Are diabetics more prone to silent ischemia?

Yes: It seems that diabetes affects nerves and pain perception. Diabetics often injure feet and can get infections without noticing. Likewise they may suffer coronary ischemia without perception or it sometimes manifests as severe GI distress with nausea and vomiting but no chest pain. A sudden change in energy, nausea/vomiting or shortness of breath in a diabetic should prompt further evaluation.