Each year, more than 1 million Americans are diagnosed with Type 2 diabetes, the most common form of the metabolic disorder, which is characterized by the body’s inability to process glucose (blood sugar). The condition causes damage throughout the body, including the coronary arteries.

People with diabetes are two to four times more likely to develop heart disease than nondiabetics.

In addition, diabetics are much more likely to overlook the main symptom of a heart attack: chest pain.

The reason is that excess glucose (sugar) buildup in the blood damages nerve endings throughout the body, causing a condition called neuropathy. People with neuropathy can feel sensations such as tingling that are not actually caused by any external stimulus, or even more dangerous, it can blunt pain sensations from problems that are actually occurring.

This is why people with diabetes can be unaware of heart attack warning signs, and also why their doctors must monitor them carefully — both for signs that they are developing heart disease, or that it is becoming more severe.