Diabetes Self-Management Articles

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When “Tired Blood” is Slowing You Down

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

In all cases, it takes time for the body to create new, healthy red blood cells, so a person is likely to feel better gradually.

Because anemia can recur, depending on the cause, the steps taken to treat it may need to be continued — possibly for life — to prevent it from coming back.

Kidney disease. If you have kidney problems, you should be under the care of a nephrologist, a physician who specializes in kidney diseases. Treatment for anemia related to kidney disease may include both steps to reverse the anemia and steps to improve kidney function (or prevent it from worsening). For example, to reverse the anemia, injections of a type of drug called an erythropoiesis-stimulating agent may be prescribed to stimulate your bone marrow to produce red blood cells. In addition, drug therapy with certain types of blood pressure drugs may be prescribed to prevent further kidney damage.

Also important for preventing further kidney damage are attaining and maintaining blood glucose levels as near to normal as possible and a blood pressure level below 130/80 mm Hg. If your kidney damage is already severe, however, you may need dialysis or a kidney transplant.

No matter how severe your kidney disease, you should meet with a registered dietitian who specializes in kidney diseases to help you with your food choices. People with diabetes and kidney disease have dietary needs that are somewhat different from those of people who have diabetes and no kidney disease. In particular, they need individualized guidelines for protein, potassium, phosphorus, and fluid intake, as well as for carbohydrate intake.

Heart failure. Take your medicines as prescribed, and follow your healthy lifestyle plan. Weigh yourself every morning, and report a weight gain of 3 pounds in one day or 5 pounds in one week to your health-care team. Rapid weight gain such as this can mean that your heart function is worsening, and fluid is accumulating somewhere in your body.

Diabetes drugs. If you take either metformin or a thiazolidinedione (Actos or Avandia), ask your health-care provider to check your blood to see if you are anemic. If your lab results show a low vitamin B12 level, you may be prescribed B12 supplementation. If your hematocrit and hemoglobin are low, your dose of Actos or Avandia may reduced, you may be advised to eat more foods that are higher in iron, and/or you may be advised to start taking iron supplements.

Nutrient deficiencies. If your anemia is due to blood loss or a nutrient deficiency, you may be instructed to eat more iron-rich foods and possibly to take iron supplements.

Iron-rich foods include beef, organ meats, pork, poultry, fish, clams, and oysters. The iron in foods of animal origin such as these is usually easily absorbed by the body. The iron in plant foods, such as fruits, vegetables, dried beans, nuts, and grain products, is less easily absorbed, but absorption can be increased by eating these foods along with foods high in vitamin C, such as dark leafy greens, broccoli, bell peppers (particularly red, yellow, and orange peppers), tomatoes, mangoes, papayas, and kiwifruits.

Taking vitamin C supplements is another option for helping your body absorb iron. However, vitamin C supplements can affect the accuracy of some blood glucose meters. Before you take vitamin C supplements, ask your meter’s manufacturer if taking vitamin C (also called ascorbic acid) affects the performance of your meter.

If your nutrient deficiency is due to a lack of vitamins or minerals other than iron, such as folate or vitamin B12, you may be prescribed a supplement, and you will be encouraged to eat foods high in folate and B12.

Foods high in folate include green leafy vegetables, eggs, seafood, lean beef, organ meats, orange juice, dry beans, lentils, asparagus, and broccoli.

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