Diabetic cardiomyopathy is a heart condition caused by diabetes. Diabetes causes many changes throughout the body including how the heart makes energy. This energy change in the heart is due to hyperlipidemia which is a definitive characteristic of diabetes. Hyperlipidemia simply means there are too many fatty acids in the blood circulation. Fatty acids are also known as lipids hence the name hyperLIPIDemia.

Under normal conditions the heart prefers to use a particular ratio of glucose and fatty acids for energy. The glucose levels in the blood is what is meant when you hear “blood sugar.” In the diabetic state the heart will simultaneously become resistant to blood sugar and overwhelmed by the presence of fatty acids. This over-abundance of fatty acids creates a variety of problems in the heart. Among these problems is an increased formation of radical oxygen species(ROS), which are commonly referred to as free radicals. 

Free radicals have recently been popularized by news outlets that tell us the creation of free radicals is bad, and this is true especially when they’re made in the heart. An abnormal increase in free radicals is coupled with another common term, inflammation. The generation of inflammation results in an immune response. An immune response directed toward heart tissue indicates that heart cells are likely to be damaged and die. If heart cells are killed, they leave a gap in the muscle. This gap will be replaced by fibers as a placeholder in an attempt to maintain the structure and function of the heart. 

If there is enough inflammation and subsequent immune system initiated damage the heart will continue to lose muscle cells and become more and more fibrotic. If enough muscle cells are lost, the rest of the body will notice this and make the heart make up for the number of heart cells lost by increasing the size and strength of the remaining heart cells. Over time, the remaining muscle heart cells will increase in size becoming either wider or longer. The increase in heart cell width and length is known as concentric and eccentric hypertrophy respectively. Concentric and eccentric remodeling will likely lead to the development of heart failure.