right for you based on your diabetes goals.

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Taking a GLP-1 RA or SGLT2 inhibitor can help you manage blood sugar levels by:

• Improving hemoglobin A1c* (HbA_1c)

• Keeping blood sugar at a healthy level

• Improving how much insulin your body makes or how it responds to insulin (a hormone that helps the body keep blood sugar at a healthy level)

• Reducing the risk for having blood sugar levels that are too low (hypoglycemia)

Remember, that when your blood sugar stays at a healthy level, your heart gets healthier.

*The average of your blood sugar level over 2-3 months.

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Some GLP-1 RAs and SGLT2 inhibitors also have heart benefits. Just like how they work in different ways to manage blood sugar levels, these medicines also work in different ways to protect your heart.

• Some GLP-1 RAs have been shown to be safe in adults with type 2 diabetes and known heart disease. One example is semaglutide (Rybelsus®).

• There are 3 GLP-1 RAs that are approved by the FDA to reduce the risk of major heart events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.

  o Dulaglutide (Trulicity®)

  o Liraglutide (Victoza®)

  o Semaglutide (Ozempic®)  

GLP-1 RAs should be taken as prescribed by your doctor or healthcare provider along with practicing a heart-healthy lifestyle that includes eating healthy foods and regular activity.

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Some SGLT2 inhibitors have been shown to be safe in adults with type 2 diabetes and known heart disease. One example is ertugliflozin (Steglatro™).

There are several SGLT2 inhibitors that are approved by the FDA, and they each help your heart in different ways:

• Canagliflozin (Invokana®) is approved by the FDA to reduce the risk of major heart events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.

• Empagliflozin (Jardiance®) is approved by the FDA to reduce the risk of death from heart problems in adults with type 2 diabetes and known heart disease.

• Dapagliflozin (Farxiga®) is approved by the FDA to lower the chances of having to go to the hospital for heart failure for adults with type 2 diabetes and known heart disease or who have multiple risk factors for heart disease.

  o In adults with type 2 diabetes and heart failure with decreased heart muscle function, dapagliflozin is approved by the FDA to reduce the risk of death from heart problems and having to go to the hospital for heart failure

SGLT2 inhibitors should be taken as prescribed by your doctor or healthcare provider along with a heart-healthy lifestyle that includes eating healthy foods and regular activity.

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If you take a GLP-1 RA, you may have milder side effects like:

• Stomach issues: nausea, diarrhea, vomiting, constipation, heartburn

• Low blood sugar (if you are taking a GLP-1 RA with certain other diabetes medicines): feeling dizzy, shaky, or like your heart is racing, having blurry vision, feeling confused

• Pain in your abdomen

• Headache

Although it is rare, you should call your doctor or healthcare provider if you have any of these symptoms:

• Severe pain from your abdomen to your back that does not go away, with or without vomiting

• Trouble swallowing or hoarseness in your throat

• Nausea, vomiting, fever, yellowing of the eyes or skin, pain in your abdomen

• Blurry vision, seeing spots

• Feeling dehydrated from vomiting and diarrhea, or not urinating, feeling dizzy or weak, having fast breathing, or a fast heartbeat

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If you take an SGLT2 inhibitor, you may have some milder side effects like:

• An infection in your urinary tract or genitals

• Having to go to the bathroom more often

• Feeling thirsty

• Joint pain

• Stomach issues: constipation or nausea

You should call your doctor or healthcare provider if you have any of these serious symptoms:

• Feeling weak, tired, thirsty, or confused; have fruity-scented breath

• New pain or tenderness, or sores or ulcers in your legs

• Not urinating

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Along with taking your medicines for blood pressure, cholesterol, and diabetes as prescribed, practice these healthy habits to keep your heart healthy and to lower your blood sugar levels:

• Be physically active for least 30 minutes, 3 to 4 times a week

• Choose an eating pattern that includes whole grains, fruits and non-starchy vegetables, high fiber and low in saturated and trans fats

• Drink enough water

• Limit drinking alcohol and sugary drinks

• Quit smoking if you smoke

• Manage stress

• Get 7 to 9 hours of sleep nightly

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• Am I at risk for heart disease since I have diabetes?

• Which medicines can help me lower my blood sugars and protect my heart?

• When should I get emergency help?

• What else can I do to lower my risk for heart disease?

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Congratulations!

You have successfully completed the program: How Can I Make My Heart Healthier and Control My Sugar Better at the Same Time?

View Additional Materials View Additional Materials on this topic that you may find useful.

Centers for Disease Control and Prevention (CDC): Diabetes and Your Heart

Association of Diabetes Care & Education Specialists (ADCES): Living with Diabetes

Association of Diabetes Care & Education Specialists (ADCES): Quick Guides to Help You Manage Your Diabetes

How Can I Make My Heart Healthier and Control My Sugar Better at the Same Time?

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