A Common Type of Anemia can Affect your Diabetes Test

There are different kinds of anemia, but for this article, the word anemia will refer specifically to iron deficiency anemia. And yes, iron deficiency anemia can make your diabetes test inaccurate.

How is diabetes monitored?

The monitoring of diabetes treatment is done with the blood test called Glycated Hemoglobin or Hemoglobin A1c or HbA1c for short. The HBA1c is a reflection of the blood sugar control over the past 3 months.

Note to the science nerd reader, glycated is preferred over glycosylation because the reaction of the hemoglobin is nonenzymatic.

When someone has high blood sugar, the sugar in the blood interacts with the proteins and fats of the different cells of the body, including the RBCs, and forms a sugar-protein or sugar-fat complex that is irreversible. This reaction is called glycation and is the same reaction when you apply sugared barbecue sauce on meat while cooking. Diabetics with uncontrolled blood sugar undergo a body-wide “low and slow” internal barbecuing.

Glycation destroys the cells by causing cellular damage, promoting inflammation, and countering the beneficial effects of nitric oxide (NO). Thus contributing to hypertension and atherosclerosis formation. That is some of the ways diabetes damages the whole body.

Among all the glycated cells in the body, the red blood cells are the easiest and safest to obtain to test for the level of glycation. Since the RBCs last for 120 days, then the HBA1c level is a reflection of blood sugar control.

Erytrocyte_deoxy_to_oxy_v0.7 — A red blood cell as it travels the body with changing oxygen and carbon dioxide levels

Where does Iron deficiency anemia fit in?

The most common cause of iron deficiency anemia is blood loss. It can be from the monthly menstrual periods or from a barely-noticeable chronic gastrointestinal bleeding. A poor iron diet is also a contributor. Attention vegans.

Typically red blood cells (RBCs) last for about 120 days, which is about 4 months. When someone is iron-deficient, the body tries to hang on to whatever iron it has by prolonging the stay of the old red blood cells for more than 120 days.

Let us say someone has a high HbA1c of 9, and the target is to lower it to 7 or below with the use of diabetic medications, diet, and exercise. The blood sugar may actually get lower or be controlled, but since the old RBCs that are glycated are still present, then the HbA1c will always be high. That is, the HbA1c will be falsely elevated.

The dangers of a Falsely High HbA1c

What can happen is that on the next doctor’s visit, more medicines may be prescribed. The patient may get frustrated because he/she did everything he had to do to reduce his blood sugar but still comes up short.

The additional diabetes medicines may now put him at risk for very low blood sugar (hypoglycemia). Hypoglycemia can lead to loss of consciousness, seizures, coma, and even death if not recognized and treated on time.

What to do now?

A diabetic with a persistently high HbA1c even with medications, diet, and exercise may need to have a complete blood count (CBC) done to check if they have anemia. Anemia may be a sign of many other diseases. There may be a blood clotting problem, dysfunctional uterine bleeding, peptic ulcer disease, or even colon cancer. That is why it needs evaluation.

Correction of the iron deficiency anemia is with ferrous sulfate tablets, which is the most effective. It may take a couple of weeks to take effect. Good dietary sources of iron are in the National Library of Medicine site. For vegans, FoodNetwork has your back.

So, if you have anemia and diabetes, talk to your doctor and get it all ironed out!

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Don’t Get Sick!

References:

Coban et al., Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Acta Haematol. 2004;112(3):126-8.
Rukmini et al., Glycosylated Hemoglobin in Subjects Affected by Iron-Deficiency Anemia. Diabetes Metab J.2019 Aug;43(4):539-544. doi: 10.4093/dmj.2018.0072. Epub 2018 Nov 28.
Urrechaga et al, Influence of iron deficiency on Hb A1c levels in type 2 diabetic patients. Diabetes Metab Syndr. 2018 Nov;12(6):1051-1055. doi: 10.1016/j.dsx.2018.06.024. Epub 2018 Jun 30.

Image Credits:

By Rogeriopfm – Own work, partly based on File: Grafik blutkreislauf.jpg by Sansculotte., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8626685

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