Anemia Can Be a Problem with Diabetes

I have been fortunate to have never had anemia since developing type 2 diabetes, but I know several of our support group that have. If you have diabetes, you will need to have your blood checked regularly for anemia. It is common for people with diabetes to also end up with this blood condition. It happens when your body’s red blood cells cannot deliver as much oxygen as your body needs. If you spot anemia early on, you can better manage the issues causing it.

Usually, anemia happens because you don’t have enough red blood cells. That can make you more likely to get certain diabetes complications, like eye and nerve damage. In addition, it can worsen kidney, heart, and artery disease, which are more common in people with diabetes.

Diabetes often leads to kidney damage, and failing kidneys can cause anemia. Healthy kidneys know when your body needs new red blood cells. They release a hormone called erythropoietin (EPO), which signals your bone marrow to make more. Damaged kidneys don’t send out enough EPO to keep up with your needs.

Often, people don’t realize they have kidney disease until it’s very far along. But, if you test positive for anemia, it can be an early sign of a problem with your kidneys.

People with diabetes are more likely to have inflamed blood vessels. This can keep bone marrow from getting the signal they need to make more red blood cells.

And some medications used to treat diabetes can drop your levels of the protein hemoglobin, which you need to carry oxygen through your blood. These drugs include ACE inhibitors, fibrates, metformin, and thiazolidinediones. If you take one of these, please talk to your doctor about your risk for anemia.

If you have kidney dialysis, you may have blood loss, and that can also cause anemia.

When your brain and other organs don’t get enough oxygen, you feel tired and weak. Other signs you may have anemia include:

• Shortness of breath
• Dizziness
• Headache
• Pale skin
• Chest pain
• Cold hands and feet
• Low body temperature
• Rapid heartbeat

A complete blood count gives your doctor a good picture of what’s going on in your blood. It counts your red and white blood cells and platelets, and it checks whether the red blood cells are a normal size.

It also checks the levels of hemoglobin in your blood and your blood volume. If your hemoglobin levels are low, you may be anemic. The normal ranges are 14 to 17.5 for men and 12.3 to 15.3 for women. If you have a lower percentage of red blood cells in your blood, you may be anemic.

If you are, the next step is to find out why. Your doctor may test you for:

• Iron deficiency
• Kidney failure
• Vitamin deficiency
• Internal bleeding
• Bone marrow health

If you’re anemic because your iron levels are low, it may help to eat iron-rich foods and take supplements. For people on kidney dialysis, it's best to get iron injected directly into a vein.

If your kidneys don’t make enough EPO -- the hormone that boosts the level of red blood cells you make -- your treatment may be a synthetic version of the hormone. You’ll get an injection every week or two, or you’ll have it during dialysis. It raises hemoglobin for most people, but it may also increase your chances of a heart attack or stroke. Your doctor needs to watch you closely while you’re on it

If your anemia is severe, you may need a blood transfusion.

You can lower your risk. Make sure you get enough iron from the food you eat. Most adult women need about 18 milligrams every day. Men need about 8.

Good sources of iron include:

• Iron-fortified breads and cereals
• Beans and lentils
• Oysters
• Liver
• Green leafy vegetables, especially spinach
• Tofu
• Red meat
• Fish
• Dried fruit, like prunes, raisins and apricots

Your body absorbs iron better if you have it along with food that contains vitamin C, like fruits and vegetables. Coffee, tea, and calcium can make you absorb less of it.

High blood pressure and high blood sugar cause the kidney damage that brings on anemia. If your doctor has prescribed you medication for either high blood pressure or high blood sugar, it’s important that you take it. A good diet and regular exercise also help.

Updated List of Published Resources

Since it is now over six years since I published this blog, I felt it was time for an update. I am a person with Type 2 Diabetes. Any advice that sounds good should be discussed first and always with your doctor.

I was diagnosed in October 2003 while in the hospital with angina problems. The last thirteen years have been a learning experience and have not been easy, but I have been learning.

The first thing I had to learn and accept was - it was not my fault. The second lesson took a lot longer - I cannot change the past - it is the past and I have to learn to live in the present. Painful, yes, and at times harder than a real job. This requires my attention seven days a week and does not allow for a vacation.

Several books, all in paperback, have influenced and made an impact on my life with diabetes. I would recommend for anyone diagnosed with type 2 diabetes to read them. As with any book written about diabetes, glean what is important to you. If you are like me, you will refer back to something you skimmed earlier when it becomes important to you.

First book: The First Year - Type 2 Diabetes, New York, Marlow & Company, 312 pages, by Gretchen Becker. I discovered this book within a month of diagnosis. It gave me information that I was not receiving from my doctor. Gretchen has type 2 diabetes and she gives the best definitions and reasons for controlling diabetes in non-technical language. Look for the Third Edition.

Second book: Diabetes Type 2 Complete Food Guide Management Program, New York, Three Rivers Press, 350 pages, by Sherri Shafer. She is a RD, CDE and tackles health issues and food for the person with diabetes. While higher in carbohydrates than suits me, this book came to my rescue when I had my first severe hypoglycemia. It gave me the resources to deal effectively with it. It has been handy for hyperglycemia information as well.

Third book: Myths of a Diabetic Diet, American Diabetes Association, 238 pages, by Chalmers and Peterson. While this book is dated, it is a well written guide for preventing excesses in eating changes. This concept is important for people new to diabetes. Even though there is no diabetic diet in today's understanding of diabetes, this book is still good to read.

Fourth book: Reversing Diabetes, Warner Books, Inc., 435 pages, by Julian Whitaker. This is not a cure book. This is for people with type 2 diabetes who wish to stay off or get off medications. If you are insulin dependent like me, this may not be for you. It can be valuable for those who are not insulin dependent. I had hopes at one time, but it was not meant to be.

Fifth book: The New Glucose Revolution, New York, Marlow & Company, 349 pages, by Dr. Jenny Brand-Miller, et al. This book is a recent addition to my library and should be on everyone's read list. It gives an excellent explanation of the Glycemic Index and the Glycemic Load values of many foods. It is aimed toward those of us with diabetes, but those wanting to lose weight and be capable of keeping the pounds off will benefit from this book. With the latest news about the reliability of the glycemic index discussed here, please remember to use this as a guide and not as a glycemic bible.

Sixth book: Diabetes Solutions by Dr. Richard K. Bernstein I don't own this book yet, but I am fortunate to have it available for me to read. This book is valuable to people with type 2 diabetes that use insulin and I want my own copy soon.

All the books are or have been available at Amazon.com.

Many other books are available for those of us with diabetes to read. I will review other books when I finish them and know that I will add them to my library or pass them to someone else. The above books will remain part of my library.

Where You Live Affects Your Treatment

A study of 250 million people in four countries found that patients with diabetes, hypertension, and depression often receive significantly different treatment depending on where they live.

Eleven groups of researchers used records from the Observational Health Data Sciences and Informatics program, establishing methods of equalizing the varying methods of collection and storing patient information to make the data usable for larger future studies.

The OHDSI contains more than 600 million patient records from 14 countries, including electronic health records, insurance claims and pharmacy records. The OHDSI is coordinated by researchers at Columbia University. The researchers hope the collection of data will allow for better design of clinical trials and treatment methods. The international project is aimed at gleaning insight into how people are treated, with the hope of providing more personalized and effective healthcare based on what works in the real world, as opposed to randomized clinical trials.

"The creation of such a network is a great opportunity, not only to characterize what treatments are actually being used, but also to attempt to identify what treatments are potentially better," Dr. Nigam Shah, an associate professor of medicine at Stanford University, said in a press release. "For example, from the wide variation in second-line treatments for diabetes, we can attempt to identify those that are more effective. OHDSI puts us on a path to creating personalized evidence, which is a form of precision medicine."

For the study, published in the Proceedings of the National Academy of Sciences, the researchers analyzed data on 250 million people in four countries receiving treatment for diabetes, hypertension and depression.

Among patients with diabetes, most are initially treated with the drug metformin, though secondary treatments vary significantly between patients. In hypertension and depression, initial treatments vary even more.

The researchers also found 10 percent of diabetes patients, 11 percent of depression patients and 24 percent of hypertension patients received paths of treatment different from all other patients whose records were analyzed in the study.

"We found that while the world is moving toward more consistent therapy over time for the three diseases, there remain significant differences in how they are treated," said Dr. George Hripcsak, chair of biomedical informatics at Columbia University Medical Center and principal investigator of the OHDSI coordinating center. "This suggests that randomized clinical trials -- the gold standard in evaluating new therapies -- may not capture enough of the information needed to make their results more broadly generalizable to different populations."

Stopping Medications

When it comes to diabetes there are many success stories, especially among those who know that diet and exercise play a big part in blood glucose control. Medication is also a key to getting your numbers into a healthy range.

However, if you’re like many people who take something daily for diabetes, you probably wonder if you can ever stop. Maybe -- if your blood glucose numbers are good and you’re committed to a healthy lifestyle.

The first step is to talk to your doctor. Here’s what you can expect from that chat.

Before you assume that your doctor will even allow you off your medication(s), many will not. This is because many doctors believe diabetes is progressive and that you will need more medications and they will gladly prescribe these for you.

“First, know that it's OK to ask your doctor if you can stop taking meds once you’ve met the blood sugar goals you've both set,” says Robert Gabbay, MD, PhD, chief medical officer of the Joslin Diabetes Center in Boston.

“And it can be done,” he adds.

The first step: Tell your doctor why you want to stop. Then he’ll ask you some questions.

“The doctor’s looking for specific answers,” says endocrinologist Gregg Faiman, MD, of University Hospitals Case Medical Center in Cleveland. He wants to know:

• Is it too hard for you to keep up with taking your medicine?
• Do the side effects lower you quality of life?
• Is the medication too expensive?

After that, you and your doctor have to agree about how you’re going to keep your blood glucose under control. You wouldn’t be on the drug if you didn’t need it, Faiman says. “Stopping a medication requires an in-depth discussion. You have to commit to keeping your diabetes under control.” This last statement is very important and is what most doctors demand.

Your doctor will keep a close watch on you if he decides to give you a trial run with either no meds or lower doses.

That means you’re still going to have to do your own readings. In addition, you’ll need an A1c test when your doctor suggests it to make sure you’re still at your target level, Faiman says.

You’re more likely to be able to stop if you’re only on one drug, like metformin, and not several. But if you’re serious about diet and exercise long term, you may be able to lower doses or maybe go off one or both of your meds.

Despite your best efforts with healthy eating and exercise, you may have to go back on medication at some point.

Diabetes is a progressive disease, Gabbay says. You may be able to stop taking meds early on, but that’s not likely to be a long-term answer, even for the healthiest person. What they are not saying is that some people can stay off of medications for decades and I have net several who have done this,

One study had people with diabetes make huge lifestyle changes. They got 175 minutes of weekly exercise, and ate 1,200 to 1,800 calories a day. Most had at least a partial remission, meaning they were able to keep their blood sugar under official diabetes levels without medication or weight loss surgery.

The ones who did best were those who lost a major amount of weight and became very fit. They were also either newly diagnosed with diabetes or had less-severe disease. And they weren’t taking insulin.

While some were able to stop taking their meds, the change lasted just a few years. After that, only about half the original number were in remission.

It isn’t their fault; it’s biology, Gabbay says. Doctors don’t ever want people to feel discouraged about going back on or adding medications to help.

“Lifestyle changes are powerful, but so are medications,” he says. And together they can make a big difference in your life over the long term.

Drug Side Effects Under Reported

An astonishing 64 per cent of drug or medical device side effects are left out of the published reports that clinicians so frequently base decisions on. This is the finding of a recent paper published in the journal PLOS Medicine by a team of UK researchers. I would estimate that percentage is much higher for statins.

The paper looked at 28 studies dealing with the discrepancies present in hundreds of published trial results, versus their unpublished counterparts. Unpublished data was found in places such as pharmaceutical reports and clinical trial registries. This includes ClinicalTrials.gov in the US, one of the first of its kind set up to bring greater transparency to the industry.

The authors found that harmful side effects would have been missed between 43 per cent and 100 per cent of the time if only the published findings were consulted and 64 per cent on average.

“There is strong evidence that much of the information on adverse events remains unpublished and that the number and range of adverse events is higher in unpublished than in published versions of the same study,” the authors wrote.

The main purpose of a paper is that there is good news and that something works. Most people consider side effects to be bad news so they present the minimum possible. The journals want to publish something that is exciting and interesting. I wouldn’t say it is anyone’s fault in particular. People like to think they have the new cure for cancer. I blame the culture.

The 28 studies the team looked at each approached the problem differently; so various specific issues were highlighted in each. One study, in particular, found that although there were fewer unpublished data sources than published among the trials studied, the total number of serious side effects was higher in the unpublished set. For example, instances of “suicide ideations, attempts, or injury, homicidal ideations, and psychiatric symptoms” all higher in the unpublished set. The side effects being dealt with in these broad studies are clearly not all trivial.

The researcher authors are now calling for full and transparent reporting of trial results so that medical professionals can base their decisions on the wider picture.

This is far from an unknown problem. Loke says we are so frequently getting only “a small, incomplete picture” of what actually happened in a trial. In many instances the authors behind the 28 studies had to submit Freedom of Information requests to get a fuller picture.

John Ioannidis, professor in disease prevention at Stanford Medicine and academic editor on the PLOS Medicine study, believes most editors and journals are in fact not actually aware of the extent of the problem. “Reporting of harms has always been suboptimal, even worse than reporting of effectiveness outcomes that has also had substantial deficiencies,” he told WIRED. “Many journals are starting to take more seriously the need for making detailed protocols and raw data routinely available. This will hopefully help remedy some of this bias or at a minimum it will help probe its depth. But there will still remain a lot of unpublished data and their non-availability may keep distorting the literature.”

Please read the full article here as I would have an extra long blog otherwise,

Health Conditions Treatable by a Ketogenic Diet – Part 3

#11. Traumatic Brain Injury. Traumatic brain injury (TBI) most commonly results from a blow to the head, a car accident or a fall in which the head strikes the ground. It can have devastating effects on physical function, memory and personality. Unlike cells in most other organs, injured brain cells often recover very little, if at all.

Because the body’s ability to use sugar following head trauma is impaired, some researchers believe the ketogenic diet may benefit people with TBI.

#12. Multiple Sclerosis. Multiple sclerosis (MS) damages the protective covering of nerves, which leads to communication problems between the brain and body. Symptoms include numbness and problems with balance, movement, vision and memory.

One study of MS in a mouse model found that a ketogenic diet suppressed inflammatory markers. The reduced inflammation led to improvements in memory, learning and physical function.

As with other nervous system disorders, MS appears to reduce the cells’ ability to use sugar as a fuel source. A 2015 review discussed ketogenic diets’ potential to assist with energy production and cell repair in MS patients.

Additionally, a recent controlled study of 48 people with MS found significant improvements in quality of life scores, cholesterol and triglycerides in the groups who followed a ketogenic diet or fasted for several days.

More studies are currently underway.

Bottom Line: Studies about the potential benefits of a ketogenic diet for treating MS are promising. However, more human studies are needed.

#13. Nonalcoholic Fatty Liver Disease. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world.

It is strongly linked to type 2 diabetes, metabolic syndrome and obesity, and there’s evidence that NAFLD also improves on a very low-carb, ketogenic diet.

#14. Alzheimer’s Disease. Alzheimer’s disease is a progressive form of dementia characterized by plaques and tangles in the brain that impair memory.

Interestingly, Alzheimer’s disease appears to share features of both epilepsy and type 2 diabetes: seizures, the inability of the brain to properly use glucose and inflammation linked to insulin resistance

#15. Migraine Headaches. Migraine headaches typically involve severe pain, sensitivity to light and nausea. Some studies suggest migraine headache symptoms often improve in people who follow ketogenic diets

Bottom Line: Some studies suggest that migraine headache frequency and severity may improve in people following a ketogenic diet.

Take Home Message

Ketogenic diets are being considered for use in several disorders due to their beneficial effects on metabolic health and the nervous system.

However, many of these impressive results come from case studies and need validation through higher-quality research, including randomized controlled trials.

With respect to cancer and several other serious diseases on this list, a ketogenic diet should be undertaken only in addition to standard therapies under the supervision of a doctor or qualified healthcare provider.

Also, no one should consider the ketogenic diet a cure for any disease or disorder on its own.

Nonetheless, the ketogenic diets’ potential to improve health is very promising.

Part 3 of 3 parts.

Health Conditions Treatable by a Ketogenic Diet – Part 2

#6. Some Cancers. Cancer is one of the leading causes of death worldwide. In recent years, scientific research has suggested that a ketogenic diet may help some types of cancer when used along with traditional treatments such as chemotherapy, radiation and surgery.

Many researchers note that elevated blood glucose, obesity and type 2 diabetes are linked to breast and other cancers. They suggest that restricting carbs in order to lower blood glucose and insulin levels may help prevent tumor growth.

#7. Autism. Autism spectrum disorder (ASD) refers to a condition characterized by problems with communication, social interaction, and in some cases, repetitive behaviors. Usually diagnosed in childhood, it is treated with speech therapy and other therapies.

Bottom Line: Early research suggests some people with autism spectrum disorders may experience improvements in behavior when ketogenic diets are used in combination with other therapies.

#8. Parkinson’s Disease. Parkinson’s Disease (PD) is a nervous system disorder characterized by low levels of the signaling molecule dopamine. The lack of dopamine causes several symptoms, including tremor, impaired posture, stiffness and difficulty walking and writing.

Because of the ketogenic diet’s protective effects on the brain and nervous system, it’s being explored as a potential complementary therapy for PD.

#9. Obesity. Many studies show that very low-carb, ketogenic diets are often more effective for weight loss than calorie-restricted or low-fat diets. What’s more, they typically provide other health improvements as well.

#10. GLUT1 Deficiency Syndrome. Glucose transporter 1 (GLUT1) deficiency syndrome, a rare genetic disorder, involves deficiency of a special protein that helps move blood sugar into the brain. Symptoms usually begin shortly after birth and include developmental delay, difficulty with movement and sometimes seizures.

Read this which is a full discussion of the points I only skimmed.

Part 2 of 3 parts.