Diabetes is responsible for many health complications, including an increased risk of blood vessel disease, especially coronary artery disease. All things being equal, diabetes substantially increases the risk of heart disease. In fact, about 80 percent of people with diabetes die of some form of heart disease or a stroke. Diabetics with high blood pressure, elevated LDL cholesterol, and low HDL are even more at risk for cardiovascular problems.
In type 2 (previously called "non-insulin-dependent" or "adult-onset") diabetes, the body's cells become resistant to insulin and the pancreas cannot produce enough insulin to overcome the resistance. Insulin is the hormone that permits blood glucose (sugar) to move into the body's cells where it's used for energy. Insulin also reduces the amount of glucose released by the liver. During the initial period of insulin resistance, the pancreas tries to compensate by increasing insulin production. Over time, most type 2 diabetics show decline in insulin production and blood sugars rise even more.
The association of insulin resistance and coronary artery disease is well established. Does this mean that higher levels of insulin cause angina and heart attacks? The answer is not clear. For now, one prudent approach to elevated blood sugars and higher insulin levels due to insulin resistance is to lower the blood levels of both. This is best accomplished by weight loss and increased exercise. For type 2 diabetics not controlled despite best efforts at lifestyle change, researchers are studying whether drugs that do not raise insulin levels are superior.
In addition to lower blood sugar, optimal treatment for type 2 diabetes includes modifying all risk factors for heart disease and stroke. Ideally, blood pressure should be less than 130/80, and LDL cholesterol should be less than 70.