If you’re living with diabetes – or supporting someone who is – you might already know how important it is to keep blood sugar under control. But did you know that diabetes also increases your risk of heart disease and stroke?
In fact, people with diabetes are up to twice as likely to develop cardiovascular disease (CVD) – the leading cause of death in people with diabetes.
❓ Cardiovascular disease (CVD): a group of conditions affecting the heart and blood vessels, including heart attacks, stroke, angina and heart failure.
But there’s good news: the risk can be lowered significantly through lifestyle changes, regular checks, and the right support. This guide explains the science behind the link, how to reduce your risk, and the steps you can take today.
What’s the link between diabetes and heart disease?
High blood sugar can damage your blood vessels over time – and that can lead to serious problems.
Why this happens:
- High glucose levels damage the inner lining of your arteries (endothelium), making them more prone to atherosclerosis – a process where fatty deposits (plaques) build up and narrow the arteries.
❓ Atherosclerosis: fatty deposits form inside arteries, narrowing them and restricting blood flow, which can lead to heart attacks or strokes.
- Diabetes is also linked to high blood pressure, raised triglycerides, low HDL (“good”) cholesterol, and inflammation – all key drivers of cardiovascular disease.
❓ Inflammation: the body’s natural response to stress or injury; long-term inflammation can damage blood vessels and raise CVD risk.
According to Diabetes UK, people with diabetes are more likely to have high blood pressure and dyslipidaemia (abnormal fat metabolism, including cholesterol and triglycerides), both of which contribute to a higher risk of heart attack and stroke.
Understanding the science: Pathophysiology made simple
- In type 2 diabetes, the body becomes resistant to insulin. This causes blood glucose to rise, and the pancreas must work harder to produce insulin.
❓ Insulin resistance: when your cells stop responding properly to insulin, causing higher blood sugar levels.
- Chronically high glucose increases oxidative stress and inflammation, damaging the blood vessels.
❓ Oxidative stress: an imbalance between free radicals and the body’s ability to neutralise them – this damages cells and tissues.
- At the same time, insulin resistance often leads to abnormal fat metabolism, raising LDL and triglycerides while lowering HDL cholesterol – this is called diabetic dyslipidaemia.
- These changes can silently progress for years, increasing the risk of heart attack, stroke, and peripheral arterial disease.
People with diabetes often have a group of risk factors known as metabolic syndrome: a cluster of conditions including high blood pressure, high triglycerides, low HDL, abdominal obesity, and insulin resistance – a perfect storm for heart disease.
NICE CVD risk assessment guidelines recommend assessing cardiovascular risk early in adults with type 2 diabetes because of this close relationship.
What do cholesterol and lipid profiles mean?
When your doctor checks your cholesterol, they’re usually testing your lipid profile – a blood test that checks levels of cholesterol and other fats in the blood – used to assess heart disease risk.
- LDL cholesterol (“bad”): builds up in artery walls, increasing risk of plaque and narrowing. Target level: below 2mmol/l.
- HDL cholesterol (“good”): helps remove excess cholesterol and protect against heart disease.
- Triglycerides: another form of fat in the blood; high levels increase risk of heart disease.
- Total cholesterol: includes LDL, HDL and other fats. Target level: below 4 mmol/l.
- Sometimes doctors may refer to your Non-HDL cholesterol (Total cholesterol minus HDL), which includes all the “bad” types such as LDL and other “bad” fats like VLDL (very low density lipoprotein) and is often used as a treatment target in the UK. Target level: less than 2.5 mmol/l.
People with diabetes often show the particular pattern known as diabetic dyslipidaemia:
- Low HDL
- High triglycerides
- Small dense LDL particles – more likely to enter the artery wall
This pattern is a key driver of atherosclerosis and is often not reflected by total cholesterol alone, which is why full lipid panels are important.
UK guidelines: Managing cardiovascular risk in diabetes
NICE and NHS guidelines recommend the following:
- QRISK®3 tool: a UK tool used by GPs to estimate your risk of heart attack or stroke over the next 10 years, if you uhave type 2 diabetes and are aged 25-84. You can check with your GP if you risk has been calculated and what it means for you.
- If your risk is 10% or above, a statin (usually atorvastatin 20 mg) is advised to reduce risk – even if your cholesterol is not high.
❓ Statins: medications that lower cholesterol by reducing how much is made in the liver.
- For secondary prevention (people with existing CVD), higher doses like atorvastatin 80 mg may be prescribed.
- The goal is a non-HDL cholesterol level <2.5 mmol/L
In some cases, clinicians may use other lipid levels to guide your treatment. Discuss with your clinician what measures are being looked at, and why, to understand your personal treatment goals.
NICE does not recommend specific targets for HDL or triglycerides but advises action if triglycerides are persistently above 10 mmol/L (may require fasting sample and further investigation).
- Blood pressure should be kept below 140/80 mmHg (or 130/80 mmHg if there’s kidney or eye damage).
❓ Hypertension: the medical term for high blood pressure – a major CVD risk.
- Lifestyle measures should be offered to everyone with diabetes – whether newly diagnosed or not.
See full NICE guidance on lipid modification (NG238).
🧪 Monitoring
Lipid profiles should be:
- Measured at diagnosis of type 2 diabetes
- Reviewed annually as part of diabetes care
- Repeated 3 months after starting or changing statin therapy
The goal is not just to hit targets but to reduce overall cardiovascular risk using a combination of lifestyle support, medication, and monitoring.
Lifestyle measures that make a difference
Taking medication may be important, but lifestyle changes are just as powerful. According to the NHS and Diabetes UK, they can cut cardiovascular risk by up to 80% in some people.
Here’s what you can do:
1. Eat the right fats for heart and blood sugar health
Fat is an important part of your diet. It gives you energy, helps your body absorb vitamins, and supports hormones. But the type of fat you eat matters – especially if you have diabetes or are at risk of heart disease.
🟢 Healthy fats (Unsaturated fats)
Unsaturated fats are good for your heart and blood sugar. They can:
✔ Lower bad (LDL) cholesterol
✔ Raise good (HDL) cholesterol
✔ Reduce inflammation
✔ Improve how your body uses insulin
✔ Lower the risk of heart disease and stroke
There are two main types of unsaturated fat:
🥑 Monounsaturated fats (MUFA)
Sources:
- Olive oil
- Rapeseed oil
- Avocados
- Nuts (e.g. almonds, cashews)
💡 The PREDIMED study found that a Mediterranean diet high in olive oil or nuts reduced major heart events by 30% in high-risk individuals.
🐟 Polyunsaturated fats (PUFA)
Includes omega-3 and omega-6 fats, which your body needs but can’t make on its own.
Sources:
- Oily fish (e.g. salmon, mackerel, sardines)
- Walnuts
- Flaxseed, chia seeds
- Sunflower and soybean oils
💡 Evidence: Replacing saturated fats with polyunsaturated fats is consistently associated with lower CVD risk. A 2017 Cochrane review found moderate-quality evidence that increasing PUFA reduces heart disease events..
NHS and NICE both recommend unsaturated fats as the healthier choice for people at risk of cardiovascular disease or type 2 diabetes.
🔴 Unhealthy fats (Saturated and trans fats)
Some fats can raise your risk of heart disease. These should be limited or avoided.
Saturated fats
Raise LDL (“bad”) cholesterol and contribute to blocked arteries.
Common sources:
- Fatty red meat, bacon, sausages
- Butter, ghee, lard
- Cheese, cream
- Cakes, biscuits, pastries
- Coconut and palm oil
💡 NICE and NHS recommend less than 10% of your daily calories from saturated fat. A 2020 meta-analysis confirmed reducing saturated fat lowers heart disease risk.
Trans fats
These are the most harmful fats. They increase LDL, lower HDL, and promote inflammation.
Sources:
- Fried fast food
- Some processed or imported foods
- Items with “partially hydrogenated oils”
Trans fats are banned in UK-manufactured food, but may still appear in imported items. Always check labels.
🍽️ A simple way to eat better fats: Try a Mediterranean-style diet
This eating pattern is naturally high in healthy fats and low in processed foods.
A Mediterranean-style diet has been shown to reduce CVD risk, support blood sugar control, and improve lipid profiles.
It includes:
- Vegetables and fruits
- Whole grains
- Olive oil
- Fish
- Nuts and seeds
- Less red meat and sugar
🔄 How to make healthier fat choices
| Swap this… | For this… |
|---|---|
| Butter or lard | Olive or rapeseed oil |
| Creamy sauces | Nut-based or yoghurt-based dressings |
| Fatty red meats | Oily fish or legumes |
| Pastries and biscuits | Nuts, seeds, or fruit |
| Deep-fried foods | Grilled or roasted alternatives |
2. Increase fibre and choose better carbohydrates
The types of carbohydrates you eat – not just how many – play a major role in managing diabetes and protecting your heart.
Carbohydrates are broken down into glucose (sugar), which enters your bloodstream and is used for energy. But not all carbs are created equal. Highly processed, low-fibre carbs cause blood sugar spikes, increase insulin demand, and contribute to fat storage, inflammation, and long-term cardiovascular risk.
In contrast, high-fibre, whole-food carbohydrates slow down digestion, promote better blood sugar control, and support heart health.
Why fibre matters in diabetes and CVD:
- Soluble fibre forms a gel in the gut that slows digestion and glucose absorption, leading to smaller, slower rises in blood sugar after meals. It’s found in oats, beans and apples – helps lower cholesterol and support stable blood sugar.
- It also binds to cholesterol in the intestines and helps remove it from the body, reducing LDL (“bad”) cholesterol and improving lipid profiles.
- High-fibre diets have been shown to reduce HbA1c, blood pressure, cholesterol, and inflammation – all key drivers of cardiovascular disease in diabetes.
According to Diabetes UK and NICE guidelines, people with type 2 diabetes are encouraged to eat more fibre as part of a healthy eating pattern to improve glycaemic control and reduce cardiovascular risk.
What to eat more of:
- Vegetables (especially non-starchy ones like broccoli, leafy greens, peppers)
- Whole fruits (apples, berries, pears – not juice)
- Legumes (lentils, chickpeas, black beans)
- Whole grains (oats, brown rice, barley, quinoa, wholegrain bread)
- Nuts and seeds (chia, flaxseed, almonds)
Aim for at least 30g of fibre a day, including both soluble and insoluble fibre for blood sugar, cholesterol, gut and heart health.
What to reduce:
- Refined carbs like white bread, white rice, sugary cereals, pastries, cakes, and biscuits
- Sugary drinks (including fruit juice), which rapidly spike blood sugar without providing fibre or satiety
- Ultra-processed snacks that combine refined carbs with fats and additives – often contributing to insulin resistance and weight gain
Refined carbs are digested quickly, causing rapid spikes in blood sugar followed by crashes – this pattern increases insulin resistance over time and contributes to cardiovascular inflammation.
Choosing smarter carbs:
- Swap white rice for brown rice or barley
- Choose wholegrain bread instead of white
- Replace sugary breakfast cereals with steel-cut oats
- Bulk out meals with beans, lentils, and extra veg
Glycaemic index (GI) and glycaemic load (GL) can be helpful tools. Foods with a lower GI/GL cause slower, steadier rises in blood sugar.
A diet rich in fibre and unrefined carbs not only supports better blood sugar control but also protects your blood vessels, improves gut health, and keeps you feeling full and energised – making it easier to manage weight and reduce cardiovascular risk.
3. Be active most days: How movement supports your heart, muscles and metabolism
Being physically active is one of the most effective things you can do to manage diabetes and reduce your risk of heart disease. It helps regulate blood sugar, improves how your body uses insulin, strengthens the heart and blood vessels, and supports mental wellbeing.
But how exactly does it work in the body?
🔬 The science: how physical activity helps your blood sugar and heart
When you exercise:
- Your muscle cells become more sensitive to insulin, meaning they can take in glucose more efficiently – even without as much insulin.
- Your muscles also take up glucose independently of insulin during exercise, helping lower blood sugar levels immediately.
- Over time, regular activity helps reduce insulin resistance, a key driver of type 2 diabetes and metabolic syndrome.
- It reduces inflammation, oxidative stress, and fatty deposits in the arteries – protecting against atherosclerosis and cardiovascular damage.
- Physical activity increases HDL (“good”) cholesterol, lowers triglycerides and blood pressure, and helps manage weight and fat distribution – especially around the waist.
According to NICE and Diabetes UK, these changes can significantly reduce the risk of cardiovascular events, improve HbA1c, and support healthy ageing in people with or at risk of type 2 diabetes.
🏃♀️ What counts as physical activity?
You don’t need to run marathons. Any movement that raises your heart rate or strengthens your muscles counts – and every bit adds up.
✔ Moderate-intensity aerobic activity (you’re breathing faster, but can still talk):
- Brisk walking
- Dancing
- Swimming
- Gardening
- Cycling
- Housework with effort
✔ Muscle-strengthening activity (2x per week):
- Resistance bands or weights
- Bodyweight exercises (e.g. squats, lunges, push-ups)
- Yoga or Pilates
- Carrying shopping or climbing stairs
Strength training improves muscle mass and function, enhances insulin sensitivity, and supports long-term metabolic and cardiovascular health and includes exercises like lifting weights or resistance bands.
🎯 The recommendations:
- Aim for at least 150 minutes of moderate aerobic activity per week (e.g. 30 minutes, 5 days a week)
- Do muscle-strengthening exercises on at least 2 days per week
- Break up long periods of sitting – even short movement breaks help
Can’t do 30 minutes at once? Break it into 10-minute chunks – it still counts!
NICE recommends an individualised approach, especially for those living with complications, reduced mobility, or long-term conditions – even light activity is better than none, and benefits build over time.
🌿 Additional benefits of physical activity for people with diabetes:
- Improves mental wellbeing, mood and energy
- Reduces stress hormones like cortisol, which can worsen blood sugar and blood pressure
- Enhances sleep quality, which supports metabolic and cardiovascular recovery
- Supports weight maintenance or loss, especially when combined with dietary changes
- Increases circulation, helping reduce the risk of diabetic complications like neuropathy or foot ulcers
🧠 Did you know? People with type 2 diabetes who do regular physical activity can lower their HbA1c by up to 1%, which is similar to the effect of some medications – and with additional heart-protective benefits.
4. Stop smoking: One of the most powerful steps you can take for your heart and blood sugar
Smoking is one of the most harmful things you can do to your heart and blood vessels – and if you have diabetes, it significantly increases the risk of serious complications.
People with diabetes who smoke are at much higher risk of:
- Heart attacks
- Strokes
- Peripheral arterial disease
- Kidney disease
- Vision loss
- Poor circulation and nerve damage in the feet
The combined effect of smoking and diabetes is more than additive – it’s multiplicative, meaning the risks are compounded.
🔬 How smoking harms your body: the pathophysiology
Smoking introduces over 7,000 chemicals into the body – including nicotine, carbon monoxide, and free radicals – that damage nearly every system. Here’s how it worsens diabetes and cardiovascular disease:
🚬 Smoking and your blood vessels:
- Smoking causes direct damage to the endothelium – the inner lining of your blood vessels – making them more prone to inflammation and atherosclerosis (plaque buildup).
❓ Endothelial dysfunction is a key early step in heart disease and stroke.
- It increases levels of oxidative stress, promoting cholesterol oxidation and plaque formation.
- It causes vasoconstriction – narrowing of blood vessels – which reduces oxygen delivery and increases blood pressure.
🚬 Smoking and your metabolism:
- Smoking increases insulin resistance, making it harder for your body to regulate blood sugar.
- Nicotine stimulates the release of cortisol and adrenaline, which raise blood glucose levels and blood pressure.
- It reduces HDL (“good”) cholesterol and raises triglycerides and LDL (“bad”) cholesterol, accelerating cardiovascular risk.
🚬 Smoking and diabetic complications:
- It impairs circulation, particularly to the limbs, increasing the risk of ulcers, infections, and amputations.
- It reduces kidney function and speeds the progression of diabetic kidney disease.
- It increases the risk of retinopathy and vision loss.
According to Diabetes UK, people with diabetes who smoke are up to three times more likely to develop serious cardiovascular problems than non-smokers with diabetes.
✅ The good news: quitting brings rapid benefits
- Within 24 hours, your blood pressure and carbon monoxide levels improve
- Within weeks to months, insulin sensitivity starts to improve and circulation gets better
- Within 1 year, your cardiovascular risk drops significantly
- Over time, your risk of stroke and heart attack approaches that of someone who never smoked
💡 Research shows that quitting smoking at any age has a meaningful impact on reducing diabetes complications and extending lifespan – especially when combined with physical activity and a heart-healthy diet.
🛑 Support to help you quit
- You’re 3x more likely to quit successfully with support and medication
- Ask your GP, pharmacist or diabetes team about:
- NHS Stop Smoking Services
- Nicotine replacement therapy (NRT) – patches, gum, lozenges
- Medications like varenicline or bupropion (prescription only)
- Behavioural counselling, group support or apps
Stopping smoking is one of the most important decisions you can make to protect your heart, blood vessels and overall health. It’s never too late to quit – and the benefits begin almost immediately.
5. Limit alcohol: Protecting your liver, heart and blood sugar balance
Alcohol is often overlooked when managing diabetes and cardiovascular health, but drinking too much – even occasionally – can have significant effects on your blood sugar levels, liver, cholesterol, and blood pressure.
Understanding how alcohol behaves in the body can help you make informed choices and reduce the risk of complications.
🔬 How alcohol affects diabetes and heart health: the pathophysiology
🩸 Blood sugar and insulin response
- Alcohol interferes with the liver’s ability to regulate glucose. Normally, the liver stores glucose and releases it when your blood sugar drops. But alcohol suppresses this glucose release, increasing the risk of hypoglycaemia (low blood sugar) – especially in people taking insulin or sulfonylureas.
- Conversely, excess alcohol intake over time can contribute to insulin resistance, impairing the body’s ability to manage glucose and worsening type 2 diabetes.
This means alcohol can both lower blood sugar dangerously in the short term, and worsen long-term control if consumed frequently or in high amounts.
🫀 Cardiovascular effects
- Alcohol increases sympathetic nervous system activity – raising heart rate and blood pressure.
- It raises levels of triglycerides and may contribute to arrhythmias (irregular heart rhythms), particularly at high intakes or in binge patterns.
- Chronic drinking increases the risk of cardiomyopathy – weakening of the heart muscle.
🧬 Inflammation, fat metabolism and weight
- Alcohol metabolism produces acetaldehyde and free radicals, which contribute to oxidative stress and vascular inflammation – key processes in atherosclerosis.
- Alcohol is energy dense (7 kcal/g) and often adds empty calories that can contribute to central weight gain – a key feature of metabolic syndrome.
- It also affects liver fat processing, increasing the risk of non-alcoholic fatty liver disease (NAFLD), which is commonly seen in people with type 2 diabetes and is an independent cardiovascular risk factor.
🍷 What’s a safe amount?
In the UK, the recommended maximum is:
- No more than 14 units per week
- Spread over at least 3 days – with alcohol-free days
- 14 units = 6 pints of beer OR 6 standard glasses of wine OR 14 single shots of spirit
For people with diabetes, it’s best to drink with food, avoid binge drinking, and check blood sugar more regularly if drinking.
⚠️ Risks to be aware of:
- Hypoglycaemia may occur hours after drinking, especially overnight
- Alcohol may mask symptoms of low blood sugar (e.g. dizziness, confusion, sweating), making it harder to spot
- People with diabetic neuropathy, kidney disease or fatty liver are at greater risk of complications from alcohol
Diabetes UK advises extra caution and clear personal limits, especially when taking medications that increase the risk of hypoglycaemia.
✅ If you choose to drink:
- Stick to recommended limits
- Choose lower-sugar options (e.g. dry wine, spirits with soda water)
- Avoid sugary mixers, liqueurs or alcopops
- Have food with your drink to reduce hypoglycaemia risk
- Stay well hydrated with water
- Check your blood sugar before bed if you’ve been drinking
- Consider reducing gradually or using alcohol-free days
💡 The benefits of reducing alcohol:
Cutting back or stopping alcohol can:
- Improve blood sugar control and insulin sensitivity
- Lower triglycerides and blood pressure
- Support weight loss and better sleep
- Reduce liver fat and inflammation
- Improve mood, energy, and mental clarity
Even small reductions can lead to noticeable improvements in energy, sleep and metabolic health – and some people with diabetes see improvements in their HbA1c after reducing alcohol.
6. Sleep well and manage stress: The silent link to heart and blood sugar health
Getting enough quality sleep isn’t just about feeling refreshed – it’s essential for your heart, metabolism, and emotional wellbeing. Poor sleep and chronic stress can worsen blood sugar levels, increase blood pressure, and raise cardiovascular risk, especially in people with diabetes.
How sleep and stress affect your body:
- Lack of sleep or disrupted sleep raises levels of cortisol, the body’s main stress hormone.
❓Cortisol: a hormone that helps regulate blood sugar, blood pressure, and metabolism – too much for too long increases heart and metabolic risks.
- Raised cortisol leads to higher blood glucose levels (by stimulating glucose production in the liver) and worsens insulin resistance – especially in the early morning hours.
- It also increases blood pressure by narrowing blood vessels and retaining sodium.
- Chronic sleep disruption and stress are linked to increased appetite, cravings for high-sugar/high-fat foods, and weight gain – especially around the waist (central obesity).
- Over time, poor sleep contributes to autonomic imbalance, which can lead to irregular heart rhythms and elevated resting heart rate.
The NHS and Diabetes UK both highlight sleep as a vital – and often overlooked – part of type 2 diabetes and heart health management.
How much sleep do you need?
Most adults need 7–9 hours of good-quality sleep per night. Signs of poor sleep include:
- Struggling to fall asleep or stay asleep
- Waking feeling unrefreshed
- Snoring or stopping breathing during sleep (possible sleep apnoea – more common in diabetes and should be assessed)
Activities that can support better sleep and lower stress:
- Regular physical activity (especially in the morning or early afternoon) helps regulate your sleep–wake cycle and lowers evening cortisol levels.
- Mindfulness meditation, yoga and breathing exercises can reduce overactive stress responses and calm the nervous system.
- Spending time in nature and natural daylight helps reset your circadian rhythm – the internal body clock that regulates sleep and hormone cycles.
❓Circadian rhythm: your body’s natural 24-hour clock that controls when you feel awake or sleepy – disrupted in shift work, poor sleep habits, or irregular routines.
- Limiting caffeine and alcohol – especially after 2pm – can improve sleep quality and lower nighttime blood pressure.
- Consistent sleep and wake times, even on weekends, help your body know when it’s time to rest.
Try a relaxing wind-down routine for 30–60 minutes before bed – dim the lights, read, stretch, or listen to calming music. Avoid screens during this time, as blue light can interfere with melatonin production (the sleep hormone).
- Understand the relationship between sleep and health and how you can improve yours by reading our sleep article.
Routine checks to stay on top of
Don’t forget your annual diabetes review – and ask about these key measures:
| Check | Target | Why it matters |
|---|---|---|
| HbA1c | Ideally <48 mmol/mol (individualised) | Long-term blood sugar control |
| Blood pressure | <140/80 mmHg (or <130/80 mmHg with complications) | Reduces stroke and heart disease risk |
| Cholesterol (non-HDL) | <2.5 mmol/L (if on statin) | Tracks lipid-related risk |
| Kidney Function (eGFR & urine ACR) | Normal or stable | Diabetes can damage kidneys silently |
| Foot Checks & Eye Screening | Yearly | Picks up early signs of nerve or vessel damage |
For more on the routine checks for diabetes, please see our article here.
If you link to your GP record, you can track many of these results in the Evergreen Life app to stay on top of your health and share them with your healthcare team.
Final thought
Looking after your heart is just as important as controlling your blood sugar – and thankfully, the two go hand in hand.
By eating well, staying active, keeping up with check-ups and using medication if needed, you can protect your heart, feel better day to day, and reduce the risk of serious complications.
It’s not about perfection – just small, consistent changes that support the whole you.
✅ If you haven’t already, download the free Evergreen Life app to track your health, including managing your diabetes, and get practical tips that help you take control of your overall health.
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