Diabetes Self-Management Articles

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When “Tired Blood” is Slowing You Down

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

One condition that affects the body’s ability to absorb nutrients is celiac disease. In celiac disease, the body cannot tolerate gluten, a protein found in wheat, barley, and rye. If gluten is eaten, the normal, fingerlike folds of the small intestine flatten out, preventing the absorption of not just the gluten but of other nutrients, as well. About one in 20 people who have diabetes also have celiac disease.

Bariatric (weight-loss) surgery can also lead to nutrient deficiencies that cause anemia. Vitamin and mineral supplements are generally needed after bariatric surgery to prevent this.

Diabetes drugs. Metformin is the most widely prescribed treatment for people with Type 2 diabetes. It is now recognized that metformin can cause malabsorption of vitamin B12 and that long-term use (12–15 years) of metformin leads to vitamin B12 deficiency in 30% of people who use it. Vitamin B12 deficiency can cause anemia and also peripheral neuropathy (nerve damage in the feet, legs, hands, and arms).

Another type of diabetes drug, the thiazolidinediones, which include pioglitazone (Actos) and rosiglitazone (Avandia), can also cause mild anemia by slightly decreasing hemoglobin levels and hematocrit, a measurement of the proportion of blood that is made up of red blood cells.

A person with very mild anemia may have no symptoms, but more serious anemia can cause tiredness, weakness, dizziness, irritability, shortness of breath, and/or depression. It can also cause brittle nails; pale skin; cold hands and feet; numbness and/or tingling in the fingers, toes, and feet; chest pain; an irregular heartbeat; cravings to eat unusual things such as ice; difficulty concentrating; and sexual problems.

If you have these symptoms, ask your health-care provider to check to see if you are anemic.

Diagnosing anemia
Anemia is diagnosed with a blood test. The blood sample is analyzed for the amount of hemoglobin in the blood and for the hematocrit.

For men, the normal hemoglobin range is 13.8–17.2 grams per deciliter (g/dl), and the normal hematocrit is 40.7% to 50.3%.

For women who are not pregnant, the normal hemoglobin range is 12.1–15.1 gm/dl, and the normal hematocrit is 36.1% to 44.3%.

The normal ranges for both men and women may vary somewhat from one laboratory to another and also vary according to altitude. At higher altitudes, the body produces more red blood cells in response to the decreased oxygen available. A higher number of red blood cells means that hemoglobin levels and hematocrit are also increased.

Test results below the low end of the normal range for either hemoglobin or hematocrit can indicate anemia. If initial tests show anemia, more blood tests may be done to establish the cause of the anemia and the best approach to treatment. For example, a test for the level of iron in the blood is often done, since iron deficiency is the most common cause of anemia. Other diagnostic tools include a physical examination and asking about such things as family history of anemia, diet, use of prescription or over-the-counter drugs, heavy menstrual bleeding (in premenopausal women), and any signs of internal bleeding, such as blood in stools.

As a side note, blood glucose meters have a hematocrit range at which they give accurate results. Having a hematocrit that falls outside your meter’s range may mean you are getting inaccurate results when monitoring your blood glucose. The package insert that came with your meter should state its hematocrit range.

Treatment and prevention
The treatment for anemia depends on the cause and severity of it. For example, if anemia is due to blood loss and it’s not severe, identifying the source of bleeding and stopping it will often be enough to reverse the anemia. For other causes or more serious cases, other steps may need to be taken, such as treating an underlying disease, taking vitamin or mineral supplements, and making dietary changes.

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