October 16, 2026
Typical scene in our OPD. A 58-year-old retired bank officer, diabetic for 12 years. Very disciplined. Tablets on time, glucometer on the bedside table, walks in the park every morning. Last HbA1c, 7.1. His diabetologist was pleased, and so was he.
We suggest an ECG and an echo, and he gives us a polite look. "But my sugar is fine. What does the heart have to do with it?"
A lot, actually. Probably more than anything else.
People tend to worry about the eyes, the kidneys, the feet. Fair enough, those matter. But the thing that takes the most lives in diabetics is heart disease. Controlled sugar helps. It just doesn't finish the job.
We often explain it this way. Diabetes isn't just about sugar in the blood. It's about what that sugar does to the pipes the blood runs through.
Sugar that stays high for years roughens the inside lining of the arteries. A rough lining is sticky. Cholesterol catches on it. Plaque builds up faster than it would in a non-diabetic. And diabetes rarely shows up alone. BP is usually a bit high. Triglycerides too. HDL low. Tummy a bit big. Every one of these adds to the damage. (We wrote about this cluster in our post on metabolic syndrome.)
So it's no surprise that diabetics have two to four times the risk of heart disease. Heart attack and stroke are the top cause of death in people with diabetes. When a diabetic does get a heart attack, it's often worse, with more than one artery blocked.
In India this isn't a small group of people. The ICMR-INDIAB study put the number of diabetics at about 101 million. Another 136 million are prediabetic. Punjab is among the worst-hit states. Honestly, think of your own family. Your father, an uncle, a mother-in-law. Someone is on sugar tablets. Which means someone's heart needs more attention than it's getting.
If you take one thing from this whole article, take this.
Years of diabetes damage the nerves. Everyone knows about the burning feet and the numb toes. What fewer people know is that the nerves that carry pain from the heart can get damaged the same way. So a diabetic can have a heart that's short of blood and feel no chest pain. None.
This is called silent ischemia, or a silent heart attack. It happens far more often in diabetics. It's not rare for us to spot the scar of an old heart attack on a routine echo, and when we ask, the patient has no idea when it happened. Sometimes they remember a bad night of "acidity" a few months back. That was probably it.
So for diabetics, no chest pain does not mean no problem. Look out for the quieter stuff. Getting out of breath on the stairs. Tired all the time, more than usual. Heaviness in the jaw, shoulder, upper back or upper stomach. Sweating, nausea or feeling dizzy out of nowhere. Sugar readings jumping around for no obvious reason.
If something new like this shows up, call your doctor. If it comes on suddenly, with sweating or breathlessness, it's an emergency. Don't sit at home waiting for it to pass. And don't drive yourself.
It's not one magic test. It's keeping four or five numbers in check, not just sugar.
Rough targets for most adults with diabetes look like this. Your doctor might set different ones based on your age and history, so take these as a starting point:
Cholesterol is where we catch most people out. Their report says LDL 110, printed as "normal" by the lab, so they relax. But that normal range is for the general public. For a diabetic heart it's too high. (More on that in our post on cholesterol and your heart.)
As for tests, an ECG and a lipid profile once a year is the bare minimum. Add kidney tests (creatinine and urine albumin), because damaged kidneys and damaged hearts usually travel together. If you've had diabetes for many years or have other risks, your cardiologist might add an echo, a treadmill test or a CT calcium score. The point is to find trouble early, while it's still small.
Nothing fancy here. Just ordinary things, done every day, for years. That's the hard part.
Walk, ideally 20 to 30 minutes after a meal. A post-dinner walk brings down the sugar spike better than most people expect. Eat more vegetables, dal and whole grains. Less sugar, less refined flour, less fried stuff. Keep an eye on the sugar people forget about: four cups of sweet tea a day, biscuits with each cup, packaged "fruit" juice, and those "sugar-free" mithai that are still loaded with ghee. Keep the waist in check. Sleep 7 hours. And if you smoke, quitting will help your heart more than nearly any tablet we can write.
Medicines count too. Plenty of diabetics also need BP and cholesterol tablets. Those aren't side extras, they're protecting the heart directly. Some newer diabetes medicines have also shown in big trials that they cut the risk of heart attack, heart failure and kidney damage, not just sugar. Whether they suit you is your doctor's call, but ask about them at your next visit.
Two requests. Don't stop or change medicines yourself because one report looked good. And don't start aspirin or some "heart tablet" because your neighbour takes it. What helps one person can harm another.
Most diabetics in Punjab see a physician or diabetologist regularly. That part is working. What usually doesn't happen is a heart check until something goes wrong. Sugar gets tested every three months. The heart gets tested in the emergency room.
We'd like to change that. At CareBest Hospital, our cardiology team works alongside your diabetes doctor, not against them. A cardiac check-up for a diabetic covers the whole picture: ECG, echo if needed, BP, cholesterol targets, kidney markers, and whether a stress test makes sense. For the basics of how blockages form, see our post on coronary disease. Our older article on diabetes and heart risk has more background.
If your sugar is under control, well done. Genuinely. It takes effort and plenty of people don't manage it. But that's half the work. The other half is your heart.
Diabetic for five years or more? Over 40? BP, cholesterol or a family history of heart trouble as well? And no proper heart check in the last year? Then it's time.
Book a consultation with our cardiology team at CareBest Hospital, Jalandhar. Bring your sugar reports with you and we'll go through everything together.
CareBest Hospital, Jalandhar. Because Every Diabetic Heart Deserves Protecting.