Diabetic link to anaemia

Anaemia can cause inaccurate hba1c results. The hba1c relies on a predictable lifespan (and size etc) of red blood cells. Diseases and conditions that effect red blood cells may well give falsely high or low hba1c. If you have such a condition they should be looking at alternative testing and assessment methods such as glucose tolerance tests, or fructosamine tests (often used in pregnanc) as well as regular blood glucose tests (fingerpricks).

It is the low iron not the count that matters.

Not an expert at all. But are you taking Metformin because it can make you deficient in b12
And make some people anaemic.

Iron deficiency anemia (IDA) can increase the red blood cell turnover which can increase glycation of Hb leading to higher HbA1c values.

onnecar said:

I'm no expert on that. Although the team at the surgery, always go by both when assessing my anaemia and have told me on many occasions that although iron is low the blood count is ok, so they are not so worried. In any case, I was more thinking of an intrinsic connection. i.e. why are people with diabetes more prone to anaemia, which it seems we are, and is there a link with insulin resistance that could give rise to anaemia or vice versa?

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Why do you think people with diabetes are more prone to anemia?

blood count is a generic term for various levels. For iron you want to look at haemoglobin, serum iron, ferritin, transferrin, total iron binding capacity (tibc)

onnecar said:

I do not think it. I found info on the net that suggests the two are related. I am looking at all possible causes of my anaemia. Have been for years and have yet to find one. If there is info on the net, then I'm assuming that other people have also come across it and have maybe found more info on it. I've been diabetic for many years and also been anaemic for a long time. My diet is fine. My weight is fine. This is an example of a link, but there are plenty more.

Anemia and Its Associated Factors Among Type 2 Diabetes Mellitus Patients Attending Debre Berhan Referral Hospital, North-East Ethiopia: A Cross-Sectional Study - PMC

Anemia is one of the common complications of diabetes mellitus (DM), which has an adverse effect on the progression and development of other diabetes-related complications. In spite of this, relatively little information is available on the ...

www.ncbi.nlm.nih.gov

I'm not sure why you are sending me a link to LCHF I already know all about this diet.

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Ok I could have said what led you to believe/think/know/suspect this etc? There was no intended meaning other than discovering how you came to be questioning this. A little oversensitive there maybe?

I’ve also had long term iron deficiency and have researched causes widely. This is the first time I’ve ever seen anything suggesting diabetes itself as a cause. I’ll dig deeper. Mostly it seems to be blood loss whether visible or internal, diet, or malabsorption somewhere along the digestive system, sometimes something like SIBO or parasites or low stomach acid. A deficiency in a cofactor can be responsible too like b12, folate etc. i guess if you are suffering a diabetic complication from something like gastropareisis then that could affect absorption or a medication so fall into that category.

I’m confused why you are anemic yet your doctors do nothing about it and dismiss it? Or is there dispute about what constitutes deficiency between you?

The article you link to talks of the majority of diabetic anemia cases relate to kidney damage/failing. I assume you’ve ruled that out. Along with the other mentioned causes such as medications.

Supplements and dosing regimes come in many forms and it seems common for certain supplements to be tolerated less or better than others. The NHS tend to only prescribe a couple of types renowned for poor tolerance. There are other gentler or liquid versions available and whatever you take having a high dose of vitamin c with it does help many of the side effects a lot. Theres a good Facebook group “The Iron Protocol (for iron deficiency with or without anemia) that has guides that explain the processes, causes and gives suggestions. Obviously as a peer fb group it’s not scientifically peer reviewed (but then officially neither is this forum but it’s still incredibly useful as a signposting tool) but they do have links and good anecdotal support for what they suggest. Could be worth a read.

Im slowly improving my ferritin levels from years at single figure by using a mix of different supplements and high dose vitamin c to ward off side effects and a variety of cofactors to keep everything else well balanced and optimal. I do take regular breaks which slows the process but keeps it heading the right way. I’ve made it to 20 at last and am aiming to be nearer 100 eventually. (NICE define under 30 as automatically iron deficient regardless of other levels) My hb is not quite classically anemic so most drs ignore the situation and all co factors just slide in above lab minimums but still way below optimal. I can’t find my cause for sure either.


I didn’t send you any links. What I think you are seeing is my “signature“ available/visible on the bottom of all my posts. Many posters have these with links to popular information.

onnecar said:

It's a long story about my anaemia. Incidentally I was not being oversensitive, merely stating facts. That is the trouble with only seeing things in print. There is a cold calculating quality about statements and info etc.
I also have a hiatus hernia and take a ppi for that. I cannot tolerate iron supplements, I've tried lots over the years, partly due to stomach reaction, or setting off hernia symptoms. I have had tests and cameras with all negative results. I eat meat and veg plus healthy foods. I hope that answers your question on that score. I will probably have to have an iron infusion if it gets much lower, but the NHS will not do that until it reaches a certain level. My ferritin/iron is currently at level 8. My most recent area of investigation is why diabetics are more prone to anaemia, as would seem to be the case. I just thought that surely someone somewhere must have had a similar issue and potentially found an answer. I may never know the answer, but there is no harm in asking the question.

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serum iron and ferritin are not the same thing at all. Serum iron varies throughout the day a bit like blood glucose does. Ferritin is more stable, although susceptible to false highs with inflammation. It represents stores of iron but when stores are low various processes that need iron prioritise and neglect some of the lower order requirements (image) in order to maintain haemoglobin as normal

PPI can cause it as they mess up absorption of nutrients and cause low stomach acids. Obviously with a HH not so easy to avoid them though. I’m not trying to grill you, just look at it from a new set of eyes as sometimes that helps. And as you say I am someone in a similar situation, unfortunately without a solid answer though. I’m still not sure which way the association with diabetes goes though. Potentially both ways

Ive had ferritin as low as 5 with the nhs declaring it as not an issue and just a little low! And a gastroenterologist refuse iron infusions. I hope you fair better.

This link to an Oxford based clinic with a forward looking view might help convince someone in the nhs to take it seriously and offer you an infusion seeing as supplements are so problematic https://nssg-test.oxford-haematolog...y-management-service-info-for-gps_L95xP4v.pdf and also a royal college of nursing guidance document https://www.rcn.org.uk/professional-development/publications/pub-007460. A couple of others if the lack haemoglobin is an issue are https://www.rcpjournals.org/content/clinmedicine/21/2/107 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986027/

I’ve come across mention of links between diabetes and anaemia in a number of places.
here are some examples



and this on the false diagnosis of T2 due pre-existing anaemia


as far as I can recall, most such articles describe a link between reduced iron absorption and the complications that diabetes may cause - which would imply it is less likely in the recently diagnosed, and more likely in those who were diagnosed much longer ago. Though, someone with pre-existing anaemia risks being wrongly diagnosed is their anaemia causes the HbA1c test result to be distorted.

Personally I suspect that the ‘anaemic’ carb heavy diet that most diabetics are told to eat (low fat, low red meat and eat carbs ‘for energy’ and to feel full) may be at least part of the problem.