Anemia & Diabetes

Aruna.V
Jr. Dietitian
Diet Department

What is anemia?
Anemia is a condition where the level of hemoglobin is below normal. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body.



Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and feel tired or experience shortness of breath with activity.

Normal Hemoglobin value:

Male = 13-18gm%
Female = 11-16gm%

What causes anemia in people with diabetes?

Anemia is one complication of uncontrolled Type 2 diabetes, due to a condition called diabetic nephropathy. Nephropathy is a disease of the kidneys, common in diabetics. When the kidneys are healthy they produce a hormone called erythropoietin. Erythropoietin acts on the bone marrow to stimulate it to make new red blood cells and helps to stabilize red blood cells. In nephropathy, erythropoietin levels are low and so the bone marrow does not make enough red blood cells to carry the required amount of oxygen to all parts of the body. When the number of red blood cells is low or when the amount of hemoglobin is abnormally low, it results in a state of anemia.


Anemia is one complication of uncontrolled Type 2 diabetes, due to a condition called diabetic nephropathy. Nephropathy is a disease of the kidneys, common in diabetics. When the kidneys are healthy they produce a hormone called erythropoietin. Erythropoietin acts on the bone marrow to stimulate it to make new red blood cells and helps to stabilize red blood cells. In nephropathy, erythropoietin levels are low and so the bone marrow does not make enough red blood cells to carry the required amount of oxygen to all parts of the body. When the number of red blood cells is low or when the amount of hemoglobin is abnormally low, it results in a state of anemia.



Other causes are as follows:

•Deficiency of Vitamin B12: Vitamin B12 deficiency develops when you cannot absorb this vitamin from food.
•When the body destroys cells responsible for absorption of vitamin B12.( pernicious anemia occurs).
•Surgery that alters the surface area of your stomach or the last section of your intestine (ileum)
•Digestive diseases such as Celiac disease and Crohn's disease
•Diabetes drug therapy with metformin. Anemia occurs in nearly 30% of diabetes patients using metformin for at least three years.

Iron deficiency is due to a lack of dietary iron. Nearly 20% of women, 50% of pregnant women, and 3% of men are iron-deficient.
•Women are at higher risk due to menstruation, lactation, or pregnancy – conditions that increase the requirement.
•Growth spurts demand higher iron levels.

What are the symptoms of anemia in diabetes?


People with diabetes who have anemia may feel weak, become tired easily, and have problems carrying out routine activities. Since these symptoms are also symptoms of diabetes, it may be difficult to determine if the symptoms are caused by anemia or by diabetes.

What are the effects of untreated anemia in diabetes?

Studies show that having anemia along with diabetes may increase the likelihood of developing diabetic eye disease, developing heart disease or having a stroke. People who have both diabetes and anemia are more likely to die earlier than those who have diabetes but not anemia. Fortunately, anemia can be treated, and benefits such as increased energy, activity level and improved quality of life can be achieved.

How to prevent anemia

People with diabetes can take steps to decrease their risk of developing anemia.
Cut the risk of developing anemia by controlling both blood glucose and blood pressure. Studies have shown that people with very good blood glucose control and blood pressure control have a lower risk of developing kidney damage.

Cutting the risk of kidney disease cuts the risk of anemia.

What are the treatments available?

Correction of anemia not only leads to less tiredness, more energy, and an improved quality of life but also to a reduction in mortality and admission to the hospital. Studies suggest that treatment of anemia slows the development of some of the complications of diabetes including damage to the nerves, the eyes and the kidneys.
Treatment varies according to the cause of the anemia. Iron or vitamin supplements may be recommended. Anemia that is associated with kidney disease may require treatment with drugs called erythropoiesis-stimulating agents (ESAs) that stimulate red blood cell production.

Another goal is to treat the underlying condition or cause of the anemia.

Dietary Factors:

Low levels of vitamins or iron in the body can cause some types of anemia. These low levels may be due to poor diet or certain diseases or conditions.


Iron

Iron found in foods is either in the form of heme or non-heme iron:

• Heme Iron. Foods containing heme iron are the best sources for increasing or maintaining healthy iron levels. Such foods include (in decreasing order of iron-richness) clams, oysters, organ meats, beef, pork, poultry, and fish.

•Non-Heme Iron. Non-heme iron is less well-absorbed. Eggs, dairy products, and iron-containing vegetables have only the non-heme form. Such vegetable products include dried beans and peas, iron-fortified cereals, bread, and pasta products, dark green leafy vegetables dried fruits, nuts, and seeds.

Vitamin C

Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits


Vitamin B12

Low levels of vitamin B 12 can lead to pernicious anemia. The only natural dietary sources of B12 are animal products, such as meats, dairy products, eggs, and fish.


Folic Acid

Folic acid (folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus.


Steps to Help Prevent Anemia
•Control your blood glucose
•Control your blood pressure
•Eat recommended amount of iron
•Include vitamin C rich foods in your diet
•Avoid caffeine which limits iron absorption