Regardless of whether you're living with type 1 diabetes, type 2 diabetes, or any other form of diabetes, managing your underlying conditions is crucial. Although conditions like high blood pressure or kidney disease are often talked about, one lesser-known complication is anemia. Here, we'll explore the link between diabetes and anemia and how to manage both conditions and improve overall health.
What is Anemia?
Anemia occurs when the body lacks enough red blood cells or hemoglobin to carry oxygen to its tissues and organs effectively. It's quite common, with over three million cases diagnosed annually in the United States. Oftentimes, anemia is caused by an iron deficiency, but can also occur in individuals with chronic diseases, genetic disorders, or even blood loss from heavy menstrual periods or chronic bleeding. Some of the most common symptoms of anemia include:
- Fatigue
- Dizziness
- Lightheadedness
- Shortness of breath
- Headache
- Pale skin
- Low body temperature
- Cold hands and feet
- Chest pain or palpitations (in severe cases)
If you have both anemia and diabetes, you may notice that many of these symptoms are similar to those of high blood sugar. This can make it challenging to understand which symptoms contribute to anemia and which contribute to high blood sugar. The best way to differentiate the two is to check your blood glucose levels often. If you're still experiencing these symptoms despite high blood sugar readings or ketones, contact your doctor to undergo testing for anemia.
Types of Anemia Relevant to People with Diabetes
Around 38.4% of Americans with type 2 diabetes also have anemia. While some may experience low iron levels, there are a few types of anemia that are more relevant to those living with diabetes. These include things like:
- Anemia of Chronic Disease
- Iron-deficiency Anemia
- Anemia and Kidney Disease
- Metformin-related Anemia
The Relationship Between Diabetes and Anemia
First, it’s essential to note that diabetes does not cause anemia, and anemia does not cause diabetes. Yes, they are related, but having one doesn't mean you'll automatically develop the other. In short, living with diabetes puts you at a greater risk of developing anemia. Individuals with additional complications may be at even greater risk for anemia. Below are some comorbidities that can increase the prevalence of anemia.
Nephropathy and Reduced Erythropoietin
Nephropathy is a broad term used to describe any disease or damage to the kidneys. It's a common complication of diabetes, as prolonged high blood sugar levels over the years can damage the small blood vessels in the kidneys' filtering units, the glomeruli. As filtration becomes increasingly difficult, it can result in a loss of nephron function and, eventually, kidney failure.
As damage or failure progresses, the kidneys gradually stop producing an essential hormone called erythropoietin (EPO), which signals the bone marrow to initiate red blood cell production. Unfortunately, the early stages of kidney disease are often asymptomatic, which is why it's important to get tested early and often when living with diabetes. Catching anemia early may alert your doctor to potential kidney function issues, allowing for early intervention and treatment.
Progression of chronic kidney disease can cause additional symptoms, such as muscle cramps, nausea, vomiting, changes in urination, and more. If end-stage renal disease occurs, you'll need to undergo regular dialysis or receive a kidney transplant.
Chronic Inflammation
People with diabetes are more likely to have chronic, low-grade inflammation, especially in the blood vessels. Although it can occur with any diabetes, those with type 2 diabetes mellitus may experience chronic inflammation more often. Several interconnected factors can contribute to this, some of which include the following:
- Several studies have shown that people with diabetes may have an altered gut microbiome, which can lead to increased intestinal permeability, also known as "leaky gut.” This allows certain bacteria to enter the bloodstream, triggering an immune response and inflammation.
- Insulin resistance can also create a metabolic stress that triggers the release of pro-inflammatory cytokines by immune cells.
- Excess visceral fat (fat around the organs) can secrete adipokines, which promote inflammation within the body.
- High blood sugar can trigger the production of other hormones and mitochondrial activity, which in turn activate inflammatory factors.
When inflammation reaches the blood vessels, it further prevents the bone marrow from receiving hormones such as EPO, thereby increasing the risk of anemia.
Diabetes Medications
Certain diabetes medications can also lower hemoglobin levels in your body. Hemoglobin is necessary for blood to carry oxygen throughout the body. So, when these levels are decreased due to medications, then combined with potential complications, it can further increase the risk of developing anemia.
ACE inhibitors help treat high blood pressure and kidney disease, but they can affect the kidneys' ability to produce erythropoietin (EPO). This leads to decreased red blood cell production. ACE inhibitors can also cause mild hemodilution by increasing plasma volume. This, in turn, can artificially lower hemoglobin concentration without an actual reduction in red blood cell numbers. Although less common, it can play a role in some individuals.
Metformin is another medication that can increase the risk of anemia or worsen existing cases. Metformin can interfere with the absorption of vitamin B12 in the small intestine. Since B12 is essential for healthy red blood cell production, deficiency is a common cause of anemia.
Nutritional Deficiencies in People with Diabetes
Anemia can also occur due to general nutritional deficiencies. This can happen to anyone, regardless of whether they have diabetes. Typically, anemia caused by deficiencies is due to potential dietary issues or malabsorption of iron or folate. While it's essential to consult your doctor to determine the cause of anemia, you can try increasing your intake of iron-rich foods. Some great options to add to your diet include:
- Beef liver
- Chicken liver
- Lean red meat (beef, lamb, pork)
- Turkey (especially dark meat)
- Canned tuna or sardines
- Tofu and tempeh
- Lentils
- Chickpeas
- Kidney beans, black beans
- Spinach (cooked for better absorption)
- Pumpkin seeds
- Quinoa
- Iron-fortified cereals or breads
- Dark chocolate (70% or higher cocoa)
You can also try increasing folate-rich foods. Folate is an essential vitamin that helps support red blood cell formation, so it acts as a precursor to building up iron stores. Some folate-rich foods include:
- Dark leafy greens (spinach, kale, Swiss chard, collard greens)
- Asparagus
- Brussels sprouts
- Broccoli
- Avocados
- Beets
- Lentils
- Black-eyed peas
- Lima beans
- Sunflower seeds
- Oranges and orange juice
- Papaya
- Bananas
- Fortified breakfast cereals
- Enriched pasta
- White rice
- Enriched bread and flour products
If you have any questions or concerns about your diet, consult your doctor or a registered nutritionist.
The Impact of Anemia on Diabetes Management
Anemia may also complicate diabetes care management in some. It can interfere with glucose control and increase the risk of serious complications, which is why it's important to get checked for anemia and undergo treatment. Some ways that anemia can impact diabetes include the following.
Worsening Glycemic Control
When red blood cell counts are low, the body's ability to deliver oxygen to tissues is reduced. This lack of oxygen (tissue hypoxia) compromises cellular energy production and may disrupt normal glucose utilization and insulin sensitivity. Additionally, anemia often causes fatigue and decreased physical activity, contributing to poorer glycemic control.
False HbA1c Readings
In iron deficiency anemia, red blood cells tend to live longer than usual, allowing more time for glucose to bind to hemoglobin, which can falsely elevate HbA1c levels. In contrast, in other forms of anemia (like hemolytic anemia), red blood cells may break down prematurely, falsely lowering HbA1c values.
Cardiovascular Risk
Both diabetes and anemia are independent risk factors for cardiovascular disease, but when they occur together, the risk increases even more. Anemia makes the heart work harder, while diabetes compromises vascular health. When combined, they can lead to expedited cardiovascular complications.
How to Treat Anemia
The best way to treat anemia is first to understand what is causing it. Although anemia is common for people with diabetes, that doesn't necessarily mean the underlying cause is the same. Since some causes can be serious, such as diabetes and chronic kidney disease, diagnosing and treating other conditions is an essential part of increasing your body's iron metabolism and stores.
After understanding the cause, your doctor may recommend one or more ways to address anemia. Some of the most common include:
- Oral iron supplementation
- IV iron supplementation
- Vitamin B12 injections
- Erythropoiesis-stimulating agents or hormones
- Blood transfusion (only in severe cases)
Although iron supplements shouldn't directly impact blood sugar levels, there may be some instances where they alter glycemic control. Your doctor will discuss these details with you depending on your individual circumstances and make recommendations for changes in diabetes care.
Managing diabetes is easier when you have the right support. Byram Healthcare offers a wide selection of diabetes supplies, delivered discreetly and directly to your door. Whether you need glucose meters, test strips, or continuous glucose monitors, our team is here to help you stay on track.
