January 10, 2022/Diabetes & Endocrinology

How Your Diabetes Can Mask Heart Disease or a Heart Attack

When symptoms are muted, listen closely to your body

diabetes and heart

If you have diabetes, you likely know that it sometimes causes neuropathy, or nerve damage. But you may not realize that diabetes-related neuropathy can sometimes mask the signs of heart disease or cause you to miss important symptoms of a heart attack.


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More than two-thirds of people with diabetes will end up having some form of neuropathy. The most common type is peripheral nerve damage, which creates numbness, tingling or weakness in your hands and feet.

But there’s another, more serious type that can damage the nerves that lead to your heart, bladder, intestines and blood vessels — autonomic neuropathy. “When this occurs, the body is sometimes unable to regulate functions like urination or feel sensations like pain in these areas,” says registered diabetes nurse, Susan Cotey, RN, CDCES.

This is especially concerning if you have diabetes. Not only are you at higher risk for neuropathy, but you’re also more likely to have heart disease. If the neuropathy dulls the nerves leading to your heart, you may not notice symptoms of heart disease such as chest pain.

Here’s what you need to know.

Diabetes-related heart attack symptoms

If you have diabetes, get in tune with your body. Learn to listen closely and act on what it’s telling you.


If you have any symptoms of a heart attack, report them to your doctor immediately. Don’t wait to see if the pain goes away. “For instance, indigestion that doesn’t pass quickly is sometimes a sign of a heart attack,” says Cotey.

Make sure to visit your doctor for regular checkups, too. Annual tests can reveal a problem before symptoms occur. Early treatment can reduce the likelihood that small issues turn into larger ones.

If you have neuropathy, symptoms that might be very apparent in someone else are not as noticeable for you. Watch for any of these signs of a possible heart attack:

  • Chest pain or a feeling of fullness.
  • Nausea.
  • Heartburn.
  • Unusual fatigue.
  • Pain in your jaw, neck or left arm — particularly for women.
  • Shortness of breath without much exertion.
  • Light-headedness.
  • Sweating or clammy hands without exertion.

What you need to know about neuropathy

You can’t always avoid neuropathy, but lifestyle changes can help reduce your risk even if you have diabetes.

Keeping your blood glucose levels in a healthy range is extremely important. You can do this by maintaining a healthy weight, getting regular exercise and eating a healthy diet. Also, avoid smoking and limit your alcohol intake.


If you think you may have autonomic neuropathy, watch for these symptoms:

  • Dizziness or fainting when you stand.
  • Urinary problems like incontinence or inability to fully empty your bladder.
  • Sexual difficulties like erectile dysfunction or low libido.
  • Digestion difficulties like appetite loss, difficulty swallowing and heartburn.
  • Sweating too much or hardly at all.
  • Intolerance to exercise.

If you have any of these symptoms, see your doctor right away. Getting an early diagnosis and treatment can help slow nerve damage and repair problems. Treatment options for neuropathy may include:

  • Pain medication.
  • Physical therapy.
  • Occupational therapy for coping with pain and loss of function.
  • Aids like braces to increase mobility and reduce pain.
  • Nutritional changes.

If you have Type 2 diabetes, have your doctor screen you annually for autonomic neuropathy. If you have Type 1 diabetes, the American Diabetes Association recommends annual screenings starting five years after your diagnosis.

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