If you live with diabetes, you may be aware that having the condition and its complications may put you at greater risk of developing anemia. But how are the two conditions related and what does this mean for you?

This article will investigate the relationship between diabetes and anemia, and what you should know if you have diabetes-related complications impacting your life.

According to the National Heart, Lung, and Blood Institute, Anemia is a condition in which the blood doesn’t have enough healthy red blood cells to function properly. This leads to reduced oxygen flow to the body’s organs.

There are more than 3 million cases of anemia diagnosed in the United States every year, making this a very common condition.

You may experience the following symptoms:

  • extreme fatigue
  • pale skin
  • shortness of breath
  • lightheadedness
  • rapid heart rate
  • low body temperature
  • cold hands and feet
  • headache
  • dizziness

It’s important to note that some anemia symptoms are similar to symptoms of high blood sugar, including dizziness, lightheadedness, extreme fatigue, rapid heart rate, and headache.

Check your blood sugar often to make sure you’re not confusing high blood sugar for suspected anemia. If your symptoms continue for a few days or weeks without high blood sugar numbers or ketones, call a healthcare professional to get checked for anemia.

Diabetes doesn’t cause anemia and anemia doesn’t cause diabetes. The two conditions are related, though.

Up to 25 percent of Americans with type 2 diabetes also have anemia. So it’s relatively common for people with diabetes, and especially diabetes-related complications, to also develop anemia.

However, if you have one condition or the other, you won’t automatically develop the other condition.

As seen in this 2004 study, Anemia is a common complication of people with diabetes who develop chronic kidney disease because damaged or failing kidneys don’t produce a hormone called erythropoietin (EPO), which signals to the bone marrow that the body needs more red blood cells to function.

Early stages of kidney disease (nephropathy) may be asymptomatic, but if you’re diagnosed with anemia and you have diabetes, it might be a sign that your kidneys aren’t working properly.

People with diabetes are also more likely to have inflamed blood vessels. This prevents the bone marrow from even receiving the EPO signal to create more red blood cells to begin with. That makes anemia a more likely result.

Additionally, if you have existing anemia and are then diagnosed with diabetes, it may make you more likely to develop diabetes-related complications, such as retinopathy and neuropathy (eye and nerve damage).

A lack of healthy red blood cells can additionally worsen kidney, heart, and artery health, systems that are already taxed with a life lived with diabetes.

Certain diabetes medications can decrease your levels of the protein hemoglobin, which is needed to carry oxygen through the blood. These diabetes medications can increase your risk of developing anemia:

  • Metformin. This is one of the most commonly prescribed type 2 diabetes medications for helping to manage glucose levels. This study shows metformin can cause malabsorption of vitamin B12, and long-term use of the drug (more than 10 years) can lead to a vitamin B12 deficiency in up to one-third of people who use it. Vitamin B12 deficiency can cause anemia. It’s recommended to get an annual blood panel if you have diabetes and are a long time metformin user.
  • Fibrates. This type of medication is used to lower triglycerides as well as LDL slightly, for people with diabetes at risk for cardiovascular complications. Examples of fibrates include: clofibrate (Atromid-S), gemfibrozil (Lopid), and fenofibrate (Antara, Lofibra, and Triglide).
  • Angiotensin-converting enzymes (ACE) inhibitors. ACE inhibitors help blood vessels to relax and open, in order to help improve blood flow and lower blood pressure. These meds are often prescribed for those with diabetes and chronic kidney disease. There are many different ACE inhibitors, including lisinopril, enalapril, and benazepril.,
  • Thiazolidinediones. Sometimes known as TZDs or glitazones, these medications lower the insulin resistance in people with type 2 diabetes.

Since blood loss is also a significant contributor to the development of anemia, if you have diabetes and are on kidney dialysis, you may want to talk with your healthcare team about your increased risk of anemia as well.

Anemia can affect blood sugar levels in several ways.

One 2010 study found that anemia produced false high blood sugar levels on glucose meters, leading to dangerous hypoglycemia events after people overtreat that false high blood sugar.

As shown in a 2014 study, there’s a direct link between anemia caused by iron deficiency and higher amounts of glucose in the blood. A 2017 review of several studies found that in people both with and without diabetes, iron-deficiency anemia was correlated with increased A1C numbers.

This resulted from more glucose molecules sticking to fewer red blood cells. After iron-replacement therapy, HbA1c levels in the studies’ participants decreased.

If you receive an anemia diagnosis and you live with diabetes, there are many excellent treatment options.

  • If you’ve been diagnosed with iron-deficiency anemia, it may help to eat more iron-rich foods and/or take a supplement. Some iron-rich foods include: beans, lentils, oysters, liver, green leafy vegetables, tofu, red meat, fish, and dried fruits such as prunes, raisins, and apricots.
  • If you take metformin and have low iron levels, resulting in an anemia diagnosis, talk with your diabetes care team about possibly changing your diabetes medication or changing your dose.
  • If you’re on kidney dialysis, it’s best to get iron injected directly into your vein by your doctor (this will raise your hemoglobin enough for most patients, but be aware that is can also increase your risk of both heart attack and stroke).
  • If your kidneys are damaged and they’re not producing enough EPO, you may be prescribed a synthetic form of the hormone (rhEPO) to promote red blood cell production back to normal levels. However, as seen in this 2012 study, 5 to 10 percent of people on rhEPO therapy develop a resistance to the drug. Your doctor will have to closely monitor you while on this therapy to help prevent resistance.
  • Lastly, if your anemia is severe enough, you may need a blood transfusion.

Treatment will depend on the underlying cause of the condition, but may include supplementation with iron and/or vitamin B.

If your anemia is caused by blood loss, a blood transfusion may be necessary. If your body’s blood production is reduced, medications to improve blood formation may be prescribed.

Diabetes and anemia are closely related, though neither directly causes the other condition.

Diabetes-related complications such as kidney disease or failure and inflamed blood vessels may contribute to anemia. Certain diabetes medications can also increase the likelihood of developing anemia. Anemia may also make diabetes management more challenging, with higher A1C results, false high blood sugars, and a potential risk of worsening organ health leading to future diabetes complications.

Still, anemia is very treatable with supplementation, dietary or medication changes.