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Can Anemia Cause Low Blood Sugar


How Does Diabetes Affect Anemia

Low Blood Sugar

When blood sugar is poorly-controlled, many different body organs are affected. Some of these bad effects can lead to anemia.

Here is how:

  • Kidney disease

The number one cause of anemia in people with diabetes is kidney disease. Red blood cell production requires a hormone from the kidneys. But as kidneys become damaged, they make less and less and without this hormone, the body doesnt make enough red blood cells.

Since 40% of people with diabetes have some sort of kidney disease, it isnt surprising that many of them have anemia also.


  • Heart Failure

Heart failure and anemia feed off one another. The worse anemia gets, the harder the heart has to work, causing more kidney failure which causes more anemia which in turn causes more heart failure. Its a vicious cycle.

  • Nutrient Deficiencies

Diabetes can impair the guts ability to absorb iron, B12, and folate. This is especially true in patients whove had gastric bypass, or who also have celiac disease .

  • Diabetic drugs

Some diabetes medications such as Metformin can interfere with B-12 absorption. One study showed that 30% of patients using Metformin for more than ten years developed B-12 deficiency . Other medications, such as Actos and Avandia, can dilute hemoglobin concentration in the blood though it isnt clear whether this causes the same problems that true anemia does.

Hypoglycemia In Children: Pediatric Ketotic Hypoglycemia

Some children experience pediatric ketotic hypoglycemia, involving low blood sugar levels and high levels of a substance known as ketones.

Doctors do not know exactly why this happens, but causes may include:


  • metabolism problems that the child was born
  • conditions that lead to excess production of certain hormones

Symptoms usually appear after the age of 6 months and disappear before adolescence.

They include:

  • mood changes
  • clumsy or jerky movements

If a child shows any of the above signs or symptoms, they should see a doctor as soon as possible.

Association Between Iron Deficiency And A1c Levels Among Adults Without Diabetes In The National Health And Nutrition Examination Survey 19992006

  • Catherine Kim, MD, MPH,
  • Kai McKeever Bullard, PHD, MPH,
  • William H. Herman, MD, MPH and
  • Gloria L. Beckles, MD, MSC
  • 1Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
  • 2Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 3Departments of Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan.
  • Corresponding author: Catherine Kim, cathkimumich.edu.
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      Predictors Of Hb Level

      The mean Hb was 139.3 ± 0.3 g/l for men and 129.0 ± 0.7 g/l for women . Multiple regression revealed five independent predictors of Hb, including GFR, sex, AER, HbA1c, and iron stores . These five variables explained 42% of the Hb variance in the entire clinic population. While sex was an important determinant of raw Hb levels, represented by divergent reference ranges in the general population , the most powerful predictors were TSAT and GFR, accounting for 22 and 10% of the variance in Hb, respectively. Similar results could be obtained in multivariate analysis using either MDRD-estimated GFR or DTPA-GFR .


      Sickle Cell Trait May Confound Blood Sugar Readings Among African

      Can Diabetes Cause Anemia?

      A routine diabetes test produces lower blood sugar readings in African-Americans with sickle cell trait than in those without, potentially leading patients to remain untreated or with a mistaken sense of blood sugar control, study finds.

      The test and the trait: A new study in JAMA finds that HbA1c tests underreport a key blood sugar measure in African Americans with sickle cell trait.

      PROVIDENCE, R.I. A new study in JAMA provides evidence that hemoglobin A1c , a common blood biomarker used to measure blood sugar over time, may not perform as accurately among African-Americans with sickle cell trait and could be leading to a systemic underestimation of blood sugar control among that population.

      Sickle cell trait is a genetic hemoglobin variant found in 8 to 10 percent of African-Americans. It occurs in people with one copy of the mutation that, if they had two copies, would result in sickle cell disease.

      The analysis of data from more than 4,600 people participating in two major studies found that HbA1c readings were significantly lower in individuals with SCT than in those without SCT, even after accounting for several possible confounding factors.


      The questions the study raises about using HbA1c among sickle cell trait carriers matter for treatment as well as diagnosis, added study senior author Dr. Wen-Chih Wu, a cardiologist at the Providence Veterans Affairs Medical Center and associate professor of medicine and of epidemiology at Brown University.

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      Diabetes Effect On Anemia

      The elevation of proinflammatory cytokines plays an essential role in insulin resistance and induces the appearance of cardiovascular complications diabetic micro- and macrovascular, kidney disease and anemia. By increasing especially IL-6. IL6 decreases the sensitivity of progenitors to erythropoietin and promotes apoptosis of immature erythrocytes. During the development of diabetes mellitus, nephropathy may arise, which further undermines the renal production of erythropoietin, positively contributing to an deterioration of anemia. According to Escorcio et al. approximately 40% of diabetic patients are affected by kidney diseases. The decreased renal function and proinflammatory cytokines are the most important factors in determining reduction of hemoglobin levels in those patients. Moreover, the inflammatory situation created by kidney disease also interferes with intestinal iron absorption and mobilization of iron. Therefore, diabetic patients with kidney disease have the highest risk for developing anemia.

      Listen To Your Doctor

      If you follow a meal plan or take medications that increase insulin to manage low blood sugar, its important to stick to the plan your doctor prescribed to help prevent drops in your blood sugar level.

      Not eating the right foods or taking the right medications at the right times can cause your blood sugar to drop. Check in often with your doctor so they can adjust your treatment plan if and when necessary.


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      The Diabetes And Iron Deficiency Anemia Connection

      Its common to see elevation of ferritin, the storage form of iron, in cases of insulin resistance and diabetes. This is because ferritin is also considered an acute phase reactant, which means it spikes in the presence of inflammation. Ferritin is primarily stored in the liver, and its common for it to elevate in cases of fatty liver disease, which is strongly connected to insulin resistance.

      However, serum iron levels tend to fall in diabetic patientstheres an inverse correlation between iron levels and HbA1c . There are several possible reasons for this.

    • Kidney complications. Elevated blood sugar will, over time, damage the tiny blood vessels in the kidneys in the same way that it can damage the vessels anywhere else . Smaller vessels show damage first, which is why kidney damage is one of the side effects of diabetes to watch out for. The significance here: the kidneys produce the hormone erythropoietin, which tells bone marrow to make more red blood cells. Underperforming kidneys will also decrease production of erythropoietin, leading to anemia. This study shows that diabetics with reduced renal function are more likely to end up with iron deficiency anemia than those with without reduced renal function.
    • Malabsorption. Diabetes is often associated with malabsorption of nutrients, including iron. Often this manifests as diarrhea, which may also go back to autonomic neuropathy.
    • Gene Expression Regulating Glucose Homeostasis During Id

      Is Anemia a Complication of Diabetes|Can Anemia Cause Gestational Diabetes

      Some studies examined the hepatic expression of genes involved in maintenance of glucose homeostasis during ID. These studies have shown that dietary intervention tend to elicit biologically meaningful, transcriptional responses. The ID rats in each group showed significant alterations in the expression of genes representative of glucose metabolism .

      Distinguished changes in gene expression include those genes associated with metabolic pathways including both glycolysis and gluconeogenesis.


      The significant increase in the glucokinase expression is likely due to the relative increase in circulating insulin levels observed in the ID groups, as insulin is a known inducer of hepatic Gck mRNA expression. Increased expression of Gck could potentially be very important as ID animals have been shown to have an increased reliance on glucose as a metabolic substrate, and Gck is able to rapidly increase the rate of glucose phosphorylation in the liver in response to the elevations in blood glucose levels. Furthermore, as Gck catalyzes the first step in hepatic glucose utilization it can contribute multiple pathways including glycogen synthesis, glycolysis, and de novo lipogenesis which could explain the enhanced glucose utilization and hyperlipidemia reported in response to dietary ID .

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      How Can I Prevent Kidney Disease And Other Problems From Diabetes

      Controlling blood sugar is the best way to protect your eyes, heart, nerves, feet, and kidneys. It lowers your risk for all health problems from diabetes. This is true for all people with diabetes with or without kidney damage. Ask your healthcare provider what you need to do to control your blood sugar.

      Questions To Ask Your Doctor

      • If I have anemia once, will I always have it, or will it come back again?
      • If I have anemia during pregnancy, is there a risk of passing it to my children?
      • If I have anemia during pregnancy, am I more at risk of having it after?
      • If I have a health condition that causes anemia, what is the risk of passing it to my children?

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      Type 1 Diabetes And Anemia

      Pernicious anemia an autoimmune disease that impairs the guts ability to absorb B12 is the most common anemia in type 1 diabetes. Pernicious anemia can be dangerous because it can strain the heart and blood vessels especially hard. One study found that patients with Type 1 diabetes and anemia were twice as likely to develop a macrovascular disease as those without anemia. Happily, B12 injections are very effective treatment.


      Ida And Glycemic Control In Patients With Type 1 Dm

      A1C Errors

      Tarim et al. performed a prospective study including 37 patients with type 1 diabetes . Patients with ID had higher levels of HbA1c than patients without iron deficiency. After iron supplementation for three months, these patients showed a significant decrease in HbA1c levels. In patients with Type 1 DM, HbA1c decreased from a mean of 10.1 ± 2.7% to a mean of 8.2 ± 3.1% . Additionally, HbA1c in ID non-diabetic patients decreased from a mean of 7.6 ± 2.6% to 6.2 ± 1.4% after iron therapy .

      In support with this finding, El-Agouza et al. studied 47 students with IDA . After treatment with oral iron for 20 weeks their HbA1c significantly decreased from 6.2 ± 0.6% to 5.3 ± 0.5 %.

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      Prevalence Of Prediabetes Diabetes Id And Anemia

      Approximately 35% of men and women had HbA1c or FBG above the prediabetes thresholds. Although 11.1% of men and 9.2% of women were classified as having diabetes by either FBG, HbA1c, physician diagnosis or medication use, only 6.2% of men and 4.8% of women had diabetes using both HbA1c and FBG, physician diagnosis or medication use . The prevalence of ID and/or anemia was ~20% for men and 40% for women.

      Table 1 Percent or mean values for sample characteristics according to sex in Chinese adults aged 1875 years, 2009 China Health and Nutrition Survey


      From the prediabetes models, relative to normoglycemia, men with anemia alone versus normal iron/hemoglobin were more likely to be classified with prediabetesHbA1c . Similarly, in comparison with prediabetesFBG, men with anemia alone had higher relative risk of being classified with prediabetesHbA1c . Men with ID alone or IDA had higher relative risk of prediabetes HbA1c than prediabetesHbA1c+FBG. Women with ID alone versus normal iron/hemoglobin were more likely to be classified with prediabetesFBG relative to prediabetesHbA1c . There was relatively little difference in prediabetes by HbA1c versus FBG for women with IDA.

      Sensitivity analyses

      In our analysis with stratified models by region , we did not see differences in the direction or magnitude of associations, however, estimates were imprecise due to small sample size.

      Anemia Management In Persons With Diabetes

      The good news is that managing anemia isnt too much different from managing the diabetes itself. You need a good diet, a disciplined approach, and qualified medical help:

      Ways to take care of yourself include:

      • Keep your BMI and waist circumference in healthy ranges by exercising and eating healthy
      • Eat foods rich in iron, folic acid, B-12 and vitamin C
      • Manage your high blood pressure
      • Commit to good glycemic control
      • Keep your doctor appointments
      • If you have Celiac disease, follow a Gluten-free diet
      • Meet with a dietician if you are unsure about the food choices to make

      Does diabetes cause anemia?


      Indirectly, yes: the complications that diabetes cause make anemia more likely. Taking care of yourself and controlling your diabetes is the most important thing to do to decrease your risk.

      Will anemia make my diabetes worse?

      Anemia can make your complications from diabetes worse. It can worsen eye disease, kidney problems, heart disease, and make diabetic ulcers harder to heal. It also decreases the quality of life because of the lack of energy. Leave your comments down below!

      TheDiabetesCouncil team would like to thank Dr. Mitch Winkler for his feedback. You can learn more about him on this page

      TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on May 28, 2020


      References

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      Consequences Of Anemia In Patients With Diabetes

      So why it is so important for people with diabetes and anemia to seek treatment? There are several reasons!

      First of all, anemia can worsen many typical diabetic problems: kidney disease, heart disease, and eye and nerve damage, for example.

      Since anemia can impair oxygen delivery to body tissues, it can make it even harder for a diabetic person to heal ulcers and surgical wounds.


      The heart of patients with diabetes are already under strain. The added stress of anemia can drive already-overworked heart muscle into hypertrophy, failure, and death.

      Besides the physical problems, anemia can worsen fatigue, depression, and quality of life for the person with diabetes.

      So what does this all mean? It means that anemia can complicate life for people with diabetes tremendously. The importance of identifying and treating anemia cannot be overestimated.

      Role Of The Funding Source

      Hypoglycemia (Low Blood Sugar) and How to Avoid it

      The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report and the decision to submit for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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      Id And Ida Andglycemic Control In Patients With Type 2 Dm

      Christy et al. found a positive correlation between IDA and increased A1C levels, especially in the controlled diabetic women and individuals having FPG between 100-126 mg/dl.

      In addition, investigations performed on diabetic chronic kidney disease patients, and diabetic pregnant women showed increased HbA1c levels in iron deficiency anemia , which was reduced following iron therapy and improvement of Hb level .

      Anemia in diabetic patient appears to have a remarkable unfavorable effect on quality of life and is associated with disease progression and the development of co-morbidities. Reduced hemoglobin levels, even to a limited degree, can identify patients at increased risk of progressive renal disease. Although anemia is clearly associated with both micro- and macrovascular complications in patients with type 1 diabetes, it remains to be established what role anemia may have in the development or progression of these complications . There is a direct relationship between anemia and diabetic kidney disease, A number of studies, including the reduction on endpoints in non-insulin-dependent diabetes mellitus with angiotensin II antagonist losartan trial, have suggested that reduced Hb levels, even within the normal range, identify patients with NID-DM at increased risk for progressive renal disease .

      Iron & Diabetes: Your A1c

      So why am I babbling on about iron? Because there are two different iron-level conditions that are relevant to diabetes. The first is hemochromatosis, a genetic disease found most commonly among people with Celtic ancestry.

      Hemochromatosis makes you absorb too much iron, and the high iron levels attack many organs in the body, including the beta cells. So people with the hemochromatosis gene are at very high risk of getting diabetes. Some people absorb enough iron that their skin turns slightly brown, and if they develop diabetes, its sometimes called bronze diabetes because of the bronzed color of the skin.

      The other condition is the exact opposite, a form of anemia, or too little hemoglobin in your blood. It occurs when you dont absorb enough iron or when you lose iron because youve lost a lot of blood. Without iron, you cant make hemoglobin, and without hemoglobin, you cant make enough red blood cells.

      This condition is called, not surprisingly, iron-deficiency anemia.

      A test for both these conditions is the ferritin test. Ferritin is the protein that the body uses to store iron, and its a good indicator of overall iron levels in the body. Low ferritin could mean iron-deficiency anemia. High ferritin could mean hemochromatosis.

      Conversely, if you find you have iron-deficiency anemia and you treat it with iron supplements, your A1c will go down.

      So many things can affect our health, and so many things can affect the lab tests we use to monitor our health.

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      Possible Causes With Diabetes

      Diabetes affects your bodys ability to use insulin. Think of insulin as the key that unlocks your cells, letting glucose in for energy.

      People with diabetes use a variety of treatments to help their bodies use the glucose in their blood. Among these are oral medications that increase insulin production and insulin injections.

      If you take too much of these types of medications, your blood sugar may drop too low. People also sometimes experience low blood sugar when planning to eat a big meal, but then they do not eat enough.

      Skipping meals, eating less than normal, or eating later than normal but taking your medication at your normal time can also lead to low blood sugar levels.

      Unplanned excess physical activity without eating enough can also cause a drop in blood sugar levels.

      Drinking alcohol when youre on these medications can also lead to low blood sugar, especially if it replaces food. When the body is trying to get rid of alcohol it becomes worse at managing blood sugar levels.

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