Handouts: Anemia & Diabetes

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Glossary
Diabetes: Disease which causes your body to either not make enough insulin (type1) or not use insulin the right way (type2)

Diabetic eye disease: Damage to small blood vessels of the retina

Erythropoietin: Hormone that regulates red blood cell production

Hematocrit: Percentage of red blood cells in a blood sample

Hemoglobin: Protein carried by red blood cells that transports and delivers oxygen throughout your body

What is anemia?
Anemia is a below-normal level of hemoglobin* or hematocrit*. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity.1

How common is anemia in people with diabetes?
There are over 17 million people in the United States who have diabetes. About 5-10% have type 1 diabetes and 90-95% have type 2 diabetes.1 Diabetic kidney disease is a common cause of kidney failure. Approximately one-third of people who have type 1 diabetes for at least 15 years develop kidney disease.2 Many people with kidney disease develop anemia.

What causes anemia in people with diabetes?
Kidney disease is a common complication of diabetes. Damaged kidneys may not produce enough erythropoietin (EPO), a hormone that regulates red blood cell production. Less EPO in turn means fewer red blood cells and their protein hemoglobin to deliver oxygen to your body’s organs. If there are not enough red blood cells, your body does not get the right amount of oxygen, resulting in anemia. Additional causes of anemia are low levels of iron or low levels of certain vitamins that your body needs to produce hemoglobin and make healthy red blood cells.1

What are the effects of untreated anemia in diabetes?
Studies show that having anemia along with diabetes may increase the likelihood of developing diabetic eye disease, developing heart disease or having a stroke.3,4 People who have both diabetes and anemia are more likely to die early than those who have diabetes but not anemia.1 High death rates are even more common in anemic people with diabetes who also have heart failure and/or kidney disease.5 While managing anemia may be life saving in some circumstances, treatment has not proven to guarantee a longer lifespan.

How do I know if I have anemia?
The best way to determine if you have anemia is to discuss your blood counts and changes in hemoglobin and hematocrit with your doctor. Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache. It is important to see your doctor on a regular basis in order to be tested for possible anemia.

What treatments are available to help me?
Treatment will vary by the cause of the anemia. Iron or vitamin supplements may be recommended. Anemia that is associated with kidney disease often requires treatment with drugs that stimulate red blood cell production. Noteworthy though are recent studies which suggest that it is best not to try to correct the anemia to normal levels.6 Close communication with your doctor will help him or her provide the treatment that is best for you based on what is causing the anemia.

*Normal Lab Values: Normal hemoglobin >12 g/dL for women, >13 g/dL for men; normal hematocrit >36% for women, >39% for men.

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References

  1. National Anemia Action Council. Anemia: A Hidden Epidemic. Los Angeles, CA: HealthVizion Communications, Inc; 2002.
  2. NIDDK: Diabetes Control and Complications Trial. Available at: http:// diabetes.niddk.nih.gov/dm/pubs/control/#kidney.
  3. Friedman EA, et al. Am J Kidney Dis. 1995;26:202-208.
  4. Qiao Q, et al. J Clin Epidemiol. 1997;50:153-158.
  5. Collins A, et al. Adv Stud Med. 2003;3(3C);S14-S17.
  6. Singh A, et al. New Eng J Med. 2006;355:2085–2098.

Information Handout Disclaimer
This educational material is designed to assist you in your discussion with health care professionals. It is not intended for use as the primary basis for medical judgments or decisions and does not replace personal consultation with your doctor, nurse, pharmacist, etc. NAAC disclaims responsibility and liability for the use of any information obtained from this educational material. All of the content comprising this work is the sole and exclusive property of NAAC and may be copied, reproduced, distributed, displayed, posted or transmitted with consent from and proper attribution to NAAC. The content of this handout was developed independently and without any input from the sponsors.

Handouts Last Updated: January 14, 2009