Jack Griswold has lived with T1D since age six and has a family history of early-age heart attacks. Now 75, his heart health and moderation of his risk factors have been at the forefront of his mind. He takes statins to keep his cholesterol in check, keeps close track of his glucose levels, and stays fit with frequent hiking and mountain biking.  

About 15 years ago, Griswold, who lives in Saratoga, California, began noticing an ache in his shoulders that spread to his elbows during exercise. He knew enough to see a cardiologist right away. 

“This, of course, was pectoral angina,” he said, referring to the chest pain caused by a lack of oxygen-rich blood to the heart. “I am one of the lucky ones,” he added because he felt it worsening. Some people don’t have symptoms at all, leading to a “silent” heart attack — especially those with diabetes-related nerve damage. More on this below.  

With Griswold’s proactive steps, his cardiologist found atherosclerosis (hardening of arteries from a buildup of plaque), resulting in a triple coronary artery bypass graft (CABG) procedure.

Griswold said he now lives with a partial blockage of a small cardiac artery that’s not significant enough for surgery. “It still produces angina, so I have a ‘warning system’ telling me to reduce effort,” he said. “I always have nitro pills (nitroglycerin tablets to treat angina) and glucose tabs with me, and I still hike and mountain bike.”  

 

Diabetes and heart disease, what’s the connection? 

Cardiovascular disease (CVD) is a common diabetes-related complication. It’s also the number one cause of mortality in people with diabetes, stemming mainly from the increased risk of stroke and heart attack. In other words, those with T1D, or any type of diabetes, are more likely to develop heart disease and have risk factors than those who don’t. While the connection between diabetes and heart complications is clear, so are the steps to foster heart health — through nutrition, exercise, and a healthy lifestyle.   

Diana Isaacs, an endocrine pharmacist at Cleveland Clinic, where she is the director of education and training in diabetes technology, explains why diabetes may increase the likelihood of heart problems.

“Having too much glucose in the bloodstream over time can increase inflammation in the blood vessels. This can make it more difficult for blood to flow, which can increase blood clotting, leading to a heart attack or stroke,” she said. “When combined with high blood pressure and high cholesterol, this risk increases even more.” 

A challenging aspect of managing heart health is that there can be few warning signs before things go wrong. “Many times, there will be no symptoms,” Isaacs said, noting that having extremely high blood pressure is one exception. Keeping blood pressure, cholesterol, and glucose levels within target goals will help protect the heart.   

The best way to do this with T1D, Isaacs said, is by meeting time in range (over 70%) and A1C goals. Using an AID system can help to support these glucose goals, she said. 

 

Eating a healthy diet 

Dana Roseman, a dietitian, diabetes care specialist, and director of technology and research at Integrated Diabetes Services, has lived with T1D for three decades. “When I’m caring for people with diabetes, cardiac health is always at the forefront of my mind,” she said, “whether it’s dealing with diet, exercise, or medications.” 

Even though having T1D raises the stakes for heart health, many falsely believe they need different or more aggressive heart care, said Roseman. “A heart-healthy diet is universal,” she said, “so it doesn’t have to be different for folks living with type 1 versus someone who might have a family history of cardiovascular disease or high-risk factors.”  

 

Roseman recommends people with T1D focus on heart-healthy foods, including: 

  • Plant sources of healthy fats (chia and flax seeds, nuts, and avocado) 
  • Omega 3 fatty acids (fatty fish such as salmon and tuna, olive oil, and avocado) 
  • Fiber-rich foods (berries, apples, whole wheat breads, and nuts) 
  • Colorful vegetables (kale, broccoli, spinach, carrots, and beets) 

 

She also recommended reducing inflammatory foods, which include foods with high-sugar content, processed foods, and saturated fats. 

 

Staying active 

“Cardio (exercise) is fuel for health,” Roseman said. “In terms of diabetes management, strength training, and yoga are really important for insulin sensitivity.” 

Isaacs agreed that lifestyle modifications — such as diet, exercise, and stress management — can significantly affect heart and diabetes health. She recommends: 

 

  • Setting a goal of 150 minutes per week of moderate-intensity activity 
  • Eating a diet low in saturated and trans fats 
  • Maintaining a healthy weight 
  • Getting enough sleep 
  • Minimizing stress as much as possible 

 

“Even something as simple as walking 10 minutes, 2-3 times a day, could make a big difference in heart health,” she said. “It can also help a person to maintain muscle mass as they age and make it easier to achieve glucose and blood pressure targets.” 

 

Medications can help 

Statins and other medications may be effective tools to promote heart health. Diabetes drugs such as GLP-1 agonists and SGLT2 inhibitors suggest benefits for weight management, glucose control, and cardiovascular health for type 2 diabetes but have not yet been approved for T1D. Many with T1D who have used these therapies report noticeable benefits. Studies are ongoing.  

“They are often used off-label or can be obtained on-label if being used to treat obesity, kidney disease, or sleep apnea,” Isaacs said. “Hopefully, more data will emerge over time on the specific cardiovascular outcomes in people with T1D.”  

Those with T1D who are curious about these drugs should talk with their healthcare provider, she said. 

 

Parting advice 

“With T1D, we want to be proactive,” Roseman said, speaking both about taking care of herself and her patients. “We want to make sure we’re aware of our health risks and take preventative steps, whether through blood pressure, measuring cholesterol, or looking at the whole health profile. Diabetes care isn’t just about blood glucose. Paying attention to cardiovascular health is part of that, too.” 

Griswold said his key to maintaining a healthy heart has been staying active, enjoying life, and keeping a positive attitude. “Eat healthy foods, get lots of exercise,” he said, “not necessarily running marathons but simply daily walks or bicycling relative to one’s ability is key for keeping your heart healthy.” 

Griswold added that easing one’s mind by finding outlets for relaxation and enjoyment is a less obvious but still crucial component of heart health. This is especially important and all the more challenging given the added stress T1D can bring.  

“Reduce stress!” he exhorted. “It’s a hidden gremlin that seriously messes with one’s blood glucose. Too many folks ruminate over their stressful scenarios. Try not to worry so much.”  

Griswold advises seeking out others with T1D to share tips and experiences. Take action if you need more help from your healthcare team. Find opportunities for ease and joy when possible — your heart will thank you. “The secret is to seek help that you are comfortable and confident with,” he said. “Life is still good, even with T1D. Never give up!”