Diabetes and Anemia: Risk Associated Due to Anemia in Patients With Diabetes

Last updated on April 19th, 2022

If a person is diabetic, he or she has to get their blood checked for anemia on a regular basis. It’s common for diabetics to also end up with this blood problem. If a person spots anemia at the beginning, he or she may better manage the problems causing it. Many individuals must have heard of anemia and must be aware that it has a direct relation with the blood.

In addition, many individuals relate anemia to feeling exhausted. However, possibly not too many individuals could describe precisely what anemia is. In simple terms, anemia is a medical condition where the healthy RBCs number is lower than normal and/or a lower-than-usual quantity of hemoglobin in the RBCs.

Oxygen is carried from the lungs to the rest of the body parts via RBCs. The particular part of the RBC that transfers oxygen is referred to as hemoglobin. Also, RBCs transfer waste products from the cells to the urinary and respiratory systems to get eliminated from the body.

When either the number of RBCs or the quantity of hemoglobin is low, less oxygen is received by the body’s cells as compared to the normal. A low level of oxygen might result in fatigue and other signs like weakness, trouble while exercising, and dizziness.

Anemia may develop because of several reasons. In actual fact, there are above 400 types of anemia. However, they all might be classified under these 3 general groups:

  • Anemia resulting from blood loss.
  • Anemia results from a reduction in the production of RBCs in the bone marrow or decreased production of RBCs.
  • It resulting from the destruction of RBC.

Anemia is a moderately common health problem; however, it frequently goes unknown and hence remains untreated. Its signs are unclear and easily mistaken for signs of other severe or long-lasting medical conditions.

However, even mild anemia may considerably lessen a person’s quality of life, and unmanaged anemia might result in severe chronic health effects.

Diabetes and Anemia

Diabetes does not directly result in anemia, however, several complications and health problems related to diabetes may add to it. For instance, both diabetes-associated renal disorder (nephropathy), as well as nerve damage (neuropathy), may add to the development of anemia.

Moreover, consuming certain oral anti-diabetes medicines elevate the risk of developing anemia. Also, diabetics might have anemia due to not consuming well or having a medical problem that hinders the absorption of nutrients.

  1. Renal disorder. Usually, a hormone named erythropoietin gets secreted by the kidneys. This hormone stimulates the bone marrow to form RBCs. In a condition named diabetic nephropathy, the small blood vessels that filter waste products from the body get damaged and begin “leaking” chemicals like protein into the urine. Simultaneously, the quantity of erythropoietin formed by the kidneys is decreased, giving rise to anemia. Few research studies have found that lowered production of erythropoietin, as well as anemia, occurs earlier in diabetics and people with renal disorder as compared to people with renal disease as well as no diabetes. Both recurrently high levels of blood sugar and high blood pressure may result in renal damage.
  2. Neuropathy. In individuals with a type of neuropathy named autonomic neuropathy, the body might not be capable of appropriately signaling the kidneys to form more amount of erythropoietin in response to anemia.
  3. Lack of nutrition. Many diabetics have nutrient deficiencies that result in anemia. Nutrient deficiencies may be resulting due to either not consuming a sufficient amount of nutrients (as an individual limit his or her food choices, for instance) or by the body’s incapability of absorbing the nutrients that are consumed. Lack of iron, vitamin B6, vitamin B12, as well as folate all may bring about anemia.
  4. Heart dysfunction. Diabetics are at enhanced risk for heart failure, or the incapability of the heart to pump a sufficient amount of blood to meet the body’s requirements. Reduced heart working may bring about renal impairment, and a majority of individuals with heart failure also suffer from nutritional deficiencies; both of these may add to anemia. Roughly, 20% of individuals having heart failure are anemic.
  5. Celiac Disorder: Another condition that influences a person’s body’s capacity to absorb nutrients is celiac disorder. In celiac disorder, a person’s body fails to tolerate gluten, a protein present in barley, wheat, or rye. If gluten is consumed, the normal, fingerlike folds of the small intestine compress, avoiding the absorption of gluten together with other nutrients. Around 1 in 20 diabetics also have celiac disease.
  6. Bariatric (weight loss) surgery might also bring about nutrient deficiencies that are responsible for anemia. Vitamin, as well as mineral supplements, are usually required following bariatric surgery to avoid this. 
  7. Anti-diabetes medications. Metformin is the most extensively recommended treatment for individuals having type 2 diabetes. Now, the medicine is known for causing malabsorption of vitamin B12. A long-term use (12–15 years) of metformin brings about a deficiency of vitamin B12 in 30% of individuals who use it. A deficiency of Vitamin B12 may result in anemia as well as peripheral neuropathy (nerve damage of hands, feet, arms, or legs).
  8. Anti Diabetes Medicine: Another class of anti-diabetes medicines, the thiazolidinediones, which involve pioglitazone (Actos) and rosiglitazone (Avandia), may also result in mild anemia by reducing the levels of hemoglobin and hematocrit to some extent. Hematocrit is the extent of the proportion of blood that is formed of RBCs.

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Possible Reasons for Anemia

Generally, it occurs due to the fact that a person does not have an adequate number of RBCs. This is what makes the person more expected to get diabetes complications, such as eye and nerve damage. Moreover, it may deteriorate heart, kidney, as well as artery disease, which more commonly occur in diabetics.

Individuals fail to identify they have a renal problem until it’s very far along. However, if a person tests positive for anemia, it might be an early indicator of a problem with the kidneys.
diabetes and anemia
Diabetics are also more expected to have inflamed blood vessels. This may keep bone marrow from getting the sign they need to make more RBCs.

Few drugs used for treating diabetes may drop the levels of the protein hemoglobin, which a person requires to carry oxygen via the blood. These medicines may be ACE inhibitors, fibrates, thiazolidinediones, and metformin. If a person is on kidney dialysis, there is a possibility of blood loss, and that may also result in anemia.

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Signs of Anemia

When a person’s brain and other organs fail to receive an adequate amount of oxygen, he or she starts feeling tired and weak. Other symptoms of anemia can be:

  • Difficult breathing
  • Drowsiness
  • Headache
  • Chest pain
  • Low body temperature
  • Cold hands and feet
  • Pale skin
  • Fast heartbeat

Tests for Anemia

An overall blood count provides a good picture of what’s going on in the blood. It counts the number of RBCs, WBCS, and platelets, and it assesses whether the RBCs have a normal size.

In addition, it assesses the levels of Hb in the blood and the blood volume. If the Hb levels are low, the person is said to be anemic. The standard limits are 14 to 17.5 for males as well as 12.3 to 15.3 for females. If a person has a lower percentage of RBCs in his or her blood, the person is said to be anemic.

If anemia is diagnosed, the next step is to look out for the reason behind it. The healthcare provider might test the person for:

  • Lack of iron
  • Renal failure
  • Lack of vitamins
  • Internal bleeding
  • Bone marrow health

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Diagnosing Anemia

The diagnosis of anemia is done using a blood test. Analysis of blood samples is done for the amount of Hb in the blood as well as for the hematocrit.

  • For males, the standard Hb range is 13.8 to 17.2 grams per deciliter (g/dl), as well as the normal hematocrit, is 40.7% to 50.3%.
  • For females who are not pregnant, the standard Hb range is 12.1 to 15.1 gm/dl, as well as the normal hematocrit, is 36.1% to 44.3%.

The standard ranges for both males and females might differ from one lab to another and may also differ as per the altitude. At higher altitudes, a person’s body forms more RBCs in response to the reduced available oxygen. A greater number of RBCs implies that Hb levels and hematocrit are also enhanced.

Test results under the low end of the standard limit for either Hb or hematocrit might show anemia. If preliminary tests indicate anemia, more blood tests can be performed to find the reason behind anemia and the most excellent approach for its treatment. For instance, a test for the iron level in the blood is performed recurrently, as the lack of iron is the most common cause of anemia.

Other diagnostic tools may involve a physical assessment and discussing things like diet, family history of anemia, usage of prescription or OTC medicines, heavy menstrual bleeding (in premenopausal females), as well as any symptoms of internal bleeding like blood in stools.

Anemia Treatment

If a person is anemic as his or her iron levels are low, it might be a great help to consume iron-rich foods or supplements. For individuals on kidney dialysis, it’s best to obtain iron injected directly into a vein.

A person can get an injection of EPO every week or two, or he or she can have it during dialysis. It elevates the levels of Hb for many individuals, however might also enhance the possibilities of a heart attack or stroke. If a person is seriously anemic, a blood transfusion might be required.

Also Read: What level of blood sugar is dangerous?

Preventing Anemia

A person may lower his or her anemia risk. Take care that the person obtains enough iron from the food that is eaten. Many adult females require roughly 18 milligrams of iron every day. Males may require about 8.
Good sources of iron include beans, lentils, iron-invigorated bread and cereals, oysters, liver, tofu, leafy greens like spinach, red meat, dried fruits like raisins or apricots, and fish.

A person’s body absorbs iron better he or she takes it in combination with food consisting of fruits, veggies, and vitamin C. Tea, coffee, or calcium can make the person absorb less of it.

Hypertension and high blood glucose raise kidney damage that brings the person to anemia. If a physician has recommended the person drugs for either high blood pressure or high blood glucose, he or she must consume them. A good diet, as well as regular exercise, also assists in the same.

Anemia, in diabetic patients, is commonly related to decreased kidney function secondary to diabetic nephropathy. A lot of research studies have assessed this association of anemia in diabetic patients as well as have attributed anemia to lowered kidney function.

But there have been no identified analytical studies performed to assess the prevalence and predictors of anemia in diabetic patients in the absence of evident nephropathy.


What level of anemia is said to be serious?

The level of Hb from 8 to less than 10 g/dL is considered as grade 3, or severe anemia, while Hb under 8 g/dL is grade 4 or can be life-threatening anemia, as well as grade 5 is death.

What foods should be avoided if you are anemic?

Tea, coffee, milk, foods containing tannins like grapes, corn, and sorghum, foods consisting of phytates or phytic acids like brown rice or whole-grain wheat products, as well as foods containing oxalic acids like chocolate, peanuts, and parsley.

What are the health problems resulting due to anemia?

Left untreated, anemia may bring about several health problems like extreme fatigue. Severe anemia may make a person feel so exhausted that he or she is unable to complete daily tasks.

Does diabetes result in low hemoglobin?

Low Hb concentration in diabetics is found to be related to a more rapid decline in glomerular filtration rate in comparison to that of other renal disorders. Diabetic nephropathy as well as diabetic retinopathy bring about an enhanced vulnerability to low Hb levels.


  1. https://www.diabetesselfmanagement.com/managing-diabetes/general-health-issues/anemia/
  2. https://ashpublications.org/blood/article/126/23/4545/93585/The-Prevalence-of-Anemia-in-Diabetic-Patients-with

Last Updated on by Dr. Damanjit Duggal 


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