October 8, 2016

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.

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