Diabetes and Anemia:

A Difficult Combination When Managing Your Diabetes

| Feb 16, 2012

There are lots of articles about diabetes, as well as all kinds of information about anemia. But what if you have both? About 25 percent of people with diabetes have some level of anemia. This article explains how the two conditions interact.

What Is Anemia, and Why Is It Linked to Diabetes?

In anemia, there are fewer red blood cells than normal, resulting in less oxygen being carried to the body's cells. People with anemia often feel tired or weak and may have difficulty getting through activities of daily living. Other symptoms include paleness, poor appetite, dizziness, lightheadedness, rapid heartbeat, and shortness of breath. Because these symptoms can also be associated with diabetes, they are sometimes not recognized as evidence of anemia.

Anemia may occur with diabetes because the hormone that regulates red blood cell production, erythropoietin (EPO), is produced by the kidneys. Kidney damage at several levels is a complication of diabetes, and one problem often leads to the other. Changes in the kidneys that occur with diabetes range from diabetic nephropathy all the way to chronic kidney disease. Early detection and treatment is essential to prevent or delay disease progression. Information in greater detail can be found at www.kidney.niddk.nih.gov.

Other causes of anemia are low levels of iron or other vitamins, as well as prolonged illness.

Diagnosing Anemia

A simple blood test done during a doctor visit, called a complete blood count or CBC, is used to check for anemia. The two elements of the test that reveal anemia are hemoglobin and hematocrit. Hemoglobin is the part of red blood cells that carries oxygen to the cells. Hematocrit indicates the percentage of red blood cells in the blood.

How Does Anemia Affect Your Diabetes Care?

If you have anemia, your blood glucose tests may not be accurate. Studies that looked at blood glucose monitor accuracy found that low hematocrit levels can falsely increase glucose measurements, leading to monitor test results as much as 20 percent too high. Healthcare providers and patients need to be aware of this combination and consider it when responding to glucose levels, especially when treating patients on insulin.

Patients with anemia should ask their healthcare provider which blood glucose meter might be best for people with both anemia and diabetes. This question is currently being evaluated by the American Diabetes Association and the FDA.

Why Does Hematocrit Affect Glucose Monitor Accuracy?

All glucose monitors are designed to measure the level of glucose in the blood, but, unfortunately, not all blood is the same. A major difference between blood samples is the percentage of red blood cells, or hematocrit. The average hematocrit for men is slightly higher than the average for women. Young children tend to have a lower hematocrit than adults. As people age, hematocrit values usually are lower.

Low hematocrit is a common side effect of many illnesses and of drug therapies like metformin. Reductions in kidney function that occur in diabetes can also cause lower hematocrit values.

Hematocrit is part of the calculation that all glucose monitors use for measuring glucose. Monitor companies pick a "most likely" hematocrit value for their monitor calculation. If your hematocrit differs significantly from the hematocrit value used by the manufacturer, your monitor test results will be affected. The larger the difference between the manufacturer's hematocrit value and your hematocrit value, the bigger the effect will be on your meter's accuracy. Small changes in hematocrit are not a problem, but as patients move into anemia, the effect on accuracy is larger. Some of the newer meters have hematocrit corrections built in.

Treatment of Anemia in Diabetes

Iron supplementation is the most common treatment for anemia. When kidney disease is involved, there are additional options that you can discuss with your healthcare provider. If no cause other than reduced erythropoietin (EPO) production is found, anemia can be treated with a genetically engineered form of EPO that is usually injected under the skin two or three times a week. The US Food and Drug Administration recommends that patients treated with EPO therapy achieve a hematocrit between 30 and 36 percent.

Adjusting your diet to include foods rich in iron, folic acid, and vitamin B12 may also be helpful. Ask your diabetes educator or registered dietitian to help you adjust your meal plan to include these nutrients.

Preventing Anemia

A number of steps can be helpful in preventing anemia. Keep your blood glucose at the target levels set by you and your healthcare provider, and maintain your blood pressure under 130/80. Control your lipids, and work with your healthcare team to manage your cholesterol and triglyceride levels. Finally, eat a well-balanced diet that includes foods containing iron.

Ever since the Diabetes Control and Complication Trial in 1993, studies have shown that the largest influence in diabetes care is the person with diabetes. Your participation in your own care is critical, so it's important to be aware of how anemia can affect your diabetes.

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Categories: Anemia, Blood Test, CBC, Chronic Kidney Disease, CKD, Complete Blood Count, Diabetes, Diabetes, FDA, Folic Acid, Food, Glucose Monitor, Glucose Results, Hematocrit, Hemoglobin, Insulin, Iron, Iron Supplement, Kidney Disease, Metformin, vitamin B12

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Posted by ndocroth on 21 February 2012

You write that "people with anemia often feel tired or weak and may have difficulty getting through activities of daily living. Other symptoms include paleness, poor appetite, dizziness, lightheadedness, rapid heartbeat, and shortness of breath."

You do not question if there could be a common cause for both anemia and diabetes.

Daily, new research data surface that connect such a possible underlying cause in non-celiac gluten sensitivity (GSE) and/or celiac disease (CD).
Due to a genetic predisposition (HLA-DQ2/DQ8), a person's duodenum may be affected by grain proteins. The resulting inflammation of the duodenum impedes its ability to
- monitor insulin production
- control bile release
- produce vitamin K (keeps calcium in the bones and out of the arteries)
- absorb minerals and nutrients(incl. calcium, iron, etc.).

Making such a connection would stand to reason, when we consider that a majority of diabetics who undergo gastric bypass surgery no longer experience blood sugar imbalances once a possibly inflamed duodenum is bypassed.
Of course, without the action of the duodenum, mineral deficiencies become lifelong.

Posted by Anonymous on 21 February 2012

It is important to remember that celiac disease also can cause anemia. Because type 1 diabetes and celiac disease frequently occur together because similar genetic influences it is important to rule out celiac disease as the cause of anemia in a T1 diabetic patient.

Posted by Anonymous on 26 September 2012

I'm diabetic and was recently tested and turns out I have also anemia now. I'm not surprised at all since I don't eat red meat at all. My diet's mostly vegetarian, I force myself to eat meat whenever I do. Anyway! I'm just commenting this cause the reason of having anemia may not be related to the diabetes (like in my case).

Posted by Anonymous on 23 June 2014

Another common cause of anemia is monthly bleeding. A good percentage of menstruating women have low iron levels, as do I. After many years of wondering why I'm so cold and pale much of the time, I am now supplementing with daily iron. Finally my skin color has changed from paperwhite to a little more natural tan, and I'm no longer wearing a ski hat to bed in the summertime.

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