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Diabetes, Heart Attack Risk and Diabetic Ketoacidosis

Krista Giannak

Last updated: October 20, 2016 7:17 pm

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People with diabetes have heart attacks or strokes more than twice as often as people without diabetes. 1 In addition, two out of three people with diabetes eventually die from these conditions, according to the American Diabetes Association. 2

Heart Disease Risk Factors

According to the Centers for Disease Control and Prevention (CDC), if you have diabetes your risk of death by heart disease may be two to four times greater than for someone who doesn’t have diabetes. 3 The American Heart Association cites the same statistic, adding that at least 68 percent of people with diabetes who are older than 65 years of age die of heart disease. 4

Other risks for heart disease include high LDL cholesterol levels, high blood pressure (hypertension), and high triglyceride levels, according to the CDC. 5 Many people with diabetes also have a combination of other risk factors: low HDL cholesterol, obesity and a sedentary lifestyle. 6

High Blood Sugar and Heart Disease

Over time, high blood sugar may lead to increased fatty deposits on blood vessel walls, affecting blood flow and increasing the chance of blood vessel hardening. This is according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). 7

Heart Attack Warning Signs

The risk of having a heart attack is higher for diabetics and diabetics who have already suffered one heart attack have an even greater risk of having a second. NIDDK mentions some important warning signs that may indicate you might be experiencing a heart attack, such as chest, arm, jaw, neck, back or stomach pain. 8

Other possible symptoms of a heart attack include shortness of breath, nausea, sweating and lightheadedness. 9

Reducing Your Risks as a Diabetic

If you have diabetes, the NIDDK suggests that you and your doctor manage a combination of risk factors, referred to as “the ABCs of diabetes.” These factors are A1C, blood pressure and cholesterol levels. 10

The agency advises you get your A1C levels tested at least twice a year, have your cholesterol levels tested at least once a year, and have your blood pressure taken every time you see a health care professional. Managing these risk factors helps reduce your risk for heart disease. 11

SGLT2 Inhibitors: Risks and Side Effects

To control your diabetes, your doctor may ask you to make diet, exercise and medication changes. To lower blood glucose levels in adults with type 2 diabetes, in conjunction with exercise and diet, the U.S. Food and Drug Administration (FDA) has approved a class of prescription drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors. According to the FDA, these medications “lower blood sugar by causing the kidneys to remove sugar from the body through the urine.” 12

In May of 2015, the FDA released a safety announcement concerning SGLT2 inhibitors and their potential to cause a condition called diabetic ketoacidosis (DKA). 13

Specifically, the FDA warned that “the type 2 diabetes medicines canagliflozin, dapagliflozin, and empagliflozin may lead to ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalization.” 14

The FDA advised patients with diabetes who are taking SGLT2 inhibitors to seek immediate medical attention if they experience possible signs of DKA. These possible warning signs may include “unusual fatigue” or sleepiness, nausea, vomiting, abdominal pain, breathing trouble and confusion. 15

In addition, the FDA warned that diabetes patients taking SGLT2 inhibitors who develop DKA may not necessarily experience the high blood sugar levels typical of DKA. According to the May 2015 safety announcement regarding SGLT2 inhibitors and reported cases of diabetic ketoacidosis, the “high anion gap metabolic acidosis accompanied by elevation in urine or serum ketones in the reported cases was not associated with the very high glucose levels that are typical for diabetic ketoacidosis.” 16

On December 4, 2015, the FDA issued a second Safety Communication, notifying the public that the FDA was adding new warnings to SGLT2 inhibitor drug labels. The new SGLT2 inhibitor labels will warn “about the risks of too much acid in the blood and of serious urinary tract infections.” 17

According to the FDA other possible side effects of SGLT2 inhibitors include kidney problems, dehydration, increased cholesterol in the blood, yeast infections, and, when combined with certain other prescription drugs used to treat diabetes, low blood sugar. 18 Get more information about the possible risks and side effects of SGLT2 inhibitor.

  1. “Heart Disease,” American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/heart-disease. (Accessed November 23, 2015). 

  2. “Heart Disease,” American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/heart-disease. (Accessed November 23, 2015). 

  3. “Conditions That Increase Risk for Heart Disease,” Centers for Disease Control and Prevention. http://www.cdc.gov/heartdisease/conditions.htm. (Accessed November 23, 2015). 

  4. “Cardiovascular Disease & Diabetes,” American Heart Association. http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/. (Accessed November 23, 2015). 

  5. “Conditions That Increase Risk for Heart Disease,” Centers for Disease Control and Prevention. http://www.cdc.gov/heartdisease/conditions.htm. (Accessed November 23, 2015). 

  6. “Cardiovascular Disease & Diabetes,” American Heart Association. http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/. (Accessed November 23, 2015). 

  7. “Diabetes, Heart Disease, and Stroke,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx. (Accessed November 23, 2015). 

  8. “Diabetes, Heart Disease, and Stroke,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx. (Accessed November 23, 2015). 

  9. “Diabetes, Heart Disease, and Stroke,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx. (Accessed November 23, 2015). 

  10. “Diabetes, Heart Disease, and Stroke,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx. (Accessed November 23, 2015). 

  11. “Diabetes, Heart Disease, and Stroke,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx. (Accessed November 23, 2015). 

  12. “FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood,” U.S. Food and Drug Administration, May 15, 2015. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. (Accessed November 23, 2015). 

  13. “FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood,” U.S. Food and Drug Administration, May 15, 2015. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. (Accessed November 23, 2015). 

  14. “FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood,” U.S. Food and Drug Administration, May 15, 2015. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. (Accessed November 23, 2015). 

  15. “FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood,” U.S. Food and Drug Administration, May 15, 2015. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. (Accessed November 23, 2015). 

  16. “FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood,” U.S. Food and Drug Administration, May 15, 2015. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM446954.pdf. (Accessed November 23, 2015). 

  17. “SGLT2 Inhibitors: Drug Safety Communication – Labels to Include Warnings About Too Much Acid in the Blood and Serious Urinary Tract Infections,” U.S. Food and Drug Administration, December 4, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm475553.htm. (Accessed December 7, 2015). 

  18. “FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood,” U.S. Food and Drug Administration, May 15, 2015. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM446954.pdf. (Accessed November 23, 2015).