Wil Dubois

Got questions about navigating life with diabetes? Well, this is your chance to Ask D'Mine! Our weekly advice column, that is — hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil takes on two questions about how other conditions play into diabetes and what our D-Community might need to know when factoring those other health hassles in...

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Ruth, type 1 from Florida, writes: DKA coma and blood sugar of 1,739 at diagnosis 40 years ago was a rough way to find out I was diabetic. I now have anemia and no longer make good red blood cells. Does this skew my A1C number and blood glucose results with my meter?

Wil@Ask D'Mine answers: Yep, anemia can mess up A1Cs and home testing, as both are engineered under the assumption that everyone has the "normal" number of red blood cells.

Generally speaking, folks with most kinds of anemia can expect false lows on the A1C, meaning the score will give you a false sense of security. This is because anemia is generally associated with either shortened red blood cell life, or high turnover of red blood cells due to blood loss. In either case, if the blood cells aren't around for the normal period of time, they don't have the chance to get exposed to as much sugar as the test assumes they have been. Think of it like kitchen sponges. If you left one sponge in the dishwater for five minutes to fully saturate, and then dipped a second one in the water for a moment and wrung them both out to measure their water content, the sponge that was just dipped would hold less water.

Interestingly, however, if you happened to have iron-deficiency anemia, it would be the other way around:squeezing-sponge The A1C would give you a false high and scare the pants off of you for no good reason. While many studies have identified the correlation between iron-deficiency anemia and falsely elevated A1Cs, the reason for the false highs are not clear. One theory is that in iron-deficiency anemia the blood cells may have extended lives. Now we've taken a power washer to the sponge to force more water into it. Another theory has to do with the iron levels themselves and their effect on the test results, and our kitchen sponge is powerless to help explain this.

For what it's worth, there are plenty of other medical conditions and factors that can throw off A1Cs. For a complete list you can go here.

As to your meter, low levels of red blood cells — a.k.a. low hematocrit — will give false-high readings on most conventional meters, with some meters clocking erroneous readings 68% higher than the actual blood sugar. That sets you up for over-correcting with your insulin and suffering from epic lows. I'd recommend that you get a meter that uses dynamic electrochemistry technology, as these meters seem immune to the effects of low hematocrit. An example would be the AgaMatrix Presto.


Mariaj, type 2 from Oregon, writes: I've had a number of cancers, three of them organ ones, and each time they took out lymph glands: 13, 21, and some other number I've not been able to track down. Now in my 70s after at least 25 years of type 2 diabetes (pen, syringe, insulins), my lymphedema is getting out of control. I've read online a lot about the usual things I can do to "help" but get less and less success. While I do have some other health problems, I do eat well, I've used compression socks and a leg compression machine, and I exercise. (Just in case you thought I might be 600 pounds lying around being depressed.) Yesterday my leg burst open in 5-6 little places (which bled) from the force of the edema. I'm looking for three answers: Does diabetes contribute to lymphedema significantly? Is there any way I can tackle lymphedema from the diabetes angle? And: Have you dealt with severe lymphedema in diabetics before?

Wil@Ask D'Mine answers: No, I haven't. While I've got a handful of diabetes patients who are cancer survivors and/or undergoing cancer treatment, none of them as yet had to deal with severe lymphedema. Knock on wood. By the way, readers, lymphedema (lymph + edema) is a medical term for limbs swollen due to missing lymph glands. You can think of it like a damaged municipal storm drain system, where some percentage of the drains in the gutters are blocked and cause street corners to flood after the rain.

Like diabetes, there's no cure for lymphedema. Like diabetes, there are treatments. Unlike diabetes, the treatments don't seem to work very well.

The treatments for lymphedema are generally therapies, rather than drugs. Using a "water pill" or similar diuretic medication isn't any help because the swelling is essentially caused by permanent breaks in the drainage system, and diuretics can't solve that problem. To extend our analogy, you could pictSo Many Other Health Conditionsure a diuretic like Drain-O that can open up a clogged pipe, but not fix a broken one.

Mariaj, you're already using some of the treatments, and I'm sure you've probably been exposed to the rest: Compression bandages or clothing to force the backed-up lymphatic fluid back upstream into your trunk; pneumatic compression pumps; and manual lymph drainage massage. Medscape blithely refers to these therapies as, "cumbersome, uncomfortable, inconvenient, and time-consuming."

Ya think?

I'm told that in really bad cases, surgery is sometimes used to reduce the tissue in the limb or limbs. I guess the idea is to leave less area for fluid to build up. Yikes. Sounds brutal!

Lymphedema leads to a lot of skin problems, like the ones you reported, with bursts, tears, ulcers, etc. Of course diabetes carries risks of skin issues, too, if the blood sugars aren't kept well controlled. Skin dried out from mildly elevated blood sugars can become a disastrous health crisis if your leg is swollen up like a balloon and wanting to explode from inside due to lymphedema. So the answer to your first question about does diabetes make lymphedema worse is: Maybe.

Of course, diabetes doesn't do anything at all. Other than make it hard to have normal blood sugar. It's the damn blood sugar that causes us all the trouble. If your blood sugar control is less than stellar, then I think it's possible that the diabetes will make the lymphedema worse — or at least the side effects of lymphedema worse — as your skin will be weaker, more prone to rupture, and slower to heal. And apparently lymphedema can also increase your infection risk. Of course, if your blood sugars are high, infections are slow to heal. (I find it grotesquely ironic that it's neither the diabetes nor the lymphedema, but their mutual and intertwined side effects, that make you suffer so.)

So I don't think that diabetes inherently makes the lymphedema worse, but it certainly is a sucky combo that feeds on each other in a most evil way.

As to your last question of breaking out the diabetes tool kit to take on the swelling from your lymphedema... Sorry, no. I can't think of anything brilliant. Other than the same old crap of keep your blood sugars in control, blah, blah, blah, yadda, yadda.

But that doesn't really seem like much help.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.